VHA helps nurses to develop work processes that are more patient-centric

Nurses work in a world of broken systems, wasted time and energy, which can be incredibly frustrating and detrimental to patient care. Most national studies show that nurses spend as little as 30 percent of their day engaged in direct patient care activities, and this can contribute to poor patient outcomes in terms of infections and other complications, poor patient and nurse satisfaction and poor quality of care overall. Nurses at hospitals in Maryland and North Carolina decided to do something about this problem, and worked with VHA Inc., the national health care network, to develop work processes that are more patient-centric and create a more efficient work environment.

"This program is a success because the front-line staff nurses, nursing leaders and chief nursing officers at these organizations are inspired to make a difference for their patients, and they've worked to move workflow back to the bedside and broken down barriers that have naturally developed through the years that have taken nurses away from direct patient care," said Crystal Mullis, RN, BSN, MBA, MHA, director of performance improvement for VHA's regional office in Charlotte.

The collaboration project, called Return to Care, began in September 2009 and is ongoing. As a result, several of the hospitals have increased the amount of time nurses spend engaged in direct patient care. One hospital increased nursing time at the bedside by two hours per nurse per 12-hour shift, and many are seeing improved patient satisfaction scores.

At Upper Chesapeake Medical Center, Bel Air, Md., VHA's Return to Care program has enabled nurses to spend an extra hour at the patient bedside per nurse per 12-hour shift. This has helped reduce patient falls, pressure ulcers and medication errors. It has also yielded labor savings and improvements in patient and nursing satisfaction. "This program has become a permanent part of our culture, because we know it works," says Joyce Fox, MS, RN, NEA-BC, vice president of patient services at Upper Chesapeake.

The keys to success were adapting leading practice strategies from VHA's Leading Practice Blueprints™ and Leading Practices Portal™ including:

-- Rounding hourly (purposeful) -- Conducting bedside shift reports (RN handoff at the bedside) -- Addressing medication administration inefficiencies -- Streamlining documentation -- Minimizing hunting and gathering activities related to equipment, supplies and medications -- Enhancing care coordination communications -- Wireless phone technology -- Whiteboard Communications -- Multi-disciplinary Rounds