1. Sallie Alvarez NGR6874 April 18, 2014 STAT NURSE PROGRAM (Dufour, n.d.)

2.  Patient need an accompanying nurse when leaving unit for procedures, diagnostic testing because they are at increased risk for morbidity and mortality (Warren, et al., 2004).  Nurses leave behind other patients when they leave the unit and risk adverse effects for those patients if another nurse is not vigilant  Nurses feel stretched and concerned for the wellbeing of patients both on and off the units. SIGNIFICANCE OF PROBLEM Adverse effects, during transport, range from 6%-70% with hypoxia and hypotension the most common (42%, 42% respectively) (Kue, et al., 2011). (Huffington Post, n.d.)

3.  Nurses expressed frustration and concern regarding the need to be in two places at once. Because of the high risk to patients, nurses need to accompany all patients to procedures, while leaving their other patients behind without proper supervision, increasing risk of adverse effects to those patients.  After several near misses with the patients left behind while they were transporting other patients, the nurses brought the issue up with the Professional Nurses Practice Council (PNPC).  Concern was shared hospital wide and a plan of action was proposed to assist the nurses with transporting patients safely and adequately caring for those in the unit. BASELINE DATA

4.  University of Missouri Hospital and Clinics piloted a Stat Nurse program(Stearley, 1994):  Stat nurse to accompany patients off unit and allow patient’s nurse to stay behind and care for other patients  Stat nurses assisted with codes, and taking over nurses’ patient load for meal breaks, meetings and time needed off unit.  Stat nurse program very successful in ICU and subsequently implemented hospital wide. POTENTIAL STRATEGIES

5.  Change difficult in any organization but especially one that has a large workforce with over 26 years of service with the organization  Culture wants to resist change and keep the status quo whether current policy makes sense or not.  Plan is to implement Kotter’s change model (Kotter International, 2012) to transition to new policy of transporting patients. CULTURE AND CHANGE MANAGEMENT STRATEGIES

6. Stat Nurse Plan  Three full time RNs employed  Positions will be Monday-Friday 7a-7p  Responsibilities will include:  Accompany patients to procedures/diagnostic testing and on return trip if needed  Assist unit unit nurses with code response, admissions, discharges, telephone orders or other nursing duties, with priority given to the transport of patients SUMMARY OF PLAN DESIGN (Colourbox, n.d.)

7. Based on Kotter’s Change Model  Step one: Create urgency  Highlight of risk to patient safety and possible delay in diagnostic testing if nurse is unavailable to accompany patient  Step two: Create a coalition  Create a team of nurses to determine the needs of the facility and how the stat nurses will work to fill those needs.  Step three: Develop vision and strategy  Job goals will be determined and priorities set. All feedback will be considered. Determine how and when the new stat team will be integrated into the facility. SUMMARY OF PLAN DESIGN

8.  Step four: Communicate the change vision  Continue to reinforce the plan with the staff and highlight benefits of the new task force as an improvement of quality to both patients and nurses.  Step five: Get rid of obstacles  Acknowledge and address all concerns brought forward.  Step six: Generate short term wins  Pilot the program on a unit and demonstrate and highlight successes of the program, continue to troubleshoot any obstacles POTENTIAL OUTCOMES EVALUATION

9.  Step seven: Produce more change  Fine-tune plan and listen to feedback from the nurses on how improvements can be made. Show that feedback is important and necessary for ultimate success.  Step eight: Anchor the changes  Publicize the successes of the pilot, encourage continuation of the new task force with emphasis on the benefits provided to the patients, work environment for nurses and potential gains for the hospital. POTENTIAL OUTCOMES EVALUATION

10.  Cost of the Stat RN program will include:  Cost of 3 RN/workday- $1000/day  Technology purchase- $1500.00  Informatics labor to upgrade software- $0.00  Potential gains  Safer patient care for both patient transported and patients left on unit  Quicker turnaround for diagnostic testing, resulting in higher quality care  Increased patient satisfaction, leading to potential higher HCAHP scores  Improved work environment for nurses, leading to higher nurse retention and lower nurse turnover. COST AND POTENTIAL SAVINGS

11.  Baseline data should be collected, i.e. HCAHP scores, time frames to transport patients for procedures, delays to admit or discharge patients  New data collected after pilot of 3 months to determine whether improvements were noted and if changes need to be made before implementing hospital wide.  Gather feedback from the staff on whether they feel alleviated by having the stat nurse available. POTENTIAL OUTCOMES EVALUATIONS

12. Dufour, F. (n.d.). File photo of a nurse pushing a stretcher. [Photograph]. Retrieved from http://www.citynews.ca/2012/09/23/northern-nursing-station-used-medical- flights-to-shop-report/http://www.citynews.ca/2012/09/23/northern-nursing-station-used-medical- flights-to-shop-report/ Colourbox. (n.d.). Stock photo of stretcher, hospital, hospital staff. Retrieved from http://www.colourbox.com/preview/1145298-701846-.jpg Huffington Post, (n.d.) Hospital stretcher. Retrieved from http://l.huffpost.com/gen/147814/thumbs/o-HOSPITAL-STRETCHER- http://l.huffpost.com/gen/147814/thumbs/o-HOSPITAL-STRETCHER- facebook.jpg Kotter International. (2012). The 8-step process for leading change. Retrieved from http://www.kotterinternational.com/ourprinciples/changesteps/changesteps Kue, R., Brown, P., Ness, C., Scheulen, J., (2011) Adverse clinical effects during intrahopsital transport by a specialized team: a preliminaryt report. American Journal of Critical Care, 20(2), 153-162. doi: 10.4037/ajcc2011478 REFERENCES

13. Stearley, H.E. (1994). Stat nursing- alive and well. Nursing Economics$, 12(2), 96-105. Warren, J., Fromm, R., Orr, R., Rotello, L., & Horst, H. (2004). Guidelines for the inter and intrahospital transport of critically ill patients. Critical Care Medicine, 32(1), 256-262.