What made you decide to become a nurse? Was it the thrill of directly impacting a patient’s life? Or, was it because you really love tracking down medications and filling out paperwork? I’m going to guess it wasn’t the latter, and the people at the Institute for Healthcare Improvement agree.
In a recent article this week in the Wall Street Journal, Laura Landro explored the institute’s new partnership with the Robert Wood Johnson Foundation to develop Transforming Care at the Bedside, a program “to help hospitals increase to 70% the amount of time nurses spend in direct patient care while improving the work environment for nurses.”
This initiative attempts to answer the increasing need to streamline the work nurses are doing, while improving nurses’ delegation practices, “shifting more routine tasks to certified nurse assistants and other less high skilled staffers.” In an interview between Landro and Patricia Rutherford, a nurse and vice president at the institute, Rutherford explained, “We shouldn’t be using expensive professional nursing time doing unnecessary and inefficient things when that time could be reinvested in direct patient care.”
The institute isn’t the first to notice the lack of time nurses are spending with patients. In 2008, the American Journal of Nursing published a series of studies that found direct patient care “accounts for less than 50% of working hours.”
NursingCenter’s own clinical editor, Lisa Bonsall, MSN, RN, CRNP, remembers her frustrations at the bedside. “Patient care is what nursing is all about. I can remember clearly being pulled away from the bedside searching for supplies or medications, or even fixing or calibrating equipment. One time, I was caring for a patient admitted with DKA (diabetic ketoacidosis), who needed finger stick blood glucose checks every hour for titration of his insulin drip. We had two machines on our unit and one was broken. At about my third hour of the shift, the machine that was working needed to be calibrated…[which] took quite some time. This event not only took me away from the bedside, but put him at risk as I was unable to check his blood sugar for about two hours. Fortunately, no untoward events occurred, but I remember thinking at the time, ‘There’s got to be a better way!’”
Studies show the more time a nurse is at the bedside, the better the outcomes. Bonsall explains, “The relationship between patient safety and nursing care is documented in the research, including direct impacts on healthcare-associated infection, readmission rates, and mortality. We are the ones noticing the subtle changes in a patient’s status. If we are repeatedly pulled away from the bedside, those changes can go unnoticed.”
In a 2010 internal audit conducted by Presbyterian Medical Center, it was discovered that “nurses were involved in direct patient care at the bedside for only 2.5 hours every 12-hour shift.” Nurses were spending too much time searching for missing test results and supplies and not enough time monitoring their patients. After implementing the Transforming Care at the Bedside program, the center was hitting “6.5 hours per shift at the end of 2013 with a goal to hit 8.5 hours by the end of 2015.”
Time will tell if the center is able to hit their goal. But, as more hospitals begin to take a robust approach at managing their nurses’ time and delegation strategies, the hope is to return nurses back to why they began their work in the first place – to care for the patients.