Today’s Webinar will begin at 11:30AM

1. Today’s Webinar will begin at 11:30AM 3/28/12

2. Introduction

3. More Introduction • Please do not put your phone on hold; use the mute function or *6 • Please type questions or comments into text box • If time permits, we will open up the phone lines at the conclusion of the presentation

4. Connie Jastremski, MS, MBA, RN, ANP-CS, FCCM

5. Patricia Davis, RN, Project Coordinator

6. 2001Why consider an Admission Nurse Program? Projected Nursing Shortage into 2012 and beyond Changes in supply and demand Recruitment to rural healthcare environment Fewer people entering and staying in nursing Projected need for more health services as population aged Overall RN vacancy in 2001 Patricia Davis, RN Connie A Jastremski, RN Network CNO

7. Three Approaches to Augment Nursing Workforce • Increase number enrolled nursing students and retain them through graduation • Retain new graduates, all nurses, including older nurses • Attract nurses who seek different roles or want to return to the bedside Bassett Healthcare Network-Bassett Medical Center

8. Retaining Older Nurses • In early 2000, began to receive attention • Alert to knowledge and wisdom • Identify new roles Bassett Healthcare Network-Bassett Medical Center

9. Review of Literature • Age and performance • Human Resource benefits entice older worker • Career fulfillment • Work design Bassett Healthcare Network-Bassett Medical Center

10. Business Case for Retaining Older Nurses • Turnover costs are staggering • Equal to or greater than two times salary • 2000 nurse turnover 21.3% • National average salary for med/surg RN of $47,000 • $94K for specialty area nurse • 2002 NYS Education Department • Brain drain decreases innovation, increases errors, reduces efficiency, undermines growth strategies Bassett Healthcare Network-Bassett Medical Center

11. Loss of Knowledge • Hard to quantify • Efficiency knowledge – how to get job done faster and better • Negative patient outcomes Bassett Healthcare Network-Bassett Medical Center

12. The Admission Nurse ProgramRecruiting and Retaining • Admission Nurse implemented 2001 • Specialized, limited RN role with core requirements • Admission Nurse completes entire admission process, followed by handover to accountable RN • Appealing to retired, inactive, under employed, office workers eager for “hands on” • Per diem category, self-schedule, 4 hour shifts, weekly Bassett Healthcare Network-Bassett Medical Center

13. Summary of Intervention • Eight RNs have served in the role, with five current RNs employed in the role • Program does not serve the units of Psychiatry, Peds, Birthing Center, or ICU Bassett Healthcare Network-Bassett Medical Center

14. Throughput Data • Context • 180 bed rural, teaching hospital located in Upstate New York • Admissions/Discharges/Transfers • 10, 982 admissions annually (32/day) • 10, 973 discharges annually (32/day) • 7, 194 transfers in or out • Timing • ADT workload builds at 11 am, decreases at 11 pm • Peak hours 12 noon through 8 pm Bassett Healthcare Network-Bassett Medical Center

15. Rationale for the Intervention • Realities of retention and recruitment challenges in rural area • Idea emerged from staff nurse; not immediately implemented • Context of throughput gridlock • Evidence of improved satisfaction with smooth admission • Earlier proposal revisited and piloted • Purpose to admit patients in thorough, consistent, timely fashion from all areas – ED, clinics, peri-op, outside agencies and initiate medical and nursing regimens • Expose new group to Bassett nursing culture and possibility of other roles in the organization Bassett Healthcare Network-Bassett Medical Center

16. Expected Outcome(s) • Small test of change • Satisfied – and retained – Admission Nurse • Satisfied – and retained-staff nurses • Good productivity • Thorough documentation • Satisfied patients Bassett Healthcare Network-Bassett Medical Center

17. Recruitment and Orientation of RNs • Recruitment – targeted RNs with experience who had left the work place or retired • Key recruitment question to potential applicants’ “What would it take for you to come to work in the hospital?” Bassett Healthcare Network-Bassett Medical Center

