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Use of the ‘Buddy System’ to Improve Call-Light Response Time
Libertad Mendivil
Department of Nursing, Metropolitan State University of Denver
NURA 4300 Leadership and Management in Professional Nursing Practice
Diane Ream DNP, RN
December 5, 2021
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Use of the ‘Buddy System’ to Improve Call-Light Response Time
The call light system is often used by patients in order to meet their needs whether that is
to perform daily activities, ask for medication, report discomfort, or receive updates on their care
(Nelson & Staffileno, 2017). Delays in call light response time can lead to serious patient safety
and care implications (Nelson & Staffileno, 2017). Implementing a buddy system in a hospital
care setting can improve call light response times and subsequently improve patient safety,
patient satisfaction, and care outcomes (Nelson $ Staffileno, 2017). This is especially true for the
cardiovascular unit at Medical Center of Aurora where patient falls were seen as a common issue
during my time there. The proposed change of the buddy system which will include pairing up
staff nurses together at the beginning of the shift where either of them will be responsible for
answering each other’s call lights when the primary nurse is unavailable (Nelson & Stafilleno,
2017). In this way, nurses would be able to share responsibility and answer call lights at an
appropriate time (within five minutes). The proposed change will be discussed throughout this
paper in terms of the need for change, assessment of the organization’s environment,
identification of a Quality and Safety Education for Nurses (QSEN) competency, defining of a
change theory, effects on the target system, short-term and long-term goal statements, influences
from politics, power, and policy, sources of resistance, the timeline to implement the change,
integration of the four basic functions of a manager, and evaluation of the change.
Critical Thinking and Clinical Reasoning
The section on critical thinking and clinical reasoning will examine the need for change,
the organizational environment in the cardiovascular unit at Medical Center of Aurora, and the
QSEN safety competency related to the proposed change.
Need for Change
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A call light system is often the main source for patients to communicate with healthcare
staff about their need for medication, toileting assistance, and equipment alarm noise, all of
which occur in the patient’s room (Nelson & Staffileno, 2017). Because a call light system is
designed to get patient care delivered to the patient, it is of utmost importance to answer and
meet the requests of the patient in a timely fashion. Patients perceive their call light as a
communication tool and a direct channel to their health care, according to a study conducted by
Montie et al. (2017). Participants believed that the time it took for their call light to be responded
to had an impact on when they would receive care (Montie et al., 2017). Safety incidents and
concerns were caused by delayed or missed call light responses (Montie et al., 2017). Reasons
for delayed or missed call light responses were attributed to several factors including nurses
being unable to attend the needs of a patient because they were assisting someone else, having
call lights go off simultaneously, inability to distinguish urgent alarms from the call light from
the non-urgent alarms, and development of alarm fatigue (Ali & Li, 2020). There are clear issues
with the call light response times as evidenced by the observations made in the studies done by
Ali & Li (2020) and Montie et al. (2017).
A study done by Nelson & Staffileno (2017), designed an evidence based bundle that
included the creation of new nurse workflows to reduce call light frequency and improve
efficiency and accountability for call light response times. The buddy system required that each
nurse be assigned a staff nurse partner at the start of each shift to help answer each other's call
lights when the primary nurse was unavailable (Nelson & Staffileno, 2017). Shared
responsibility between nurses for answering call lights would improve call light response times
and therefore increase patient safety and satisfaction with their care.
Organizational Environment
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Medical Center of Aurora is a 346 bed acute care hospital that mainly serves the Aurora
and Denver communities in Colorado (The Medical Center of Aurora, n.d.). One of the units at
Medical Center of Aurora is the cardiovascular unit which serves those who have heart
conditions. During my Medical Surgical nursing rotation, I got the opportunity to see how the
cardiovascular unit at Medical Center of Aurora operated. I noticed that the call light system on
the cardiovascular unit connected the patient’s call light button to the nurse’s phone. Often, I
would witness nurses take a long time to answer their phone when a patient was calling because
they were either providing care for another patient, were unavailable, were charting, or they
simply did not want to attend to a certain patient. I also constantly heard patients complain about
the call light response times. On various occasions, patients would get tired of waiting for help to
arrive and they would get up on their own and engage in unsafe practices. Most, if not all,
patients on the unit were a high fall-risk and were in need of one or two people to help them
ambulate. When help was unavailable for more than 10 or 15 minutes, patients would ambulate
without assistance. I was aware of six falls that occurred during my time at Medical Center of
Aurora and they were all connected to not having assistance when needing to ambulate. During
my time on the cardiovascular unit at Medical Center of Aurora, there was one day when two
patients fell one right after the other. A high incidence of these events were noted by staff and I
am sure they are aware of the problem. The issue with properly addressing the call light response
time is that nurses on all units at Medical Center of Aurora are consistently understaffed and
overworked.
