St. Anne’s nurses find time for direct patient care

A decade ago, when Doreen Williams was still a practicing nurse, things weren’t like this. Nurses, she says, actually spent most of their time nursing. Caring for patients at the bedside, talking with them and their families, making sure all their needs were met.
These days, one national study found, nurses spend just 1.7 hours in a 12-hour period providing direct patient care. At St. Anne’s Hospital in Fall River, where Williams is director of patient care, the problem may not be quite so dire, but it had been noticed.
So last year, the hospital applied to join Transforming Care at the Bedside, a national research project launched in 2003 and sponsored by the Robert Wood Johnson Foundation and the Institute for Healthcare Improvement. St. Anne’s is one of 68 hospitals now enrolled.
The project focuses on four goals:
• Ensuring that patients in medical and surgical units get safe, reliable, effective and equitable care.
• Creating a “joyful and supportive” professional environment that nurtures professional growth and helps teams work together to provide excellent care.
• Providing “truly patient-centered care” that respects the whole person and family and ensures continuity of care.
• Maximizing efficiency and good work flow.
The project sets targets in each of those areas, such as reducing medical errors, to zero; reducing voluntary turnover for nurses to 5 percent or less per year; and reducing the hospital readmission rate within 30 days to less than 5 percent.
One other target, of particular interest to the St. Anne’s team, is getting nurses to spend 70 percent of their time on direct patient care.
But how do you do that?
For starters, you find out what they’re doing with their time now. So the hospital designated two units to participate in the project, and gave the nurses PDAs that page them at random throughout their work days. Each time, they must document where they were before the alarm sounded and where they are going next.
The first trial run with the PDAs showed more than half the nurses were not at the bedside when paged, Williams said recently.
“I remember we used to spend quite a bit of time at the bedside,” she said. “It’s just having to do all this documentation that gets them away from the bedside. It’s core measures [data-gathering required as part of the patient chart], all of the things that the nurse is supposed to be doing as well as taking care of the patient.”
Having so little time keeps nurses from being able to talk with patients as much as they wish, educate them and ensure their needs are fully met – which, in turn, might reduce re-hospitalizations. “That’s why we need to streamline,” she added, “so they can get back to the bedside.”
And this project makes identifying and solving problems easier because it works on a rapid cycle, Williams said. The nurses wear the PDAs for a couple of days, they analyze the data, and then the nurses in the study unit (the other is just a control group) brainstorm and come up with ideas to save time and be more efficient.
For example, having found that nurses spent a lot of time looking for supplies, the hospital has started stocking the most commonly used items in larger quantities, Williams said. In addition, others on the care team are being asked to help out more, so if a patient needs help, the first person who walks by can at least look in, acknowledge their need, and alert someone who can meet that need.
The study unit has also set up a system with red, yellow and green magnets that nurses can use to alert their colleagues that they need extra help, and it has set up a whiteboard in each room to set goals for each patient, using it as a way to work more closely with the person.
And to keep nurses from having to go to the front desk constantly to take calls, cell phones have been brought in, so they can be reached without leaving their patients.
All the new strategies are tested and evaluated right away, so if they don’t make a difference, the unit can try new approaches.
Kiley Medeiros, clinical leader in the study unit, said that for the nurses, it’s “very exciting” to have a chance to participate directly in a research project and in improving their own unit. And while the time spent on paperwork can only be reduced so much – she estimates it at one-third of her workday – getting back even 15 minutes can make a big impact, she said.
“Fifteen minutes is a lot of time to have conversation with the patients and their families,” she said. “You’re able to be in the room with them and go over in-depth their education, go over their goal for the day and go over what they find important in the day. It allows you to have the patient more involved in their care.” •