Putting Nurses Back at the Bedside,Introduction of an Admission,Discharge,Resource Nurse in Pediatric Critical Care

Purpose:
In the PSCU,nurses reported decreased satisfaction with the following 2 indicators on the 2010 NDNQI RN Survey:time spent with patients & time to document. Nurses attributed their decreased time to document and spent with patients to admissions recieved during their shift.

Significance:
The PSCU admits more than 2000 patients annually. Multiple complex and time consuming admissions and discharges are the rule and not the exception. This can lead to a decrease in nursing time spent at the bedside, and in turn missed care, and decreased nurse satisfaction.

Strategy and Implementation:
The PSCU Nurse Practice Council, Leadership Team and CNS collaborated to develop a framework for this PI project. An analysis of admission activity was undertaken. The decision was made to pilot an ADR Nurse role between peak admission hours and analyze its impact on nursing satisfaction, time to document and time spent with patients. An ADR nurse role outline was developed, including a protocol for admissions arriving during the challenging change of shift time period. 100% of staff was educated regarding the scope of the role before the trial. Post-trial analysis clearly demonstrated the benefits of an ADR nurse in the PSCU. The role went live in February 2011, and was staffed by internal candidates who work two eight hour shifts in the ADR role (spanning change shift) and two twelve hour shifts in bedside staffing.

Evaluation:
When polled,95% of nurses were satisfied with the ADR role.The 2011 NDNQI RN survey data shows increased nursing satisfaction from a t-score of 68.17 in 2010 to 73.46 in 2011.Time to document increased from 62% in 2010 to 86% in 2011.Time spent with patients increased from 76% in 2010 to 88% in 2011

Implications for Practice:
An ADR nurse can increase nurse satisfaction, time at bedside, and time to document.Putting satisfied,well-supported nurses back at the bedside may have a positive impact on Nursing Outcomes. The ADR nurse role has contributed to measurable improvements in VAP,CABSI and Shunt infections in the PSCU.