Improving Nursing Efficiency
Nurses are amongst the essential pivots in the healthcare delivery system. Of all the cadres, they have the most intimate contacts with patients in and out of hospital setups. Their services ensure that patients obtain the best possible care, which in turn contributes to patient outcomes as well as patient satisfaction. However, the field of medicine is a dynamic one, and changes are bound to ensue often. Part of the change that is currently shaping up the sector includes the emphasis on value systems. For optimal value to be obtained, the cost of healthcare services must be trimmed to a substantially low level while at the same time, the health outcomes must be at optimal levels. While nurses may not have much of an influence in dictating healthcare expenditures, they are at the front line of patient management. They can, thus, directly and significantly contribute to health outcomes. It is, therefore, of utmost importance that their services be optimized. However, over time, the practice of nursing has remained rigid, with very much what was done decades and perhaps centuries ago still being practiced. The effect of this rigidity amid a dynamic system is nursing performance at a suboptimal level. A systemic analysis must be carried out to identify areas of weaknesses and initiate the process of change.
Statement of the Problem
Nurses spend inadequate time with patients under their care. Several studies have highlighted that nurses spend the majority of their time out of contact with patients. A study done in 2011 showed that, on average, nurses spend approximately thirty-seven percent of their time with patients (Westbrook, 2011). In a shift of eight and a half hours, this translates to slightly above three hours spent with patients. Whereas a significant amount of time is spent on activities that could have potential benefits to patients, it is not lost to the fact that a proportion of that time is unaccounted for and, therefore, termed ‘wasted.’ Another research enumerated the percentage of time wasted by nurses to be 6.6% (Hendrich 2008). Nonetheless, this percentage still fails to explain the surprisingly low contact time between nurses and patients.
Documentation duties performed by nurses consume the most considerable amount of their time. One research showed that up to twenty-nine percent of nurses’ time is spent on completing paper works (Westbrook, 2011). Another study produced almost similar results and elaborated in other areas that affect nurse-patient contact time. It was established that other than documentation, coordination of care with other professionals in the hospital and medication administration significantly contributed to the reduced contact-time between nurses and patients (Hendrich 2008). It was established that approximately 38.6% of the time nurses work in hospitals was spent at the nursing station (Hendrich 2008). Also, coordination of care proportioned close to twenty-percent of nursing practice time. If nurses are to spend more time with their patients, then the single most important strategy would be to reduce the time spent on documentation and coordination of care. Based on the figures provided above, relieving nurses of these duties could increase the contact time between nurses and patients by up to fifty percent.
Possible Changes based on Lewin’s Change Theory
Lewin’s theory of change has been touted as providing the most fundamental building blocks for change. It is useful in aiding systems to adapt to the dynamics that are constantly evolving in the healthcare system (ANA, 2016). It is modeled on three fundamental steps: unfreezing, changing, and refreezing. Unfreezing highlights issues that need to be addressed, changing entails the implementation of new programs, while refreezing revolves around establishing permanence towards established changes.
Decreased contact time between nurses and patients has already been discussed. To go around this problem, it would be worth it to establish the position of a Nursing Records Officer, NRO. To achieve this, a new curriculum would have to be developed. The new curriculum would focus on records mostly kept by nurses, chain of command in hospital setups, essential patient management, and basic protocols to follow under different circumstances. Persons who undergo training under this curriculum would thus be able to effectively do recording work for nurses and coordinate care among the various cadres of healthcare workers in the hospital. They would, therefore, be the principal assistants to nurses and would be required to be ever-present around identified and assigned nurses while carrying out their duties. To make this change permanent, the legislation would be needed to redefine nursing roles in the hospital setup and carry over the other tasks to the new cadre of health workers, NROs.
Criteria to evaluate Outcome
The purpose of establishing the NRO position is to maximize contact-time between nurses and their patients. This is achieved by relieving them of two activities that consume a significant proportion of their time: documentation and coordination of care. Increased contact time between nurses and patients is expected to contribute to improved patient outcomes. Evaluation of the effectiveness of this strategy would require that contact time between nurses and patients as well as health indices to assess for patient outcomes be measured. Quantitative research would, therefore, have to be carried out with the specific purpose of evaluating the aforementioned outcomes. The training of RNOs would take not more than a year. Their integration into the health system could take another year. To assess for significant changes, the program would have to be run for around two years. It would, therefore, take a total of four years for the impact to be realized.
How the change affects Nursing
The introduction of NROs would mean that nurses are no longer required to perform paper works. The responsibility to coordinate patient care would also be off their shoulders. This would lead to increased contact time between the nurses and patients, leading to better patient outcomes and satisfaction (Westbrook, 2011). Also, there is an acute shortage of nurses’ in the country (Haddad, 2020). Freeing up nurses’ time and re-allocating it to comprehensive patient care would address the deficit uniquely and excitingly.
References
ANA. (2016, September 2). A Case Review: Integrating Lewin’s Theory with Lean’s System Approach for Change. Retrieved June 4, 2020, from https://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-21-2016/No2-May-2016/Integrating-Lewins-Theory-with-Leans-System-Approach.html
Haddad, L. M. (2020, March 29). Nursing Shortage – StatPearls – NCBI Bookshelf. Retrieved June 4, 2020, from https://www.ncbi.nlm.nih.gov/books/NBK493175/
Hendrich, A. (2008). A 36-Hospital Time and Motion Study: How Do Medical-Surgical Nurses Spend Their Time? The Permanente Journal, 25–34. https://doi.org/10.7812/tpp/08-021
Westbrook, J. I., Duffield, C., Li, L., & Creswick, N. J. (2011). How much time do nurses have for patients? a longitudinal study quantifying hospital nurses’ patterns of task time distribution and interactions with health professionals. BMC Health Services Research, 11(1), 1–6. https://doi.org/10.1186/1472-6963-11-319