Guest editor Susan Newman, MSN, RN, PCCN, is a clinical nurse at St. Elizabeth Healthcare in Edgewood, Ky.
"Heather, I'm so glad you're back today! Bill was trying to get out of bed when I got here, and he nearly fell going to the bathroom. He doesn't remember why he's here."
Scenes like this are common with older adult patients, who may become confused at night when hospitalized. Having an established relationship with the patient and his or her family allows the nurse to quickly provide reassurance, review possible causes, and act as indicated. The human connection is central to the nurse-patient relationship and a core value of the nursing profession. Each person involved contributes unique qualities to this relationship and, to some extent, is changed by the human interaction. The nurse's concern for the patient's well-being as an individual, rather than as a job-related means to an end, reflects this professional commitment. Nursing practice models, which promote nursing continuity of care, value this connection.
In the acute care setting, patients often see multiple caregivers from many different disciplines over the course of even 1 day. Both patients and nurses benefit from staffing patterns that promote continuity of care. A nurse who's familiar with the patient's unique health situation, preferences, and progress lessens anxiety and promotes trust. Because stress can produce unhealthy hormonal responses, this human connection can foster healing. For the nurse, continuity provides the opportunity to assess improvement and adjust interventions in response to the patient's changing status.
As economics have become the driving force of healthcare today, pressure mounts to manage costs associated with nursing in all possible ways. One strategy that's been put forth involves much greater reliance on dedicated contingency staffing, or float pools. At a national nursing conference, a presenter endorsed the value of an RN staffing pattern consisting of only 60% core nurses assigned to each unit as regular staff members.1 A large float pool consisting primarily of new graduate nurses, would provide 40% of the nursing care to patients under this staffing model.
Employing float pool RNs as an increasing proportion of the overall workforce increases the possibility that nurse-patient relationships will be based only on a brief encounter (12, 8, or even 4 hours). In such a setting, nurses expend more time familiarizing themselves with the patient's medical problems and the tasks to be completed during the assigned time interval. Nurses have little opportunity to recognize and build on progress or to detect subtle changes needing early intervention. Patient education also falters in float pool settings.
Because of the unpredictable and variable nature of the workload in hospitals, adjusting nursing resources per patient load is a necessity for many reasons, including safety, nurse satisfaction, and economic factors. But historically, measuring nursing cost and the impact of nursing care on patient outcomes has been a struggle, and this remains true today.
Nursing researchers are developing sophisticated techniques to collect and analyze data contained in electronic medical records to develop tangible measures of the impact of nursing continuity.2 Evidence-based staffing will be key to linking individual patients and nurses.3 Patient satisfaction scores also affect the financial success of healthcare institutions, and nursing care that recognizes the individual patient is key to positive values. As professionals, we nurses must clearly articulate the value of our profession and support efforts to validate the impact of nursing care.
1. Schwedhelm K, Schweikert R. (October 9, 2015). Healthy Work Life Balance: Staffing a Medical Surgical Unit. Lecture presented in American Nurses' Credentialing Center Magnet Conference 2015, Atlanta.
2. Stifter J, Yao Y, Lodhi MK, et al. Nurse continuity and hopsital-acquired pressure ulcers: a comparative analysis using an electronic health record "Big Data" set. Nurs Res. 2015;64(5):361-371.
3. Birmingham SE. Evidence-based staffing: the next step. Nurse Leader 2010;8(3):24-26, 35.