Focusing on the patient experience from a nursing perspectiveEva Karp: Tell us about Truman Medical Center and the patient population you serve.
Amy Peters: Our mission has been to provide accessible, quality care for all patients who come to Truman regardless of their ability to pay. Our status as a safety net hospital resonates with the nursing staff and many choose to spend their nursing careers taking care of this vulnerable population. There's something about being able to serve a challenged population that speaks to our nursing staff.
You’ve been the CNO at Truman for the last three years. What areas have you focused on over this period?
Two of our primary areas of focus with the nursing leadership team have been around patient quality and safety and the patient experience. We have multiple teams working on a variety of quality and safety initiates throughout the organization. All are targeted at preventing harm for our patients in the hospital. Almost a year ago, we launched purposeful hourly rounding and bedside change-of-shift reporting with our nursing staff. More recently, we have implemented nursing leader rounding. Thanks to these initiatives, we've seen a steady increase in our patient satisfaction scores – all due to the hard work that's been done by our frontline nursing staff and by our nursing leaders in each department.
Improving nursing retention and building nursing leadershipLet’s talk through the areas of concentration for the TMC nursing staff. What are some of the challenges you have addressed and processes you have introduced over the last three years?
The focus has really been on creating a positive work environment for our nursing staff. In my years here, I've found that nurses really choose Truman because of our mission, our patient population and what we do for our community. Those things also come with challenges, so my first year as CNO, we focused on stabilizing our nursing leadership team and bringing in nursing leaders who were not only a good fit for the areas in which they were going to work but also a good fit for the organization.
I knew I needed strong nursing leaders to help create positive work environments and focus on recruitment and retention of staff. Once our nursing leadership team was in place, we started putting programs and plans in place that would help with that goal. One initiative that our nursing staff were highly appreciative of was the retention bonus. In the nursing market today, nurses are frequently offered sign-on bonuses as incentive to leave one organization and join another. But we thought it was important to recognize our nurses who have invested their careers learning, growing and providing outstanding care to our patient population.
Recently, we have revised our clinical ladder so it now offers different paths that might appeal to our newest nurses at the completion of their nurse residency program to our most senior nurses. With the different paths for our ladder, we hope to challenge a wider range of nursing staff no matter their career goals.
How health IT has improved nursing care deliveryThose are some big changes that you’ve helped happen at TMC. How has technology transformed care delivery?
The technology has been huge. We've had a couple of big technology go-lives in the last three years. We went live with new TC51 smartphones as well as new mobile computers for all the nursing staff. These two new pieces of technology has really empowered the nurses to be at the bedside more. With the addition of the TC51 smartphones and barcode scanning technology, we can now scan medications, labs specimens, blood and breast milk all at the patient bedside, which helps to reduce errors and improve patient safety. We will soon have more functionality added to the smartphones with the addition of vital sign documentation. Our nursing staff have adapted to the new technology very well. There was some hesitation at first, but now they definitely have the hang of things and comment on improved efficiencies and the ability to answer patient questions in the moment without needing to leave the room and pull the information up on the computer.
Change management and nursing leadershipWith any new change or investment, there can be challenges. In your experience, how important is a hospital or health system’s leadership in driving these changes?
It’s essential for hospital leadership to be engaged in changes that take place within the organization. Even more important, hospital leadership should be visible during the period of change to talk with staff, hear what’s going on, and provide support, encouragement and accountability when needed. Our nursing leadership team has recently made some firm commitments to improving our patient experience scores, which is significant change for our organization.
One of our biggest challenges was staff accountability. We received serious pushback when we started talking about purposeful hourly rounding and change of shift report at the bedside. Our first step was to ensure the nursing leadership team was on board and our message was consistent as they were critical to the success of this initiative. We provided education for the nursing staff around expectations for hourly rounding and bedside shift report and set our start date. The results were not awesome at the outset, but with consistent follow-up from our directors and senior nursing leadership, the staff started to understand the expectation and we started to see improvement in completion of hourly rounding as well as bedside shift report. Even better, our patients started commenting on the changes they noticed with hourly rounding and bedside shift report!
Not only was it vital for department directors to be visible on their units, it was crucial for senior nursing leadership to round and talk with patients. Our staff then provides immediate follow-up as needed. With almost a year of hourly rounding in the books, we have many successes to celebrate and have taken time throughout the year to do just that.
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