Back-to-basics approach helps nurses

Capps believes the program, which provides blueprints of best practices designed to increase the amount of time nurses spend at the bedside, gets back to the basics of what nursing is all about.

"It will renew and strengthen nursing and promote its true purpose, which is to provide patient care," she said. "Technology and communication with other caregivers is important, but to give the best care, to prevent errors, to use their fine-tuned listening and observation skills, nurses need to be at the bedside."

"Research has shown that the more time nurses spend at the bedside, the better the outcomes for hospitalized patients," said Annelle Beall, RN, CNN, director of nephrology at Athens Regional.

It's also what patients want from nurses. Studies have shown that patients associate good care with nurses being available, attentive and watching over them.

Athens Regional piloted the program in its nephrology unit because of proven leadership and stability there.

"They were one of the first hospital units to put a shared governance council in place, and could take the initiative and run with it," Capps said.

"We're known for liking new ideas," Beall said. "We had already started hourly rounding and the use of white boards — two ideas from the Voluntary Hospital Association best-practice blueprints for this program — and we've added others."

When the program was started in January, nephrology nurses conducted a study to see how much time nurses were spending at the bedside or in planning patient care. With several new procedures now in place, they expect a follow-up study to show improvement in that area.

Nephrology nurses visit their patients hourly.

"They don't just put their head in the door; there's a script they follow," Beall said. "They ask [questions] and check on pain, positioning, potty and personal things [such as the call light being within reach].

"We call it the four 'Ps' and we created quick reference tools for nurses and education plans for the patients so they'll know that they will be surrounded with care."

Since the nurses have known that someone is checking regularly, the use of call lights has decreased.

Help from volunteers

Nephrology patients also benefit from specially trained volunteers who take care of personal needs or just sit with patients who are lonely or confused.

"Volunteers operate within strict parameters and know what they can and can't do," Beall said.

The practice is popular with volunteers, patients and nurses.

"People don't volunteer in hospitals to file,"

Capps said. "They want to be where the action is

and where they can make a difference with patients. This allows them to do that and it frees up nurses

to do RN duties."

Nurses and other care providers make ample use of white boards placed in patients rooms. They write down their names and the daily care plan. They also encourage patients and their families to write daily goals.

"It doesn't have to be a clinical goal," Beall said. "It might be that the patient wants to watch a basketball game at a certain time, and we can plan his care around that. The white board helps everyone know the game plan and to establish personal relationships."

So do bedside shift reports. Nurses now hand off patients to nurses working the next shift. This is done in a patient's room, if he or she is awake. Otherwise, the nurses stand outside the patient's door.

"Nurses were initially leery of talking about care in front of the patients, but most patients and families want to know what's going on," Capps said. "Now, they see that nurses do talk to each other and pass on patients' needs. It also gives families a chance to ask questions."

Pro-active nursing

Beall says there are many benefits to the program.

"Nurses feel like they have more control over

when they see patients and the patients like it, too," she said.

Instead of waiting for the call light, nurses are taking a pro-active approach.

"We've been so pleased with how our trained volunteer initiative is working, we're ready to share it with other units," Beall said.

Athens Regional plans to extend the program to other med-surg units this year. Other Georgia hospitals are on similar tracks.

"When you think that hospitals around the country are all doing the same best-practice initiative at the same time, I think the opportunities for improvement in patient care will be astronomical," Beall said.

She's hearing only positive comments in staff meetings.

"When nurses are involved in doing what they do well, there's more job satisfaction and better patient outcomes," Capps said.