18. Orientation • Hired as per diem RNs, salary based on experience • Standard 2 day New Employee Orientation • Specialized – focused to job scope-screening, physical assessment, BLS certified • Preceptors were nurse educators (one on one) • 4 hours x 4 sessions, competency checklist • Continued follow-up and support (attention to special needs) • Self-scheduling • Annual lunch with CNO • Electronic documentation rollout- required specialized support • Invited to all Bassett nursing CE programs and RN Refresher course Bassett Healthcare Network-Bassett Medical Center

19. Survey ResultsStaff Nurses • How satisfied are you with the role of the Admission Nurse? • “very satisfied”, a great asset”, “extremely satisfied” • How has the Admission Nurse Program changed your job? • “taken a load off – allows a nurse to stop and take a deep breath vs feeling bombarded with discharges, then admissions” • “decreased stress, increased time for patient care, timely admitting of patients” Bassett Healthcare Network-Bassett Medical Center

20. Survey ResultsStaff Nurses • Has the Admission Nurse Program had an effect on your job satisfaction? • “Yes, it increased” • “Yes, because she is able to go over things with the patient. I sometimes feel I am rushing with those important things – because of so many other things going on.” • What is the best thing about the Admission Nurse Program? • “They all do a great job – so helpful to nurses” • “When the Admission Nurse is admitting patients, it gives us the chance to focus on other more acute patient.” Bassett Healthcare Network-Bassett Medical Center

21. Survey ResultsStaff Nurses • What is the one thing you would like to improve about the Admission Nurse Program? • “on duty for longer hours” • more of them on at the same time • evening coverage Bassett Healthcare Network-Bassett Medical Center

22. Survey ResultsAdmission Nurses • How satisfied are you with the role of Admission Nurse? • “I am enjoy this role immensely” • “very satisfied” • What prompted you to engage with the Admission Nurse Program? • “Desire to continue to work in nursing” • “Desire to return to nursing” • “Needed part work time but needed my weekends free” Bassett Healthcare Network-Bassett Medical Center

23. Survey ResultsAdmission Nurses • What is the best thing about being an Admission Nurse? • “being able to do hands on nursing, in a one on one setting” • “the short 4 hour shift and flexibility in scheduling” • “I have time for each patient and their family. If a patient needs a hand held, I have the time.” Bassett Healthcare Network-Bassett Medical Center

24. Survey ResultsAdmission Nurses • How difficult was it for you to become skilled in the role? • “did not seem difficult, orientation was quite thorough…we were mentored until we felt ready.” • “much of the role seemed like an extension of my previous experience as a Public Health Nurse.” • “The training was excellent and found the full new employee orientation very helpful.” Bassett Healthcare Network-Bassett Medical Center

25. Discharge Nurse Program • Due to patients awaiting admission to the hospital, beds needed to be available more quickly. • A Discharge Unit was established in a vacant space once housing a portion of the old ICU. The six bed space would accommodate six patients to await their rides home once the discharge order was written. • An experienced Med/Surg RN was seeking a position that would utilize her expert knowledge base but be less physically demanding. • The Discharge RN ran the unit with the support of a Patient Care Associate. Bassett Healthcare Network-Bassett Medical Center

26. Discharge Nurse Program • In 2011it was decided the Discharge Nurse could be better utilized by floating between the Inpatient Medical, Surgical, and Special Care Units to facilitate patient discharges. • In 2011, the Discharge Nurse completed 1300 discharges, 300 Rehabs, and 300 CHHAs. • Due to an increase in patient admission demand through Bassett’s ED, on March 19, 2012 a six bed Discharge Unit was re-established in another current open space. Bassett Healthcare Network-Bassett Medical Center

27. Future Demand for Patient CareNext Steps • In early April 2012, the six-bed Discharge Unit will become an Admission Unit. • The full time Discharge Nurse will resume her coverage and patient discharge support to the Inpatient Units of Medicine, Surgery and Special Care. • On April 16, 2012, a full time Admission/Discharge RN will support the additional patient demands of the Admission and Discharge Nurse Programs. • There is ongoing recruitment for an additional full time Discharge Nurse to support the current full FTE discharge position. Bassett Healthcare Network-Bassett Medical Center

28. Questions

31. Notes will be on our website

32. Cynosure Quality Swap MeetMay 21, 2012 www.cynosurehealth.org

33. Thanks for joining us today