At St. Joseph’s Regional Medical Center in Paterson, N.J., nurses change shifts at patient bedsides rather than at the nurse’s station. It’s a procedural innovation that makes a lot of sense to patients, who say they are grateful for the opportunity to introduce themselves to their nurses and communicate their concerns about their health.
The change was initiated by nurses at St. Joseph’s who, after hearing about a similar procedural change at another hospital, decided to implement it on their floor. They did, and so have several other hospitals in the area.
Most nurses lack the ability to turn their ideas about how to improve hospital procedures into reality. But nurses at St. Joseph’s Regional Medical Center are fortunate: They work at a hospital that participates in Transforming Care at the Bedside (TCAB) in New Jersey, a quality improvement initiative funded by the Robert Wood Johnson Foundation (RWJF) that aims to increase the amount of time nurses spend on direct patient care.
The program encourages nurses to suggest, implement and evaluate changes in their units. The goal is to improve care, and patient and nurse satisfaction.
The initiative stems from a successful nationwide TCAB program that was administered by the Foundation and the Institute for Healthcare Improvement. The national program concluded in 2008, and a New Jersey-specific program launched in September 2009. Today, 51 acute-care facilities—including dozens of hospitals, a home health agency and a children’s rehabilitation hospital—are involved.
“The nurses are the ones who make all of these suggestions,” says TCAB program manager Barbara Chamberlain, Ph.D., A.P.R.N., M.B.A. “They look for rapid-cycle changes that can be implemented quickly.”
Under the program, participating medical-surgical units test out small-scale initiatives that start with one nurse and one patient during one shift. Ideas are then adopted by one or more nurses, adapted to meet hospital needs, or abandoned.
“Sometimes we learn from failure,” Chamberlain says. “Some nurses have a hard time with that, but some are very willing to say the changes don’t work for them.”
Participating hospitals join in monthly conference calls to share ideas for procedural changes and discuss the effects of those changes. Many ideas have been adopted by other hospitals across the state, which has resulted in better care for millions of New Jersey patients.
Preliminary Results of TCAB-New Jersey Program are Positive
The three-year initiative is still in its early phases, but participating hospitals are already seeing positive results from the program.
At one hospital, for example, administrators placed white boards in patient rooms to record information like the names of nurses on duty and the room telephone numbers. At another hospital, administrators hung the names and pictures of nurses in a nearby hall so patients’ families and physicians would know who was on duty.
In other hospitals, quiet zones have been established to ensure that medications are administered without interruption; vital signs are measured less frequently; workstations have been redesigned to better accommodate patients; and paperwork and materials have been organized to eliminate unnecessary “hunting and gathering” during shifts.
As a result of these changes, “nurses are more efficient and can spend more time at the bedside,” Chamberlain says.
Transforming Care at the Bedside gives nurses the knowledge and tools they need to improve their work environment and the delivery of care, says Aline Holmes, M.S.N., R.N., the senior vice president for clinical affairs of the New Jersey Hospital Association (NJHA) and the director of the NJHA Institute for Quality and Patient Safety.
“We want the nurses to be motivated and supported by their managers to make changes,” Holmes says. “This has been a very interesting experience for chief nursing officers. They’ve really had to sit on their hands and let the ideas come from their staff nurses. But they’ve been pleasantly surprised at the way it’s turned out, and the patients love it.”
Nurses say they are happy with the program too because it gives them the power to make change and take control of their work environment. It also helps build leadership skills, which Holmes believes is an important factor in nurses’ professional development.
“Frontline staff nurses are at the intersection of quality, patient safety and care,” Holmes says. “We want to empower them to eliminate redundant care and extraneous activities so they can spend more time with patients and their families, teaching and supporting them.”
Many nurses at participating hospitals have had the opportunity to present their ideas to boards of directors and have received positive feedback. Some facilities have seen significant improvements in patient satisfaction rates, and some have won ‘most-improved hospital’ awards. Says Chamberlain: “We believe that’s attributable to Transforming Care at the Bedside.”
While the need to address disparities in care is well known, few strategies for reducing disparities have been studied systematically.
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