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APNA 29th Annual Conference S ession 3016.2: October 30, 2015 Disclosures This speaker has no conflicts of interest, commercial support, or off-label use to disclose. OBJECTIVES At the conclusion of this presentation participants will be able to Contrast the Admission/Discharge RN with that of staff RN to understand how the role decreased workload Describe how the implementation of an Admission/Discharge RN improves patient throughput Identify 3 ways in which having an Admission/Discharge RN increases staff RN satisfaction Roark 1

APNA 29th Annual Conference S ession 3016.2: October 30, 2015 Introduction Target of Project  Improve Patient Throughput  Provide Staff Support  Psychiatric RNs  36 Bed Acute Psychiatric Unit  The implementation of Admission/Discharge RN would decrease workload and increase RN satisfaction  Monday/Friday 8-1630 for 6 mos Application to Nursing Field  Admission process is a vital patient centered task  Joint Commission required  Discharge process equally important Roark 2

APNA 29th Annual Conference S ession 3016.2: October 30, 2015 Rationale for position  Wanted to help streamline process  Provide staff support  “that when nurse staffing is more favorable, patient and nurse outcomes are more favorable ” (Quinn, 2013, p. 163) .  Increased nursing satisfaction  Several studies have yielded increased nursing satisfaction with the implementation of an ADRN  Help patient throughput  “ Patient turnover, or throughput, through nursing units can significantly impact the workloads of nurses” (Quinn, 2013, p. 163). Rese Research arch Supporti Supporting Applicati g Application on & Rat & Rationale ale  Admit process can disrupt flow of care. Admission RNs steady work flow, improved patient safety, increased pt. & family satisfaction (Kirkbride et al. 2012)  NDNQI S urvey – 25% increase in j ob enj oyment, 38% time with pts. Increased, RN plan to stay on unit increased by 25% (Lane et al., 2009).  Admission nurses saved staff RNs 1.12 hours of work per shift (Lane et al., 2009).  Correlation exists between time on direct patient care and j ob satisfaction, nurses were happier who had more with patients! (S eed et al., 2010). Resear search ch Supporting pporting Appl Application & ication & Rati Rationale  ADRN is effective and increases satisfaction  Decreased OT/ Improved satisfaction (Lane et al., 2009)  Found positive nurse & pt. satisfaction scores (S iehoff et al., 2009)  In a 633 bed hospital that instituted AD RN  S atisfaction scores from AD process increased from 2.62 to 3.57 (Spiva & Johnson, 2009)  Pre-ADRN nurse satisfaction score was 36.24 post 39.05 (S piva & Johnson, 2009)  S atisfaction score before ADRN - 29.10 after 44.70 (Lane et al., 2009) Roark 3

APNA 29th Annual Conference S ession 3016.2: October 30, 2015 Scope of the Problem Late Admissions Multiple Backed up AM shift ED Patient D/ C’s Throughput/ FLOW Later PLT Discharge s ADRN Routine  Check in with Charge RN/ S taff RNs to identify discharges and potential discharges  Attend S W meeting to identify potential discharges from S W standpoint  Calls for discharge orders, discusses identified potential discharge patients who are voluntary asking to leave with psychiatrist  Completes discharges or admissions depending on priority ADRN vs Staff RN Time Line ADRN STAFF RN 0700-0730 – Report/ shift Change 800 – Discharge 0730-0800 –Accuchecks, chart/ med 900 - Discharge reviews 0800-1000 – Medication pass & patient 1000 – 1200 –Admission assessments 1230 - Discharge 1000-1100 - Discharge 1130 –Accuchecks 1330 - Discharge 1200 –Admission 1430 – 1630 - Admission 1230-1330 – Med Pass 1330 – Continue Admission 1330-1530 – Charting/ wrap up day Roark 4

APNA 29th Annual Conference S ession 3016.2: October 30, 2015 Data Results Admits & Discharges Nurse Satisfaction Survey Results Nurse Satisfaction Survey Results Nurses asked if felt an AD RN Nurses asked if AD RN has will decrease workload decreased workload Roark 5

APNA 29th Annual Conference S ession 3016.2: October 30, 2015 Nurse Satisfaction Survey Results  Has the ADRN affected your j ob satisfaction?  How has the ADRN affected your j ob workload?  How could the ADRN position be improved?  How has the ADRN affected your j ob overall?  How satisfied are you with the ADRN position? Analysis of Position  Increased Admissions on Day Shift  Average 3 with high of 4  Improved average discharge time  Since 9/1 Avg. D/C time Staff RNs T,W,TH1300  On days with AD RN, Avg. D/C time is 1045  ADRN completed over 80% of D/Cs and 25% of admits for AM shift  Overwhelming positive response from AM/PM shift staff, physicians and patients for AD RN Concepts of Leadership  Nursing leaders must be willing to support employees who can feel overwhelmed by their workload  S taff nurses must be supported by leadership to provide quality care –if not this can lead to frustration and decreased satisfaction  92% of surveyed nurses associate the nursing shortage with a decrease in quality of care and time spent with patients (S iehoff et al,2009)  49% agreed that support staff would help ease the nursing shortage (S iehoff et al,2009)  89% reported an improved work environment was a good strategy to help solve the nursing shortage (S iehoff et al,2009) Roark 6

APNA 29th Annual Conference S ession 3016.2: October 30, 2015 References Kirkbride, G., Floyd, V., Tate, C., & Wendler, M. (2012). Weathering the storm: nurses'satisfaction with a mobile admission nurse service. Journal Of Nursing Management , 20 (3), 344-353. doi:10.1111/j.1365- 2834.2011.01273.x Lane, B. S., Jackson, J., Odom, S. E., Cannella, K. A. S., & Hinshaw, L. (2009). Nurse Satisfaction and Creation of an Admission, Discharge, and Teaching Nurse Position. Journal of Nursing Care Quality , 24(2), 148–152. doi:10.1097/01.ncq.0000347452.36418.78 Siehoff, A., Gancarz, B., & Wise, C. (2009). Improving patient admissions with dedicated admission nurses. Journal Of Nursing Administration , 39 (1),11-13.doi:10.1097/NNA.0b013e31818fe75c Spader, C. (2008, August). Admission RNs Make Fast Paced Admits Less Stressful. Nurse.Com . Retrieved from http://news.nurse.com/apps/ pbcs.dll/articleAID=2008108110080#.VEbODSldUi5 References Spiva, L., & Johnson, D. (2012). Improving Nursing Satisfaction and Quality Through the Creation of Admission and Discharge Nurse Team. Journal of Nursing Care Quality, 27(1), 89–93. doi:10.1097/ncq.0b013e318227d645 Seed, M., Torkelson, D., & Alnatour, R. (2010). The role of the inpatient psychiatric nurse and its effect on job satisfaction. Issues In Mental Health Nursing , 31 (3), 160-170. doi:10.3109/01612840903168729 Quinn, L. (2013). Throughput and nurses' workloads: Influences on nurse and patient outcomes. University of Pennsylvania; 2013. Available from: CINAHL Plus with Full Text, Ipswich, MA. Accessed October 21, 2014 Roark 7