QSEN
The goal of the Quality and Safety Education for Nurses (QSEN) initiative is to provide
nurses with the expertise, skills, and attitudes necessary to provide consistent high-quality and
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safe patient care (Yoder-Wise, 2019). The QSEN competency that best applies to the
implementation of the buddy system to improve call light response time is that of safety. The
QSEN Safety competency focuses on minimizing harm to patients and providers through system
effectiveness and individual job performance (QSEN, 2020). The buddy system would help to
achieve the goal of lowering the time it takes for staff to respond to call lights. Patients who have
their needs handled in a timely manner will then have a higher level of satisfaction with their
care and will be less likely to engage in unsafe practices. To achieve the QSEN competency
nursing staff must demonstrate knowledge about the buddy system, demonstrate effective use of
the buddy system, and value what the buddy system does to enhance patient safety and care
outcomes.
Leadership and Management
The section on leadership and management will discuss the change theory that affects the
target system, short and long term goals, power and politics that influence the proposed change,
the implementation timeline, and the basic functions of a manager.
Change Theory Affects Target System
The change theory that best applies to the implementation of the buddy system is Lewin’s
theory which includes a three step change process of unfreezing, freezing, and refreezing
(Yoder-Wise, 2017). The first step of change is unfreezing, which involves the organization
realizing the need for change and the start of planning for the change process (Yoder-Wise,
2017). The staff on the cardiovascular unit at Medical Center of Aurora acknowledge the
problem related to delayed call light response times. Current practices for call light responses
need to be changed to enhance patient safety and care outcomes. The second step of change is
freezing, which entails educating people about the need for change, creating a vision to
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conceptualize and bring the change to life, integrating people in the planning and implementation
process, and taking modest actions toward the change (Yoder-Wise, 2017). Nursing staff at
Medical Center of Aurora would undergo a training to learn about the importance of answering
call lights promptly and be involved in a discussion on how the buddy system will affect nurse
response to call light needs. Lastly, refreezing involves sustaining the change over a long period
of time (Yoder-Wise, 2017). Sustaining a change over a long period of time takes effort and
constant assessment of the change. The unit manager and nursing leadership on the
cardiovascular unit must evaluate the buddy system to see if it is working.
The target system of the proposed change are the nurses and staff. The suggested change
will impact nurses’ time through needed training on the buddy system and participation in the
evaluation process. Nursing staff will also feel an increased sense of responsibility, since the
planned change involves nurses sharing responsibilities of other patients when those patients’
primary nurse is unavailable.
Goals
Goals help describe what needs to be accomplished. The use of SMART goals means that
the goals identified are smart, measurable, achievable, relevant, and time bound. Therefore, my
short term goal is that within one month all nursing staff will have a training about the
importance of answering call lights promptly (within five minutes) and nurses will have a clear
understanding of the buddy system. My long term goal is that within six months, nurses will
have a clear understanding of the buddy system and call light response time within five
minutes will be at 85%.
Power and Politics
Power is the ability to influence others in order to accomplish a goal (Yoder-Wise, 2017).
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Introducing the buddy system to the cardiovascular unit manager will have an influence on how
the change is applied and adopted because of the positional power the unit manager possesses
(Yoder-Wise, 2017). The buddy system is also part of a call light response bundle which is
research based. Current knowledge and research influences the way nurses care for their patients
and therefore it can be used as a tool to encourage the acceptance of the proposed change.
Politics involves human activity. In nursing, politics means having the ability to analyze
an issue, the ability to present a possible solution, the ability to participate in a constructive way,
and the ability to use power bases (Yoder-Wise, 2017). The ability to examine issues such as call
light response time and its relationship to patient safety and care outcomes is possessed by the
majority, if not all, nurses. Since the proposed change of the buddy system is being brought upon
the cardiovascular unit at Medical Center of Aurora, nurses can submit their suggestions and
concerns about the change to make it best suited for the nurses who actually work on the unit.
