Historically, staffing assignments were created with a 24-hour snapshot from the previous shifts. However, the charge nurses would often look back more than 24-hours to identify a nurse who had most recently cared for the infant when the infant did not have an identified primary care nurse. This made it extremely time consuming for charge nurses in the NICU to identify a consistent care provider when reviewing mounds of assignment sheets from more than the last 24-hour period. This was complicated further by the fact that most RNs work three-12 hour shifts so there can be large gaps of time in their work schedule.
Due to these aforementioned challenges, the NICU Continuity of Care Committee was formed to tackle this staffing assignment dilemma.
Goal Statement:
The goal of the committee was to create a healthy environment for the staff and families by increasing parent satisfaction with the nurses’ sensitivity to parent’s stress. This goal would be achieved by decreasing the mean number of different RN’s caring for the same infant, regardless of gestational age or length of stay.
Selected Improvement Measures:
The NICU in this hospital uses Press-Ganey as their vendor to measure parent satisfaction. One of the parent (patient) outcomes for this goal was to increase satisfaction in the staff’s sensitivity to parent’s stress. The intervention would be measured by an electronically generated report that would demonstrate a reduction in the mean number of different RNs caring for the same infant, regardless of gestational age or length of stay.
Description of the Intervention/Initiative/Activities:
The need for technology to reduce the amount of work conducted by the charge nurses in identifying nurses who have frequently and recently cared for the infant was quickly identified by the Committee. The Clinical Analytics Department was consulted to generate staffing sheets based on electronic medical record data. A new computerized staffing report was created listing the infants the nurse had cared for most frequently over the last seven days, thus facilitating a consistent care provider by decreasing the number of various nurses caring for each infant. Nurse interaction was determined by identifying the RN entering vital signs at 8 am/pm each day.
Outcome:
The new computerized system to facilitate continuity in care of nursing assignments by charge nurses was implemented and data was collected every three months. Implementation of this computerized staffing aid yielded a 14.6% reduction in the mean number of different RNs caring for the same infant, regardless of length of stay. The reduction in the mean number of RNs contributed to an increase in parent satisfaction with staff’s sensitivity to parent’s stress increasing by 4.2%.
The collaboration between the NICU and the Analytics Department is commendable. A problem was identified and innovative solutions were designed and implemented by both departments to yield a product that benefits the patient, their parents, and brings increased job satisfaction and engagement of the staff. Increased continuity of care fosters a deeper and more meaningful relationship between the parents and the nurse. The literature is replete with the benefits of a primary nursing model not only for the parents of the patient but also the caregiver. To support this fact, numerous NICU staff have expressed their increased job satisfaction when they are able to provide continuity of care with the same group of infants. Additionally, it is anticipated that the consistency of staff caring for the same patient influences a safe and healthy work environment promoting a culture of High Reliability. Continuity of care in the NICU creates a healthy work environment.