January 6, 2011

Initiative gives nurses more time at the bedside

Featured Image

Allowing nurses to spend more time with patients is the goal of a new initiative at the Monroe Carell Jr. Children’s Hospital at Vanderbilt. Here, Shawna Wiley, R.N., B.S.N., plays with Zander Matthew Paige, 3, while his mother, Alycia, and brother, Connor, look on. (photo by Anne Rayner)

Initiative gives nurses more time at the bedside

Nurses at the Monroe Carell Jr. Children's Hospital at Vanderbilt are able to spend more time at patients' bedsides after a yearlong initiative reinforced the hospital's focus on patient-centered care.

During the in-house project, Children's Hospital's nurses spent as much as 46 percent of their shift with patients, well above the national average of about 30 percent. Efforts to streamline shift reports and simplify tasks helped free up time that could be reserved for patient care.

The Children's Hospital initiative was part of a 10-hospital best practices project, conducted through the Child Health Corporation of America, which sought to increase the time a nurse spent in direct patient care during a shift.

The bedside care initiative tackled an ongoing national topic: nurses spend only 30 percent to 35 percent of their time in direct patient care.

The data is revealed in the Robert Wood Johnson Foundation's report, “Transforming care at the bedside evaluation,” which served as a guide for the CHCA initiative.

“Participating in this collaborative gave us the opportunity to identify our current barriers and develop improvement strategies to overcome those barriers,” said Stacey Morgan Schlafly, quality improvement analyst.

Schlafly and Autumne Mayfield, R.N., manager of nursing quality at Children's Hospital, worked with nursing staff to make duties more efficient through efforts that included putting supplies in centralized locations and learning how to better utilize space. By the end of the collaborative, nurses took an average of 12 percent fewer steps — tracked using pedometers — because of the changes made.

As a result of the initiative, nursing staff now perform regular bedside shift reports, in which the nurses coming on and off shift share vital information about the patient with one another as well as the family. Also, a two-sided sign for the door handle is posted outside the room that allows families to choose, “wake me for shift report,” or “do not wake me for shift report.”

“A bedside shift report is the best thing for families,” said Mayfield. “It engages them in their child's plan of care.”

As another part of the effort, white board content was standardized so that all key information — patient name, parent questions, nurse, date — was included for each patient the same way in every room. New erasable, removable and colorful labels that feature hospital mascot Champ will replace white boards soon.

Out of the 10 hospitals that participated in the bedside care initiative, Children's Hospital was one of two top performers to receive the high score for overall success, a 5 out of 5 rating.