Magnet Recognition Program® Request for Additional Documentation
Homestead Hospital
Homestead, FL
MGN20140102
TL8 The CNO uses various methods to communicate, be visible, and be accessible to nurses throughout the organization.
TL8a: Provide one example, with supporting evidence, of communication between the clinical nurse(s) and the CNO that led to a change in the nurse practice environment.
Please provide supporting evidence of the communication between the clinical nurses and the CNO related to their request to revise the Versant Program enrolment criteria and the change in the nurse practice environment that occurred.
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A new example is presented below.
NAME OF INITIATIVE
RN Staffing Adequacy in the Progressive Care Unit (PCU)
BACKGROUND AND PURPOSE
Methods Used by the CNO to Promote Visibility, Accessibility and Communication
To supplement the regularly-scheduled rounding, Chief Nursing Officer (CNO) and Vice President Gail Gordon, RN, also conducts the “Roundtable with Gail”. The Magnet Designation department coordinates with Gordon’s executive assistant in scheduling her visit during the last 15-minutes of the department’s staff meeting. The Magnet Designation department puts out a flyer one month before the scheduled meeting together with the “Ask Gail” box where staff can drop off questions for Gail to address during the session. The department’s nursing leaders are not present during these meetings to promote candid participation and discussion among the staff. Gordon rotates her visits among the ten nursing departments throughout the year.
Five days prior to the scheduled “Roundtable with Gail,” the Magnet Designation department administrative assistant picks up the “Ask Gail” box to collect the questions. To promote honest dialogue between her and the clinical nurses, the form in the “Ask Gail” box does not ask for names; only in rare occasions, the nurses or staff would voluntarily write in their names. The Magnet Designation department administrative assistant forwards only collated questions to Gordon and the department manager to maintain anonymity. Gordon uses these questions as conversation starters during her roundtable as she welcomes questions asked on the spot.
Communication between Clinical Nurses and CNO
In February 2013, Gordon was scheduled to visit the Intensive Care Unit (ICU) and PCU (also referred to as Multispecialty Progressive Care). Since both departments were managed by the same nurse manager, the staff meetings were held jointly. At that time, ICU nurses would float to PCU and vice versa. Prior to the meeting, Gordon received one anonymous question in the “Ask Gail” box: “When are we going to have 3 RNs in PCU again? My concern is patient safety.” PCU is an 8-bed step-down unit connected to the ICU.Two nurses would result in a 1:4 RN to patient ratio, which was comparable to national standards. However, 3 RNs would afford the clinical nurses a lighter patient load, especially when they have a higher acuity patient in the mix and higher patient turnover. Incidentally, PCU’s Practice Environment Score (PES) on “Staffing and Resource Adequacy” was above the mean of the comparative benchmark (100-199 bed size) in 2012 and 2013. However, Patient Care Manager Leslie Everett, RN, noted a decrease from 3.45 (in 2012) to 2.77 (in 2013).
On the day of the meeting, Gordon addressed the PCU staffing question among the clinical nurses present. She explained to them several factors contributing to the staffing inconsistency such as high inpatient volumes. For example, some PCU nurses were pulled to staff MS3 (overflow medical/surgical unit) during patient surges. Additionally, there were several nurses who were out on leave and there were challenges with filling open part-time positions (TL8 01a ICU/PCU Staff Meeting Minutes 2/19/13).
METHODS AND APPROACH
Gordon worked with Everett on tackling the contributing factors described above. Everett focused on filling the open positions. With Gordon’s approval, she obtained justification to open an additional 0.6 RN full-time equivalent (FTE). The additional FTEs used were reflected in the monthly department responsibility report (DRR) showing an increase in RN regular man hours used between March and April 2013 (TL8 02a PCU DRR). Everett also collaborated with her Patient Care Supervisors (PCS) and the Staffing Office Patient Care Manager Raul Botana RN, to minimize floating of PCU nurses to staff MS3.
Overcapacity had always been a major organizational challenge; but it was more pronounced at this time. The frequent pulling of clinical nurses from ICU, PCU and other medical-surgical units to staff MS3 during surges was a big dissatisfier among the inpatient nurses. This was also a concern among the medical-surgical nurses. At the organizational level, Gordon advocated having dedicated RNs to staff MS3. In March 2013, she participated in a meeting facilitated by Magnet Project Director Julie David, ARNP. This meeting was attended by the chief executive officer; chief financial officer; critical care services director; medical-surgical nurse managers and director; and the staffing office manager. At the conclusion of the meeting, Gordon obtained approval to staff MS3 with 2 nurses from the system Centralized Staffing Center 24/7 Monday to Friday, effective April 1, 2013 (TL8 03a Meeting Minutes 3/25/13). Everett gave an update to the ICU/PCU nurses regarding the actions taken to address their concerns during the April 2014 staff meeting (TL804a ICU/PCU Staff Meeting Minutes 4/2/2013). This closed the communication loop between Gordon and the PCU clinical nurses.
OUTCOMES
Change in the Nurse Practice Environment
Because of Gordon’s communication with the PCU clinical nurses, she became aware of their immediate concerns regarding PCU staffing adequacy. She then proceeded on effecting change by addressing contributing factors both at the unit and the organizational levels. This resulted in less pulling of the PCU nurses to staff MS3 and more consistency in staffing PCU with a RN to patient ratio of 1:3. This affected an improvement in PCU nurses’ perception of their nurse practice environment with regards to “Staffing and Resource Adequacy”.
Exhibit TL8aa: RN Perception “Staffing and Resource Adequacy” in PCU
Analysis: Above graph demonstrates that the PCU nurses perception of adequacy of staffing and resource has improved post-intervention.
Summary of Attachments/Hyperlinks/Evidences
TL8 01a ICU/PCU Staff Meeting Minutes 2/19/13
TL8 02a PCU DRR
TL8 03a Meeting Minutes 3/25/13
TL8 04a ICU/PCU Staff Meeting Minutes 4/2/2013
Exhibit TL8aa: RN Perception “Staffing and Resource Adequacy” in PCU