Transcript Nephrology Charge Nurse Meeting

Nephrology Charge
Nurse Meetings
October 1, 4, & 6, 2008
Objectives

Inform all charge nurses regarding
important information
– NDNQI RN Survey
– High Census Plan
Present overview of VHA, Inc.’s RetuRN
to Care program
 Solidify charge nurse support for
process improvements

NDNQI RN Survey
Begins October 6. Continues through
October 26th.
 Please take this survey and encourage
those who are eligible to take it.
 May seem like it is repeating itself.
 CNE refers to “Chief Nursing Officer”,
Carrie Capps
 Nurse Manager refers to Director (me)

NDNQI (continued)

Career Development Opportunities--clinical
ladder, tuition reimbursement for pursuing a higher
degree, opportunities serving in leadership positions
either on a unit council or nursing-wide council as a
member or chair; continuing education classes such
as Palliative Care, Communication, Charge Nurse or
Preceptor Classes
 Autonomy (the freedom the nurse has to make
decisions that will impact the patient.) Autonomy
typically refers to those daily decisions - within the
scope of the RN's practice - that will impact a specific
patient.
NDNQI (continued)

Nurse has a voice in planning policies and
procedures for the unit
– PD training designed and implemented by staff
– New employee/grad orientation being revamped

Nurse is not satisfied with their participation in
decision-making for the unit
– Level 4 Authority on staffing and scheduling
– Requires active participation in Unit Council

Nurse feels like they have too much
responsibility and not enough authority
– No requirements without opportunity for active
participation.
Med/Surg Overflow Unit
To open at a date December or January
 Remain open until March (likely)
 Combination of ARMC staff and
contract and/or agency nurses
 3 MEDICAL
 Details to come

High Census Plan
Policy being developed
 During peak high-census, “Bed Crunch”
times, a special plan will be
implemented so that all NON-essential
hospital functions will cease in order to
support patient care.

retuRN to Care
Overview and plan
RetuRN to Care (or R2C)
 Why?
 What?
 Who?
 Where?
 When?
 How?
Safety & Quality
A higher proportion of nursing care
provided by RNs and a greater
number of hours of care by RNs per
day are associated with better
outcomes for hospitalized patients.
– (Buerhaus et al, Health Affairs, 2006)
Avoided Days
Avoided Adverse Outcomes
Raise
RN
Proportion
Raise
Licensed
Hours
Do Both
1,507,493
2,598,339
4,106,315
59,938
10,813
70,416
4,997
1,801
6,754
Cardiac arrest and shock, pneumonia, upper
gastrointestinal bleeding, deep vein thrombosis,
urinary tract infection
Avoided Deaths
Estimates from Needleman/Buerhaus, Health Affairs, 2006
Nursing Shortage & Satisfaction

Nurses who care for patients in
medical/surgical units play a central role
in ensuring the quality of hospital care.
 But when they are over-burdened with
non-clinical demands and system
inefficiencies and failures, patient care
suffers and disillusioned nurses often
leave their jobs.
Nursing Shortage & Satisfaction
Care Category
Unit Ranges
• Direct Care 21% - 38%
• Indirect Care 32% - 55%
• Other 13% - 27%
• Waste 5% - 11%
Median
31%
45%
17%
7% C
Kaiser-Permanente/Ascension Health Study of 22,000
nursing hours (15 states, 274 hospitals, 63,000 beds)
Nursing Shortage & Satisfaction
Current Nursing Model:
FRED
Frantically Running Every Day
Patient Satisfaction
• Nurse presence is associated with
good care
• “Attentive” & “Available”
• Want nurses to “watch over them”
Davis (2005), Holistic Nursing Care
Patient Satisfaction

Direct link between employee and
patient satisfaction
Heskett et al., (1994) Harvard Business Review

Improvements in nurses' work
environments in hospitals have the
potential to reduce nurse burnout and
turnover risk and to increase patients'
satisfaction with their care.
Vahey et al., (2004), Medical Care
P4P/Finances

Never events:
•
•
•
•
•
•
pressure ulcers
certain preventable inpatient injuries (i.e., fractures,
dislocations, intracranial injuries, crushing injuries,
burns)
catheter-associated urinary tract infections (UTIs)
vascular catheter-associated infections
certain surgical site infections
objects left in surgery
air embolism
blood incompatibility
•
•
RetuRN to Care
Return to Care is a VHA’s Clinical
Improvement Services topic
 It is an approach to improving
medical/surgical patient care in
hospitals
 The goal is to make medical/surgical
inpatient care safer, more reliable,
and more focused on the patient.

ARMC’s Participation in R2C

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It must be supported by the CEO to assure senior leadership
support
RetuRN to Care must have CNO support
A Blueprint is available on the Leading Practices Portal (LPP).
A Gap Analysis exists on the LPP to determine improvement
priorities. ARMC will have to do the gap analysis. That helps
guide the blueprint choice.
Nephrology is the PILOT unit.
A time study will be done for 7 days utilizing PDAs. All
scheduled nurses will be assigned a PDA. Those will be passed
off. Time study is done 24/7.
VHA identifies the best way
to deliver care and
replicates it 5,000 times.
RetuRN to Care
Let’s
site!
get to the web
Questions?
Volunteers?
Your Support is Critical!