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APNA 29th Annual Conference S ession 3016.2: October 30, 2015 Roark 1

Disclosures

This speaker has no conflicts of interest, commercial support, or

• ff-label use to disclose.

OBJECTIVES

Contrast the Admission/Discharge RN with that of staff RN to understand how the role decreased workload Describe how the implementation of an Admission/Discharge RN improves patient throughput Identify 3 ways in which having an Admission/Discharge RN increases staff RN satisfaction

At the conclusion of this presentation participants will be able to

APNA 29th Annual Conference S ession 3016.2: October 30, 2015 Roark 2

Introduction Target of Project

 Improve Patient Throughput  Provide Staff Support  Psychiatric RNs  36 Bed Acute Psychiatric Unit  The implementation of Admission/Discharge RN would decrease workload and increase RN satisfaction  Monday/Friday 8-1630 for 6 mos

Application to Nursing Field

 Admission process is a vital patient centered task  Joint Commission required  Discharge process equally important

APNA 29th Annual Conference S ession 3016.2: October 30, 2015 Roark 3

Rationale for position

• Wanted to help streamline process
• Provide staff support
• “that when nurse staffing is more favorable, patient and

nurse outcomes are more favorable” (Quinn, 2013, p. 163).

• Increased nursing satisfaction
• Several studies have yielded increased nursing satisfaction

with the implementation of an ADRN

• Help patient throughput
• “ Patient turnover, or throughput, through nursing units can

significantly impact the workloads of nurses” (Quinn, 2013, p. 163).

Rese Research arch Supporti Supporting Applicati g Application

• n

& Rat & Rationale ale

Admit process can disrupt flow of care. Admission RNs steady work flow, improved patient safety, increased pt. & family satisfaction (Kirkbride et al. 2012) NDNQI S urvey – 25% increase in j ob enj oyment, 38% time with pts. Increased, RN plan to stay on unit increased by 25% (Lane et al., 2009). Admission nurses saved staff RNs 1.12 hours of work per shift (Lane et al., 2009). Correlation exists between time on direct patient care and j ob satisfaction, nurses were happier who had more with patients! (S

eed et al., 2010).

Resear search ch Supporting pporting Appl Application & ication & Rati Rationale

ADRN is effective and increases satisfaction

 Decreased OT/ Improved satisfaction (Lane et al., 2009)  Found positive nurse & pt. satisfaction scores (S

iehoff et al., 2009)

In a 633 bed hospital that instituted AD RN

 S atisfaction scores from AD process increased from 2.62 to 3.57

(Spiva & Johnson, 2009)

 Pre-ADRN nurse satisfaction score was 36.24 post 39.05 (S

piva & Johnson, 2009)

 S atisfaction score before ADRN - 29.10 after 44.70 (Lane

et al., 2009)

APNA 29th Annual Conference S ession 3016.2: October 30, 2015 Roark 4

Scope of the Problem

Late Admissions Multiple AM shift D/ C’s Later Discharge s

PLT Backed up ED

Patient Throughput/ FLOW

ADRN Routine

Check in with Charge RN/ S taff RNs to identify discharges and potential discharges Attend S W meeting to identify potential discharges from S W standpoint Calls for discharge orders, discusses identified potential discharge patients who are voluntary asking to leave with psychiatrist Completes discharges or admissions depending on priority

ADRN vs Staff RN Time Line

ADRN

800 – Discharge 900 - Discharge 1000 – 1200 –Admission 1230 - Discharge 1330 - Discharge 1430 – 1630 - Admission

STAFF RN

0700-0730 – Report/ shift Change 0730-0800 –Accuchecks, chart/ med reviews 0800-1000 – Medication pass & patient assessments 1000-1100 - Discharge 1130 –Accuchecks 1200 –Admission 1230-1330 – Med Pass 1330 – Continue Admission 1330-1530 – Charting/ wrap up day

APNA 29th Annual Conference S ession 3016.2: October 30, 2015 Roark 5

Data Results Admits & Discharges Nurse Satisfaction Survey Results Nurse Satisfaction Survey Results

Nurses asked if felt an AD RN will decrease workload Nurses asked if AD RN has decreased workload

APNA 29th Annual Conference S ession 3016.2: October 30, 2015 Roark 6

Nurse Satisfaction Survey Results

 Has the ADRN affected your j ob satisfaction?  How has the ADRN affected your j ob workload?  How could the ADRN position be improved?  How has the ADRN affected your j ob overall?  How satisfied are you with the ADRN position?

Analysis of Position

Increased Admissions on Day Shift

 Average 3 with high of 4

Improved average discharge time

 Since 9/1 Avg. D/C time Staff RNs T,W,TH1300  On days with AD RN, Avg. D/C time is 1045

ADRN completed over 80% of D/Cs and 25% of admits for AM shift  Overwhelming positive response from AM/PM shift staff, physicians and patients for AD RN

Concepts of Leadership

 Nursing leaders must be willing to support employees who can feel overwhelmed by their workload  S taff nurses must be supported by leadership to provide quality care –if not this can lead to frustration and decreased satisfaction

 92%

• f surveyed nurses associate the nursing shortage with

a decrease in quality of care and time spent with patients

(S iehoff et al,2009)

 49% agreed that support staff would help ease the nursing shortage (S

iehoff et al,2009)

 89% reported an improved work environment was a good strategy to help solve the nursing shortage (S

iehoff et al,2009)

APNA 29th Annual Conference S ession 3016.2: October 30, 2015 Roark 7

References

Kirkbride, G., Floyd, V., Tate, C., & Wendler, M. (2012). Weathering the storm: nurses'satisfaction with a mobile admission nurse service. Journal Of Nursing Management, 20(3), 344-353. doi:10.1111/j.1365- 2834.2011.01273.x Lane, B. S., Jackson, J., Odom, S. E., Cannella, K. A. S., & Hinshaw, L. (2009). Nurse Satisfaction and Creation of an Admission, Discharge, and Teaching Nurse Position. Journal of Nursing Care Quality, 24(2), 148–152. doi:10.1097/01.ncq.0000347452.36418.78 Siehoff, A., Gancarz, B., & Wise, C. (2009). Improving patient admissions with dedicated admission nurses. Journal Of Nursing Administration, 39(1),11-13.doi:10.1097/NNA.0b013e31818fe75c Spader, C. (2008, August). Admission RNs Make Fast Paced Admits Less

• Stressful. Nurse.Com. Retrieved from http://news.nurse.com/apps/

pbcs.dll/articleAID=2008108110080#.VEbODSldUi5

References

Spiva, L., & Johnson, D. (2012). Improving Nursing Satisfaction and Quality Through the Creation of Admission and Discharge Nurse Team. Journal of Nursing Care Quality, 27(1), 89–93. doi:10.1097/ncq.0b013e318227d645 Seed, M., Torkelson, D., & Alnatour, R. (2010). The role of the inpatient psychiatric nurse and its effect on job satisfaction. Issues In Mental Health Nursing, 31(3), 160-170. doi:10.3109/01612840903168729 Quinn, L. (2013). Throughput and nurses' workloads: Influences on nurse and patient outcomes. University of Pennsylvania; 2013. Available from: CINAHL Plus with Full Text, Ipswich, MA. Accessed October 21, 2014