Nursing execs key to PFCC

I'm writing in regards to the April article "Working Together to Improve the Patient Experience" by Richard Billingsley, MHA, MSN, RN. As a quality nurse with more than 8 years bedside experience, forming partnerships with patients and families is an essential component of providing high-quality patient- and family-centered care (PFCC). Billingsley identifies 10 steps that healthcare organizations can take to enhance the patient experience and provide a supportive structure for PFCC.

Achieving PFCC is a daunting task for many healthcare organizations and systems, which have the interworking relationships of physicians, nurses, and families-all seeking to provide high-quality patient care. With each discipline comes various concerns and barriers. Establishing core concepts, such as dignity, respect, information sharing, participation, and collaboration, can benefit healthcare organizations that are attempting to implement PFCC models.

It has been acknowledged that many hospitals and providers have difficulty empowering patients and entering into a mutual partnership to enhance the patient experience. Billingsley advocates for the adoption of strong executive leadership, either in the form of the CEO or CNO. I believe executive nursing leaders are influential in enhancing PFCC and improving the overall patient experience. Without a strong nurse executive who has an understanding of holistic healing, family-centered care is rarely achieved within organizations.

Who better than a nurse to understand the importance of providing PFCC? As nurses, it's at the core of our values to advocate for our patients and families, and ensure collaborative care from all disciplines.

Discharge planning at the bedside

In response to the May article "Reinforcing Discharge Education and Planning," by Bobbie Reddick, EdD, MPH, RN, and Cecil Holland, EdD, PhD, RN, I wish to elaborate more on this topic and take the discharge planning rounds to the patient's bedside. I've been a charge nurse now for around 3 years and we conduct Care Coordination Rounds every day to help with our discharge planning, but we don't include the patient. The case manager or social worker talks with the patient afterward to give him or her choices but I think that if we just included the patient from the beginning, it would be better. Although we all know that it's preferred for patients to get out of the hospital quicker, we have to keep the patient in mind when we're discussing discharge planning. Not only can you improve your patient education, but you can also significantly decrease your length of stay. Because we're talking about discharging the patient, we should include the patient in our discharging planning.

The discharge planning process starts upon admission to the hospital and includes a multidisciplinary team consisting of the bedside nurse, charge nurse, case manager, physician, and the patient/family members. When you get engaged with the family and patient, they're going to be more likely to get involved. It's easy for us as healthcare workers to sit back and dictate what the patient should do, but many times we forget that the patient may not want to do what we think is best. Discharge planning rounds at the bedside can improve patient satisfaction scores and the nurses' efficiency.

Whenever you don't include the patient in discharge planning, then the case manager has to go into the room and talk with the patient. When the patient has questions, the case manager asks the nurse a multitude of questions, and then we have to page the physician to ask him questions. I propose that discharge planning rounds should be performed inside the patient's room with the primary nurse, charge nurse, case manager, social worker, and PT/OT representative. When discharge planning rounds are performed in the room with the patient, you're able to hear the patient's concerns.

By including the patient, you can explain when you anticipate the date of discharge is going to be and plan with the patient any needs he or she may have at home. As healthcare professionals, we need to make sure that we put the patient first and that starts with including patients in their care plan and discharge planning.

Jennifer Jones, RN-BSN

Stephen Davis, BSN, RN