Effective Staff Utilization: Enhancing Patient Flow with Unit-Based Capacity Nurses and Workload Leveling

Purpose:
The goals were to improve nurse workload and create a budget neutral position, a Unit-Based Capacity Registered Nurse (UBC RN) – which by design offered RNs shorter shift options. UBC RNs enhance patient flow, thereby expediting admissions and discharges; resulting in improved staff satisfaction.

Significance:
In 2009, Siehoff et al. affirmed, “The hospital admission process is a time-consuming, yet vital process. Because of the amount of time needed, . . . the admission process can become fragmented and can lead to staff and patient dissatisfaction”.

Strategy and Implementation:
Workloads related to patient throughput can be more efficiently managed by staffing according to unit demands/needs. To prove this, an interdisciplinary team collaborated to investigate staffing effectiveness. Data used to design the staffing model depicted average census, transfers, admissions and discharges – all by day and by hour over a six-month time period, illustrating peak times, trends, and volumes. Reviewing patient flow data enabled the team to isolate peak activity times and thereby offer individualized staffing recommendations to each respective unit manager. Based on data, the proposal of a UBC RN was introduced to nursing leadership. Considerable emphasis was made for the UBC RN to be unit-based, given that this RN would be familiar with the staff and patient population on each particular unit. UBC RN coverage ranged from two days to five days a week with varying hours per unit, depending on need.

Evaluation:
On one medical unit, NDNQI RN survey scores for ‘intent to remain' improved from 45% to 82%; ‘quality of care' scores rose from 75th to 90th percentile; median discharge time improved by two hours; and total number of patients moved into a clean bed within 60 minutes increased from 48% to 53%.

Implications for Practice:
A dedicated UBC RN has the potential to increase RN satisfaction, decrease median discharge time and moreover, affect staff retention on units where capacity demands are exceeded.