Getting the focus where it should be: helping hospitals improve patient care

By Pat Regan, Kaiser Maui RN

Kaiser Permanente has co-authored a study designed to cast light on how the hospital work environment can be improved to help medical-surgical Nurses spend more time delivering patient care. The KP Partnership was essential for making the study successful. The ground-breaking research involved 36 hospitals, KP and non-KP, in 15 states, including 767 nurses (RN & LPN/LVN).  It recorded more than 22,000 hours of Nurses’ on-the-job activities.

The study sought to examine Nurses’ workload and work dynamics by using a time-motion approach.  It tracked exactly what Nurses actually have to do with their time at work, recording how Nurses moved through the nursing unit during an entire shift, as well as the physiologic impact the work environment had on the Nurses. Care coordination/communications and medication administration were also primary focuses of the study.

The study found that the average Nurse during an average shift traveled 3 miles (1-5 miles, less on night shifts).  It also found that Nurses were able to spend less that 1/5 of all time during a shift on direct patient care activities (assessments, vital signs, etc.). 

As will come as no surprise to Nurses, most of the Nurses’ time (documented to be 35.3%) was spent on documentation; 20.6% (or 86 minutes per shift) was spent on care coordination; and the third largest category involved medication  administration resulted in time expenditures of  17.2%. Waste of course was studied and actually resulted in a mere 6.6% of Nurses’ time. (Waste was defined as such behaviors as “hunting and gathering” or loss time due to the studies limitations). In addition, and also no surprise to the working Nurse, the study found that Nurses spend most of our time (69.2%) in the Nurses’ station doing documentation, care coordination, and medication preparations, leaving us in patients’ rooms just 2.8% of the time. This indicates a huge area of improvement that is needed to refocus quality care back towards the patients themselves.

The picture of the professional Nurse’s work environment and work load emerges as one in which a Nurse is constantly having to move from patient to the nursing station to supply carts and back again to the patient’s room. RN’s can only spend seconds with each patient as they fly back to the Nurses station to complete the mountains of documentation, care coordination, medication preparation and administration, which brings us finally back to the patient for a brief moment or two.

Implications

The implications for us, RNs, are clear: we need to get back to the patients’ bedsides.  For us to be able to do that, the hospital must decentralize the organization of Nurses’ work so that many of these “tasks” can be done in the patient’s room. That way, we can spend more time utilizing our skills and evidence-based knowledge in figuring out what exactly is going on with our patients and prevent complications, improving their overall hospital experience, and sending them home with better care and more health related knowledge than they came in with.

The Kaiser Partnership will be starting a project called “Destination Bedside,” initially in the Southern California region, which was created by staff RNs and implemented by staff RNs (Unit Based Teams) to improve the working conditions for all Nurses at Kaiser Permanente.

HNA and the Kaiser Partnership

It is the role of the Kaiser Partnership, in which the participating unions including HNA are equal partners, to help see that these goals can be accomplished.

The Kaiser Partnership is a huge example of how the Hawai’i Nurses Association pursues every possible avenue to advocate on behalf of its members.  We are proud to be part of this nationwide effort by unions to improve conditions throughout the Kaiser system for both patients and the Nurses who care for them.