Give floor nurses reasons to accept patients
September 1, 2000
Give floor nurses reasons to accept patients
The major barrier to reducing admission delays is to motivate floor nurses to take patients more quickly, stresses Linda Kosnik, RN, MSN, CS, chief nursing officer for the ED at Overlook Hospital in Summit, NJ.
"You have to ask yourself, what’s in it for them?’ It’s a one-way street, so you need to create motivation," she says. "Getting human beings to cooperate is the whole problem. Otherwise, the floors have no reason to take the patients."
Here are four incentives given to floor nurses at Overlook Hospital so patients are accepted without delay:
1. Patient surveys and performance appraisals address delays. Patient satisfaction is a strong motivator for nursing staff, says Kosnik. "Patients who sit in the ED for extended periods of time will be very unhappy for their entire stay," she explains.
If a patient is received from the ED, the patient satisfaction survey includes a question about the admission process. "So it is in the floor nurse’s best interest to take patients quickly and efficiently," Kosnik says. "A good turnaround time looks good for them, and patient satisfaction will be higher." (See Emergency Department Survey, inserted in this issue.)
Reducing admission cycle times was identified as a hospitalwide initiative and put into the performance appraisals of floor nurses, she says. "You can’t do this alone in the ED. You need administrative support. Reducing admission cycle times needs to be a concern to everybody, not just the ED."
2. The ED documents initial assessment. A documentation tool was created that facilitates documentation for the floor nurses. "One of the barriers to the floors taking admissions was the time it took the floor nurses to complete a four-page admission form," notes Kosnik. "It turned out that the form had the same information that was already collected in the ED."
A checklist format was created, which allows the ED to do the initial documentation for the floors. "This was part of the initial assessment which we were doing anyway, and it’s a real plus for the floors to get that done before the patient goes upstairs," she explains. (See "Initial Assessment Record," inserted in this issue.)
3. ED nurses give nonverbal reports so floor nurses don’t have to stop what they are doing to take reports. The ED no longer gives a verbal report to the floors. Instead, the ED sends reports by pneumatic tubes. "That way, the floors have all the information they need to take care of the patient right away," says Kosnik.
Previously, the time it took for ED nurses to give report ranged from five to 30 minutes, she says. "Our staff would have to call multiple times for the floor nurse to take the report," she recalls.
The floor nurses also had to stop what they were doing to take report, so they are very satisfied with the nonverbal reporting system, says Kosnik. "The floor nurse is given half an hour to evaluate the report. They notify us if they have any immediate questions or problems. Otherwise the patient is sent up directly," she explains.
The ED allows 30 minutes before sending the patient upstairs in most cases, says Kosnik. "But if the floor nurse knows they are getting an OR patient in half an hour, they might ask us to send up the patient right away. Likewise, if there is a code going on, they may ask us to delay the patient for awhile. But there are not many excuses that we will accept."
4. The ED accepted responsibility for occasionally holding patients. In reality, it’s not just the units that cause delays, Kosnik says. "We are just as guilty of holding patients as the inpatient units are," she acknowledges.
Sometimes admissions were delayed at Overlook because ED nurses were holding them in the rooms, she says. "That might be because they are having difficulty giving a report, or so they didn’t have to take another patient."
There were also times when the ED would want to admit a patient, and the nurse would call to give report, and the floors would say to send the patient upstairs, says Kosnik. "Then, the ED physician would say the patient needs a CT scan first, and we wouldn’t notify the floor."
The floor staff need to plan their day and don’t want surprises like those, says Kosnik. "If we tell them to expect a patient upstairs within a half-hour, and the patient doesn’t come for two hours, by that time, the floor nurse could have three postoperative patients to take care of," she explains. "So the next time, that nurse will be less likely to take a report on a patient."
Sources
• James Espinosa, MD, FACEP, Emergency Department, Overlook Hospital, 99 Beauvoir Ave., Summit, NJ 07902. Phone: (908) 522-5310. Fax: (609) 767-0430. E-mail: [email protected].
• Linda Kosnik, RN, MSN, CS, Emergency Department, Overlook Hospital, 99 Beauvoir Ave., Summit, NJ 07902. Phone: (908) 522-2095. Fax: (908) 522-4909. E-mail: [email protected].
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