EXCERPT: LinkedIn Feb17

All That Stands Between Nurses & Patients

As technologies continue to evolve, perhaps hospitals need to take the time to reassess their outdated work processes to effectively deliver the care that nurses want to provide. But technological innovation alone cannot solve this problem. The goal of this post is to present some ideas & observations that you (clinical leadership/administration) should consider in your ongoing initiatives to increase your caregivers’ time at the bedside.   
In 2008, the Institute for Healthcare Improvement , published a paper on how to increase the nurses’ time in direct patient care entitled, “Transforming Care at the Bedside”. Even though it’s nearly a decade old, I HIGHLY recommend reading it to anyone involved patient care as it (unfortunately) still perfectly illustrates what nearly all acute care nurses continue to live with on a daily basis… We are spending too much of our time away from the bedside (and that most of that time is time wasted).
Streamlining the communication process is a core principle in bringing nurses back to the bedside. Practically speaking, what do more efficient communication methodologies between staff & patients really look like? The most straightforward answer is that we spend less time running around searching for someone or something needed to complete a task. 
One caveat for deploying any technical solution to help in this endeavor is that any new process/methodology needs to be simple & not require too many extra steps. Too often, we have seen one inefficient workflow or task be replaced by an overly complicated product-driven solution. Ex: requiring nurses to tab through multiple menus on a touchscreen device just to send a message.
Getting Back To Bedside is Not Going To Be Enough! 
On a webinar I recently attended, a technology partner was promoting the idea of how smarter mobility approach could possibly lead to more time at the bedside. The presenter cited some findings that the national average for time at the bedside is around 18-20%. That is a fairly startling statistic considering that studies have consistently shown that time at the bedside keeps patients safer.
Simply put, nurses who are afforded more time at the bedside have better patient outcomes… we all know this…. However, it is imperative for our entire industry to recognize that interruptions are a significant problem impacting safety. Here is a study that found that nurses were interrupted mid-task at an average of eight times per shift.

So much of patient care is in the nuance of our interactions with the patient. Administration & popular culture alike propagates this idea that patient-care can be culled from devices, test results, quality initiatives & the sheer brilliance of our training & experience. In reality, the most powerful tool in any caregiver’s quiver is observation. Listening, talking, questioning - these are the qualities that make a great caregiver; & we simply are creating too much noise, too many alarms, too much documentation burden, etc.
I don’t know about you, but I really do not like the feeling of being in a patient’s room and, instead of concentrating on what the patient is telling me, I find myself thinking over the 20 things that I have to get done before lunch! I know patients perceive this, the rushed interactions & distance… even though we are in the room; we are not really there.

Getting Off – On Time
Coming off shift on time is another issue for the majority of nurses. It is sad that almost all nurses have to work past their shift just to get caught up… Again, this is born out of, too much documentation, requirements, etc. & it ultimately affects patient care through demoralization & burn-out.

Overall Workflow Efficiency
Another Institute of Medicine study (referenced here) found that the time all caregivers (not just RNs) spent at the bedside varied between 1 & 3 hours over a 12-hour shift. The majority of this time was spent walking between rooms. Let that sink in for a moment… One of the primary components of our jobs as nurses is to walk around! I don’t know about you, but I missed the Where’s Waldo class in nursing school focused entirely on looking for equipment, supplies, team members, etc.
Technology can help here in the form of more interoperable mobile communications, better tracking of equipment & people, more innovation around alarm management, etc. But the most effective way to increase efficiency is in the streamlining of each unit’s workflows. For example: (I know that I’ve said this a million times, but….) 64% of all nurse calls do not require a nurse in order to fulfill the need & 92% of all physiologic monitor alarms are false positives.
As a nurse, I only want to be notified of ACTIONABLE alarms. Since the majority of alarms are NOT actionable this means that I am bothered throughout the day un-necessarily. This is a distraction & takes valuable time I could be spending at the bedside. This is not just limited to alarms, it must also be applied to alerts in the form of patient requests. If a patient simply wants a soft drink, that can be taken care of by the PCA. It’s not that I don’t want to fulfill their requests, but this takes me away from tasks that only RNs can perform (admissions, discharge, dressing changes, sterile procedures, etc.)
So, why do we continue to send alerts & alarms with no context to the nurses? It’s crazy bananas!!!!!

Rounding Can Be Made More Effective
One thing that would help improve getting nurses back to the bedside is transforming how we approach rounding procedures. Too often, rounding is measured by frequency rather than by effectiveness. Care teams are required to go to each room, spend some time in there & move-on in an effort to demonstrate compliance or create the perception of care. However, by comparing rounding compliance reporting with nurse call request metrics, you can actually see effectiveness. Ex: within 5 minutes of the nurse’s presence in the room, the patient still made a request through the nurse call system. That’s not effective rounding!
Too often, rounding is measured by frequency rather than by effectiveness.
Patients catch on quickly that they can expect the nurse to return at certain time intervals & will hold off ringing the call bell & simply wait for the nurse to arrive. Patients must be better educated during their admission process. They must be made aware that their care team will round every hour & what that involves. When we teach this process & reinforce it through consistent demonstration, they (and their families) just might begin to curb the unnecessary interruptions of our other duties or our interactions with other patients.
Back to Top