EVEN AN EXPERIENCED FLOAT nurse can encounter overwhelming challenges in an unfamiliar unit, as can any nurse working in a unit new to him. To help these nurses keep their heads above water, we launched a project called “Bringing Excellence to Variability” (BEV) in our 522-bed Magnet facility. (The acronym also honors the project's originator, Bev Martin.)
In this article, we'll describe how we developed a program to orient novice nurses and to keep our expert float nurses up-to-date on 21 patient-care units.
For float nurses (or any nurse who's not familiar with a particular unit), getting answers to simple but important questions can be time-consuming and frustrating. To tackle this problem, we sought feedback from our float staff to identify the areas they were most concerned about. We then consolidated this information into a questionnaire that covered four major topic categories. Here are sample questions from each category.
- Admission, transfer, and discharge. Do your doctors have a dependable routine for visiting patients? What patient-education pamphlets do nurses routinely give to the patient on admission? What unit-specific information do you want float pool nurses to know?
- Communication. How do you know who your pharmacist for the day will be and how to page him? If the doctor needs to be called, does the primary or charge nurse routinely call? Does the charge nurse review all labs?
- Routines. Where can nurses find the most recent telemetry strip? Are nurses expected to remove sutures? What's the system for break coverage? Where in the station can nurses keep drinks?
- Storage. Where do you store personal protective equipment (PPE)? Telemetry electrodes? I.V. supplies?
Using this questionnaire, we conducted informal interviews with nurses, nursing assistants, and unit secretaries in each unit. We learned from staff the unit's routines for postop dressing changes, location of recent lab results, and physician-specific discharge instructions. Nursing assistants helped new nurses find supplies such as extra pillows, slide boards, and biohazard bags. Unit secretaries explained how to access the resident on-call list online.
Once the unit surveys were complete, we began identifying patterns and variations. We sorted the information into two categories, unit-specific and hospital-wide. Examples of unit-specific information included meal times, patient-education materials, and national quality measures that apply to mainly that unit. Hospital-wide information included practices that are consistent in similar units. For example, medication administration records (MARs) are kept in patient medical records in the intensive care units; in the medical/surgical units, MARs are kept in binders on the medication cart.
This method of organizing our information let us condense a vast amount of data into a usable form. To verify the accuracy of our data, we asked each unit-based educator to review her unit's information and make revisions as needed.
Our next step was to create workable tools. We developed a 19-page “Float Nurse Orientation” packet, which includes mostly hospital-wide information, such as stocking flu vaccines, communicating with pharmacy, and validating physician orders. We arranged topics in alphabetical order for quick reference.
Using a similar standardized format, we also developed a unit-specific information sheet for each nursing unit. Items listed on this sheet include location of PPE and patient-care supplies, and meal times.
We put both tools on our float pool Web site on the hospital's intranet. Each item has its own link. A nurse can download all or any part of the information.
We've received encouraging feedback about the effectiveness of our project. When we surveyed the 27 nurses in the float pool to evaluate the usefulness of our tools, 56% of them responded that they'd used the tools at least once. Of those responding who'd used the tools, 93% said the tools were helpful and accurate.
These results indicate we've made progress toward meeting our goals and that we need to promote the use of our tools.
Although we've completed our initial project, we need to ensure continuous improvement. We plan to evaluate and validate clinical practice issues in each unit and update our Web site regularly. We believe that when bedside nurses continue to improve care, we'll achieve our goals of optimal patient outcomes, safe patient care, and excellent service to our nursing units.
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