3/28/12
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Projected Nursing Shortage into 2012 and beyond
 Changes in supply and demand
 Recruitment to rural healthcare environment
 Fewer people entering and staying in nursing
 Projected need for more health services as population aged
 Overall RN vacancy in 2001
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Patricia Davis, RN
Connie A Jastremski, RN
Network CNO
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Increase number enrolled nursing students
and retain them through graduation
Retain new graduates, all nurses, including
older nurses
Attract nurses who seek different roles or
want to return to the bedside
Bassett Healthcare Network-Bassett Medical Center
In early 2000, began to receive
attention
 Alert to knowledge and wisdom
 Identify new roles
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Bassett Healthcare Network-Bassett Medical Center
Age and performance
 Human Resource benefits entice older
worker
 Career fulfillment
 Work design
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Bassett Healthcare Network-Bassett Medical Center
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Turnover costs are staggering
◦ Equal to or greater than two times salary
◦ 2000 nurse turnover 21.3%
National average salary for med/surg RN of
$47,000
$94K for specialty area nurse
2002 NYS Education Department
◦ Brain drain decreases innovation, increases
errors, reduces efficiency, undermines growth
strategies
Bassett Healthcare Network-Bassett Medical Center
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Hard to quantify
Efficiency knowledge – how to get job done
faster and better
Negative patient outcomes
Bassett Healthcare Network-Bassett Medical Center
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Admission Nurse implemented 2001
Specialized, limited RN role with core
requirements
Admission Nurse completes entire
admission process, followed by handover to
accountable RN
Appealing to retired, inactive, under
employed, office workers eager for “hands
on”
Per diem category, self-schedule, 4 hour
shifts, weekly
Bassett Healthcare Network-Bassett Medical Center
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Eight RNs have served in the role, with five
current RNs employed in the role
Program does not serve the units of
Psychiatry, Peds, Birthing Center, or ICU
Bassett Healthcare Network-Bassett Medical Center
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Context
• 180 bed rural, teaching hospital located in Upstate
New York
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Admissions/Discharges/Transfers
• 10, 982 admissions annually (32/day)
• 10, 973 discharges annually (32/day)
• 7, 194 transfers in or out
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Timing
• ADT workload builds at 11 am, decreases at 11 pm
• Peak hours 12 noon through 8 pm
Bassett Healthcare Network-Bassett Medical Center
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Realities of retention and recruitment challenges
in rural area
Idea emerged from staff nurse; not immediately
implemented
Context of throughput gridlock
Evidence of improved satisfaction with smooth
admission
Earlier proposal revisited and piloted
Purpose to admit patients in thorough, consistent,
timely fashion from all areas – ED, clinics, peri-op,
outside agencies and initiate medical and nursing
regimens
Expose new group to Bassett nursing culture and
possibility of other roles in the organization
Bassett Healthcare Network-Bassett Medical Center
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Small test of change
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Satisfied – and retained – Admission Nurse
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Satisfied – and retained-staff nurses
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Good productivity
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Thorough documentation
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Satisfied patients
Bassett Healthcare Network-Bassett Medical Center
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Recruitment – targeted RNs with experience
who had left the work place or retired
Key recruitment question to potential
applicants’ “What would it take for you to
come to work in the hospital?”
Bassett Healthcare Network-Bassett Medical Center
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Hired as per diem RNs, salary based on experience
Standard 2 day New Employee Orientation
Specialized – focused to job scope-screening,
physical assessment, BLS certified
Preceptors were nurse educators (one on one)
4 hours x 4 sessions, competency checklist
Continued follow-up and support (attention to
special needs)
Self-scheduling
Annual lunch with CNO
Electronic documentation rollout- required
specialized support
Invited to all Bassett nursing CE programs and RN
Refresher course
Bassett Healthcare Network-Bassett Medical Center
1.
How satisfied are you with the role of the
Admission Nurse?
• “very satisfied”, a great asset”, “extremely
satisfied”
2.
How has the Admission Nurse Program
changed your job?
• “taken a load off – allows a nurse to stop and take
a deep breath vs feeling bombarded with
discharges, then admissions”
• “decreased stress, increased time for patient care,
timely admitting of patients”
Bassett Healthcare Network-Bassett Medical Center
3.
Has the Admission Nurse Program had an effect
on your job satisfaction?
• “Yes, it increased”
• “Yes, because she is able to go over things with the patient.
I sometimes feel I am rushing with those important things –
because of so many other things going on.”
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What is the best thing about the Admission Nurse
Program?
◦ “They all do a great job – so helpful to nurses”
◦ “When the Admission Nurse is admitting patients, it gives
us the chance to focus on other more acute patient.”
Bassett Healthcare Network-Bassett Medical Center
5.
What is the one thing you would like to
improve about the Admission Nurse
Program?
• “on duty for longer hours”
• more of them on at the same time
• evening coverage
Bassett Healthcare Network-Bassett Medical Center
How satisfied are you with the role of
Admission Nurse?
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“I am enjoy this role immensely”
“very satisfied”
What prompted you to engage with the
Admission Nurse Program?
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“Desire to continue to work in nursing”
“Desire to return to nursing”
“Needed part work time but needed my
weekends free”
Bassett Healthcare Network-Bassett Medical Center
What is the best thing about being an
Admission Nurse?
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“being able to do hands on nursing, in a one on
one setting”
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“the short 4 hour shift and flexibility in
scheduling”
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“I have time for each patient and their family. If a
patient needs a hand held, I have the time.”
Bassett Healthcare Network-Bassett Medical Center
4.
How difficult was it for you to become
skilled in the role?
• “did not seem difficult, orientation was quite
thorough…we were mentored until we felt ready.”
• “much of the role seemed like an extension of my
previous experience as a Public Health Nurse.”
• “The training was excellent and found the full
new employee orientation very helpful.”
Bassett Healthcare Network-Bassett Medical Center
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Due to patients awaiting admission to the hospital,
beds needed to be available more quickly.
A Discharge Unit was established in a vacant space
once housing a portion of the old ICU. The six bed
space would accommodate six patients to await
their rides home once the discharge order was
written.
An experienced Med/Surg RN was seeking a
position that would utilize her expert knowledge
base but be less physically demanding.
The Discharge RN ran the unit with the support of
a Patient Care Associate.
Bassett Healthcare Network-Bassett Medical Center
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In 2011it was decided the Discharge Nurse
could be better utilized by floating between
the Inpatient Medical, Surgical, and Special
Care Units to facilitate patient discharges.
In 2011, the Discharge Nurse completed
1300 discharges, 300 Rehabs, and 300
CHHAs.
Due to an increase in patient admission
demand through Bassett’s ED, on March 19,
2012 a six bed Discharge Unit was reestablished in another current open space.
Bassett Healthcare Network-Bassett Medical Center
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In early April 2012, the six-bed Discharge Unit will
become an Admission Unit.
The full time Discharge Nurse will resume her
coverage and patient discharge support to the
Inpatient Units of Medicine, Surgery and Special
Care.
On April 16, 2012, a full time Admission/Discharge
RN will support the additional patient demands of
the Admission and Discharge Nurse Programs.
There is ongoing recruitment for an additional full
time Discharge Nurse to support the current full
FTE discharge position.
Bassett Healthcare Network-Bassett Medical Center
www.cynosurehealth.org