As nursing leaders, your role entails dealing with the constraints of a growing nursing shortage, an aging workforce, and expanding patient demand. Your nursing staff is looking for your leadership to create an environment which supports their work of caring for the patient and allows them to do it even better. If there’s one benefit coming out of the ever-increasing demand on nurses, it’s the creative ways nursing executives are finding to leverage technology to address many of these challenges.

10 Tips for Nurse Efficiency, Recruitment and Retention

1 REDUCING DISTRACTIONS FROM NUISANCE ALERTS AND PAGING SYSTEMS"Current alarms and paging systems create noise levels that distract nurses and cause Press-Ganey scores to suffer due to patient complaints. Integration of alarm assignments, with notification and escalation through Emergin, serves to reduce these issues.” – Sandy Tobar, RN, MSBA, Director of Critical Care Nursing: Telemetry, ICU, Acuity Adaptable, St. John Providence Medical Center

2 MAINTAINING LINE OF SIGHT AND SOUND WITH CRITICAL PATIENT ALARMS“Patient surveys, conducted prior to opening of the new hospital, showed that patients want more private rooms, less noise, and increased responsiveness. Our use of the Emergin system for alarm notification and escalation allows us to address patient preferences without triggering additional burden for our nursing staff” – Sandy Tobar

3 REMAINING VIGILANT AND RESPONDING PROMPTLY TO PATIENT NEEDS"Alarm fatigue and the implications resulting from staff desensitization are a growing concern. We use Philips Central Telemetry to filter erroneous alarms and technical alarms (like low battery) to minimize alarm fatigue with the nursing staff. By integrating the remaining alarms from patient monitoring and nurse call systems into a central Emergin platform, we are able to assign and escalate alarms to improve alarm vigilance and response time to patient needs — One recent study showed a response time reduction from 9.5 minutes to 39 seconds1” – Sandy Tobar

4 FACILITATING MORE EFFICIENT DOCUMENTATION AND COMPLIANCE“It is well recognized that electronic documentation can improve efficiency. Some studies have shown that electronic documentation can reduce input time by up to 24%2. The eICU staff is able to further assist the efficiency of bedside staff with completion of flow sheet data and compliance documentation through virtual rounds on the patient. – Susan Goran, RN, MSN, Operations Director for Maine Health Vital Network

5 MINIMIZING UNSCHEDULED OVERTIME FOR END-OF-DAY DOCUMENTATION“When crisis hits, it often leads to unscheduled overtime at the end of a shift to update documentation. Our eICU Program allows remote staff to step in and assist with documentation during emergencies or complex admissions. This reduces the burden on nursing for documentation at the end of the shift and improves documentation accuracy.” – Susan Goran

6 ELIMINATING INTERPRETATION DELAYS AND RISK DUE TO ILLEGIBLE NOTES OR ORDERS"How often do you have three or four nurses huddled trying to interpret a physician’s order or transition notes during shift transfers? Through the electronic eICU documentation, which integrates with critical care nursing workflow, we diminish these and other problems relating to illegibility. Documentation is not only legible, but immediately accessible to multiple users at the same time.” – Susan Goran

WEBCAST SERIES: Using Technology to Move Forward in Challenging Times

7 OVERCOMING FEAR OF REPRISAL AND HESITANCY TO GET HELP, WHILE ELIMINATING CALL-BACK DELAYS"Nurses often hesitate to call physicians during off-hours. Our eICU Program provides remote patient monitoring 24x7 - with intensivist physician coverage 7 days a week, from noon to 7AM. This reassures our nurses that they can call on an expert team of critical care specialists even during nights and weekends. With the push of a button in the middle of the night, nurses get an immediate response from an eICU physician who is awake, alert, and in complete view of the patient’s history and most recent data.” – Susan Goran

8 ENABLING 24X7 NURSE MENTORING AND SUPPORT“Having remote support for the ICU provides an opportunity to leverage your most experienced nurses to provide mentors and support for new nurses, especially during off-shifts. Sometimes it is just a matter of having someone listen while you work through a problem. We have discovered that up to 40% of our eICU interventions are related to mentoring moments, whereby newer staff members learn from the experience of more seasoned team members.” – Susan Goran

9 CREATING ALTERNATIVE CAREER PATHS FOR DISABLED OR RETIRING NURSES“Think about how many nurses enjoy their jobs, but leave because of either the physical or emotional strain. Remote monitoring through an eICU Center can provide an alternative career path that continues to challenge a nurse mentally but is less demanding physically. Through technology, nurses can overcome physical challenges and continue to leverage their years of experience through a career path that continues to be both mentally challenging and patient-focused.” – Susan Goran

10 APPLYING INNOVATIVE MODELS / APPROACHES TO ENHANCE RECRUITMENT"We have created an innovative nursing rotation program in our eICU Center to address the technology interests of new recruits while instilling leadership and critical thinking skills. Senior nursing students are able to partner with seasoned eICU nurses who have 15-25 years of critical care experience. They witness first-hand our retention rates and the transition from bedside care to telemedicine. For many, it establishes a career path and encourages the student to start down that path as a critical care nurse at Resurrection. It demonstrates our commitment to being on the cutting edge of medicine, yet still in touch with nurses’ basic concerns.” – Becky Rufo, DNSc, RN, CCRN, eICU Operations Director for Resurrection Health Care

OPERATIONAL IMPACTUltimately, advances in electronics and wireless technologies are providing nurse executives with varied ways of addressing current challenges. The evidence of the effectiveness of these applications is in the resulting impact on patient care operations.

“A pre-post comparison of APACHE data over a 6-month period after eICU Program implementation at Resurrection shows a 41% mortality reduction and 38% length of stay reduction (1699 ICU days). This is estimated to have saved approximately $3 million in incremental ICU cost and approximately $5-6 million in potential preventable claim settlements.” – Becky Rufo

“We compared turnover data for the 33 months prior to implementation of the eICU Program and compared this with the 33-month post-implementation period. In the 33 months prior, 104 RNs had left critical care as compared to only 50 RNs leaving during the same period post-implementation. Using recommended VHA calculations, we estimated the cost of replacing the 54 nurses at $2.5 - 3.0 million over a 33-month time frame.” – Sue Goran

10 Tips for Nurse Efficiency, Recruitment and Retention

Links for more information:Central telemetry – www.healthcare.philips.comAlarm notification – www.emergin.comElectronic documentation – www.healthcare.philips.comeICU Program – www.eICU.net

1 California HealthCare Foundation, December 2008: Equipped for Efficiency: Improving Nursing Care Through Technology, page 6

2 California HealthCare Foundation, December 2008: Equipped for Efficiency: Improving Nursing Care Through Technology, page 19

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