Charge Nurses Take Charge: Preserving Patient Safety and Staff Satisfaction Medical Progressive Care Unit - The Johns Hopkins Hospital

Program/Project Description. The problem was frequent interruptions during change of shift, which delayed nurse report. Interruptions could be identified as: patient admission, patient transfer, telephone calls from doctors and family, monitor alarms, equipment alarms, and calls from the patient's room. W e collected data that counted for all admissions that arrived to the MPCU during the change of shift because this interruption takes the most time to tend. Our goals were: to decrease nurse report interruptions, to increase nurse satisfaction, decrease response time to patient calls and alarms, and to increase patient satisfaction. To measure our success, we took a poll to measure actual nurse and patient satisfaction. We would also know that we were successful if there were fewer complaints from patients regarding not being answered during change of shift, and less falls were recorded during the change of shift.

Process. We discussed the idea in a meeting with the Leadership team consisting of 6 charge nurses and nurse manager. Interruptions became an issue after numerous complaints by the staff for not being able to complete the report and leave on time which was due to answering bells and admitting patients that arrive within 15 minutes of the shift change. W e came up with an idea to have the charge nurse arrive to receive reports 30 minutes early. Therefore, relieving the other charge nurse of her duties, taking the pager, and having one nurse not in report available to answer call bells, and help admit patients to the unit. These nurses volunteered to pilot the idea for 2 weeks.

Solution. The charge nurse shift became 0630-1830 and 1830-0630. Charge nurses were instructed to arrive 30 minutes earlier than usual, with an incentive to leave 30 minutes earlier than usual. This was implemented by educating staff of the new changes to charge nurse times. Educating the clerical associate to not interrupt staff nurses during change of shift report, deverting most telephone calls to the charge nurse. The charge nurse also answered all call bells. The implementation also involved changes into our electronic schedule (Nighingale) by developping a new code and color to label charge nurse shifts. This way a nurse would be notified well in advance if he/she was expected to arrive early for the pilot. Other than the 6 nurses present in the meeting, 3 more nurses were included in the 2 week pilot.

Measurable Outcomes. We surveyed the nursing staff (survey monkey) pre and post implementation to measure staff satisfaction. We also gathered information prior to and during the pilot to count the actual admissions to the unit. We are awaiting our Press Ganey-Patient Satisfaction scores as they relate to how quickly their call bells were answered. We will await our staff satisfaction scores on both NDNQI and Gallup Q12 as they relate to employee satisfaction and staff engagement.

Sustainability. Due to the overwhelming positive feedback, as a unit we decided to commit to the hourly change, giving nurses the opportunity to opt out of the opportunity to be charge nurse if they did not want to arrive 30 minutes early.

Role of Collaboration and Leadership. We had to agree as a team that having one nurse available on the unit during shift change was the safest option. This could decrease the chance for patient falls, decrease nusiance alarms, increase patient satisfaction, increase nurse satisfaction. All staff nurses on the MPCU were involved in this change in practice. Our Nurse Manager was aware of the unit pilot and was very supportive of the idea to promote patient safely and satisfaction. Leadership support was demonstrated by our nurse manager allowing us to pilot this idea when no other unit was participating at the time.

Contact Person Title Email Phone

Keisha Perrin and Maddy Biggs RN [email protected] 410-955-5340

MPCU
Change
of
Shift
Transfer
Data
 


Admission
 At
change
of
shift


Discharge/Transfer
 At
change
of
shift


Total





April


10


3


13


May


14


7


21


June


18


14


32


July


5


0


5


August


7


9


16


September


4


13


17


October


10


7


17


November


8


7


15





Charge
Nurse
Response
Data
(7
survey
responses)
 Finish
report
on
time
to
cover
unit
during
report.
(Answer
patient
calls,
telephone
calls,
 equipment
and
monitor
alarms,
including
admitting/transferring
patient).

 YES
 NO
 100%
 0
 Able
to
assist
patient
needs
or
receive
transfer/admission
 
 YES
 NO
 100%
 0
 Increase
in
patient
satisfaction/safety
(subjective)
 
 YES
 NO
 71.4%
 28.6%
 Interest
in
continuing
early
change
of
shift
 
 YES
 NO
 100%
 0
 
 Quotes
:


1.


I
think
coming
in
early
helps.
And
I
think
it
is
great
that
charge
nurse
can
get
through
report
 quicker
since
we
can
hand
of
the
arrhythmia
pager
during
our
shift
report.


2.


Haven’t
seen
any
documentation
from
patients
that
their
stay
was
less
interrupted
yet.
 Some
staff
won’t
get
out
on
time
no
matter
what
help
they
can
get


I
didn't
answer
"NO"
to
any
questions.
However,
please
note
that
when
a
charge
nurse
 3.
 needs
to
take
a
patient,
he/she
does
not
benefit
from
reporting
to
the
other
charge
RN
 early.
 4.
 


Have
not
noticed
any
change
in
patient
satisfaction
‐
but
have
not
experienced
 complaints...


Staff
Nurse
Response
Data
(20
survey
responses)
 Interrupted
during
shift
report
to
respond
to
patient
needs
(Answer
 patient
calls,
telephone
calls,
equipment
and
monitor
alarms).






YES
 NO
 15%
 85%
 Interrupted

to
assist
patient
needs
or
receive
transfer/admission
 
 YES
 NO
 5%
 95%
 Finished
shift
in
a
timely
fashion
 
 YES
 NO
 95%
 5%
 Beginning
of
shift
flowed
better
 
 YES
 NO
 65%
 0
 Noticed
difference
in
patient
safety/satisfaction
(subjective)
 
 YES
 NO
 90%
 10%



 
 
 
 
 
 
 
 
 Neutral
(noticed
no
difference)
 35%
 
 Neutral
(noticed
no
difference)
 0





Quotes:





1.


Thanks


2.


I
like
it!


3.


Its
quieter
with
pumps
being
taken
care
of
quicker


4.


It
worked
well.
The
only
time
I
was
interrupted
was
when
the
unit
clerks
did
not
realize
that
they
were
 supposed
to
page
the
charge
nurse,
rather
than
me.
If
everyone
is
on
the
same
page,
I
think
it
will
flow
 much
better.


5.


I
really
like
the
pilot.
Think
it
works
well.
Only
thing
important
to
remember
is
that
many
admits
come
 between
1830
and
1900,
when
the
charge
RNs
are
in
report,
so
it
is
important
for
the
other
team
members
 to
assist
with
the
admission.


6.


During
this
trial
period,
I
had
2
admissions
arrive
at
6:50pm
and
the
charge
nurse
told
me
to
go
give
report
 and
she
admitted
the
patient
for
me.
It
was
great!


7.


I
was
only
interrupted
during
report
the
first
few
shifts
because
the
clerical
associates
were
not
aware
of
the
 pilot.
They
did
not
know
to
call
the
charge
nurse
after
7am
for
any
calls.


8.


Love
this!
Great
idea.
Can't
think
of
anything
negative
about
it


9.


Love
it
:)


10.


Less
stressful
shift
change
was
noticed...