Inviting nurses who work on the cardiovascular unit to discuss the proposed change will also
enhance their understanding and connection to the issue of call light response times. Lastly, unit
managers, nurse leaders, and nurses must hold each other accountable for implementing the
buddy system on the cardiovascular unit at Medical Center of Aurora for it to be a success.
Policies are guidelines put in place to achieve certain goals. Power and politics influence
policy change and formation. Nurse leaders and unit managers can use the power of their voice
and influence hospital policy at Medical Center of Aurora and at the state level. By changing and
forming policies by implementing the use of the buddy system to improve call light response
time, policies will influence the behaviors of nursing staff on other units and hospital systems.
Sources of Resistance
Implementation of the buddy system on the cardiovascular unit at Medical Center of
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Aurora to improve call light response time is a necessary change. Patient safety and care
outcomes appear to be compromised with current practices. The need for change in healthcare
can face challenges such as individual worker resistance. Resistance to change is defined by
Mareš (2018), as an individual’s behavior in response to a change that is being perceived as a
threat. Nurses and staff at Medical Center of Aurora may be resistant to the buddy system
because they might have ambivalent attitudes toward the proposed change. This type of
resistance is psychological. Nurses may feel that their workflow may be disrupted with the
implementation of the buddy system and simultaneously feel that it may help patients feel
adequately cared for. These ambivalent feelings may cause the buddy system to be accepted at a
slower rate. Structural sources of resistance also exist and can pertain to a lack of resources and
finances (Mareš, 2018). The main resource for the buddy system is nursing staff. Nursing staff
shortages at Medical Center of Aurora could hinder the implementation of the buddy system
since the proposed change is reliant on an adequate number of nurses.
Implementation
Application of the buddy system on the cardiovascular unit at Medical Center of Aurora
will require a meeting with the unit manager and nursing staff, training, and evaluation of the
change, all of which are discussed in detail in Figure 1.
Basic Functions of a Manager
The basic functions of a manager are planning, organizing, leading, and controlling
(Yoder-Wise, 2017). The functions of the manager influence how the proposed change will be
implemented, how it will be received by staff, and how the change will be evaluated. At each
step of the implementation process for the proposed change, the unit manager will be involved.
The unit manager on the cardiovascular unit at Medical Center of Aurora will need to plan and
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organize the initial meeting to discuss the need to improve call light response times on the unit.
Planning and organizing the initial meeting involves reserving a classroom space to conduct a
discussion, alerting staff nurses with the details of the meeting, and creating an outline for the
meeting agenda. The unit manager displays leadership by engaging nursing staff in dialogue,
listening to their concerns and ideas regarding the proposed change, and creating an environment
that is accepting of change (Yoder-Wise, 2017). Lastly, the unit manager can control the
implementation of the buddy system change proposal by having the buddy system laid out as
part of the nurse’s practice and conducting evaluations to measure the degree of effectiveness.
Evaluation
Evaluation of the proposed change will aid in understanding if the nurses are accepting of
the change and have implemented it into their practice. A staff survey will be conducted after
three months of training the staff in the cardiovascular unit at Medical Center of Aurora on the
buddy system. The survey will assess if nurses think the buddy system is helping them respond
to call lights in a timely fashion and their general thoughts on the buddy system (Figure 2).
Survey results may reveal that most nurses on the cardiovascular unit recognize the need for
change but are hesitant to make it due to current and ongoing staff shortages. Nursing staff
shortages may result in higher nurse-to-patient ratios, and nurses may reveal that they already
have too many responsibilities to accept the buddy system into their daily care.
After six months of the buddy system implementation, a random audit will be conducted
by the unit manager to evaluate call light response times. The audit may reveal that on days when
there is sufficient staffing, the buddy system is used throughout the shift. The buddy system may
not be utilized on days where there is a nursing staff deficit due to the additional duties and
obligations of the nurses' role. According to this audit, the buddy system works best when there
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is sufficient staffing. Therefore, the success of the buddy system change proposal might be
somewhat successful and adjustments may be needed.
Conclusion
Patients use their call light system as their primary means to communicate with
healthcare providers about their personal needs and care. Delays in call light response times can
have major consequences for patient safety and treatment as seen at Medical Center of Aurora
during my Medical Surgical nursing clinical. Implementing a buddy system can help improve the
response time of call light staff nurses on the cardiovascular unit at Medical Center of Aurora.
To effectively integrate the buddy system on the cardiovascular unit at Medical Center of
Aurora, leadership and management must be involved to get staff nurses to accept the proposed
change.
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References
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Figure 1
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Figure 2