Purpose

To develop a program that assesses the status of patient care units and facilitates the allocation and utilization of appropriate resources so as to optimize the patient flow throughout the hospital and maintain quality care.

Significance/Background

A delay in admission to a room has a great impact on patient satisfaction. Closing the hospital to admissions impacts the ability to care for people in the community. And overwhelming the staff with high patient acuity and not enough resources affects nurse-sensitive indicators, staff satisfaction, and patient outcomes. With the potential for these negative situations to become a reality, an initiative was established to address these concerns.

Innovation

The goal of the program is early detection of obstacles to patient flow and effective management of patient flow and resources while maintaining quality care and preventing the closure units and excessive demands on the staff. The program, nicknamed "Red Light/Green Light," is based on the traffic light concept, a universal symbol. When each patient care unit completes an assessment, the unit is placed in a color zone that corresponds to one of the colors of a traffic light with the addition of orange. The unit assessment consists of 4 categories: anticipated turnover, patient acuity, percent RN staffing, and percent RN experience level. A score is determined for each category and then combined to determine the unit's color zone. The zone is communicated to the bed manager/house manager who allocates resources and places patients on the appropriate units. Action steps are established for each color zone that include actions for the bed manager/house manager, unit manager, and unit staff. Ongoing communication is enhanced through the use of the zone calculation sheet. This program is divided into 3 phases of implementation: Phase I-Inpatient Units, Phase II-Emergency Care Center, Ambulatory Care Center, Birthing Center, Mental Health Unit, and Phase III-Clinical and Support Departments.

Evaluation

The success of the program is measured by improvements in patient, staff, and physician satisfaction, decrease in admission wait times, decrease in ER turnaround time, decrease in frequency in the yellow, orange, and red zone, and a decrease in nurse-sensitive indicators. Evaluation occurs after each phase at 6 months and 1 year after full implementation.

Implication for Practice

This CNS-lead initiative receives full support from the vice president of patient care services and the nursing directors. All levels of nursing leadership and staff were involved throughout the entire development process. The CNS drove the process by working with each unit to develop their own Acuity Rating Scale. A core group made up of the CNS, nurse managers, bed managers, and staff worked on the creation of the Acuity Worksheet, Unit Zone Calculation Sheet, and the Zone Criteria Sheet as well as the process. The core group with the addition of the nursing directors determined the action steps for each zone. Trials, periodic data collections, and focus groups facilitated the implementation process. This initiative demonstrates a role that CNSs have in impacting patient care processes, nurse-sensitive indicators, organizational goals, and patient, staff, and physician satisfaction.

Section Description

This year's annual NACNS conference is planned for Orlando, Fla, March 9-12, 2005. Over 300 clinical nurse specialists (CNSs) are expected to attend, and as with past conferences, attendees will also include graduate faculty from CNS programs, nurse administrators, and nurse researchers. The theme of the conference, CNS Leadership: Navigating the Healthcare Environment Toward Excellence, was selected to showcase the many ways CNSs acquire and disseminate knowledge and innovative practices in their specialty areas. Two preconference sessions are scheduled. One session, sponsored by NACNS Legislative/Regulatory Committee, targets information for CNSs interested in understanding the legislative/regulatory process as it deals with the practice of nursing, and will also help build skills CNSs need to engage in the process. The second session, sponsored by NACNS Education Committee, focuses on CNS education issues, and as with the education preconferences of past years, anticipates informative dialogue and much sharing among CNS educators around curriculum design, teaching strategies, and indicators of quality in the curriculum that link to the NACNS education standards to program review and excellence. The conference planning committee is proud and pleased to have Jeanette Ives Erickson, MS, RN, CNA, Senior Vice President for Patient Care Services and Chief Nurse Executive of Massachusetts General Hospital as the opening keynote speaker. She will begin the conference by highlighting the importance of CNS practice on patient safety. The planning committee is equally proud and pleased to have NACNS past-president Rhonda Scott, PhD, RN, Chief Nursing Officer of Grady Health System as the closing speaker. Dr Scott will challenge attendees to use the information from the conference to shape quality care delivered in a safe environment and to advance the profession of nursing through direct care to clients, influencing standards of care delivered by other nurses, and influencing the healthcare delivery system to be to support innovative, cost-effective, quality nursing care. A total of 64 abstracts for podium and poster presentations were selected in addition to graduate student posters. The abstracts address the 3 spheres of CNS practice with a strong emphasis on clinical practice improvements. As you will note from the abstracts published in this issue of the journal, specialty practice areas represented in the abstracts include children, adults, and gerontological patient groups; hospital, outpatient, and home care settings, and community health. In addition, a wide variety of specialty topics including smoking cessation programs, end-of-life care issues, and protocols outlining nursing approaches to improved diabetes, cardiovascular and ventilator management. A number of the abstracts described hospital and healthcare system level innovations that resulted from CNS practice. Collectively, these abstracts reflect the breadth, depth, and richness of CNS contributions to the well-being of individuals, families, groups, and communities. The following abstracts are from those presenters who elected to have their work published in the journal so those who are unable to attend this year's conference can share in the knowledge of the conference. As you read each abstract, consider the talent and clinical scholarship of your CNS colleagues who are advancing the practice of nursing and contributing to improved outcomes for patients and healthcare organizations. You may want to contact individual presenters to network, collaborate, consult, or share your own ideas about these topics. Watch for next year's call for abstracts and consider submitting an abstract for presentation at NACNS's next conference in Salt Lake City, Utah, March 15-18, 2006.