Patient Satisfaction Planner: Simple solution: Clinical training for entire staff
Patient Satisfaction Planner: Simple solution: Clinical training for entire staff
Rural hospital puts all staff at the bedside
In 1995, the 20-bed East Adams Rural Hospital in Ritzville, WA, needed to cut about $200,000 from its budget. After consolidating its hospital and primary care clinic in one facility, administrator Jim Parrish, FACHE, started looking for other areas to trim expenses.
The hospital district, which serves a population of about 4,400 residents and 25,000 vehicles passing along Interstate 90 every day, has an average daily patient census of just 1.5 to two people per day. Yet it had two RNs and one nurse’s aide on duty for each 12-hour shift.
It seemed to Parrish a natural place to look for savings.
"We decided to cut back to one nurse per day, but that created a problem of how to get things done with only one person," he recalls. Thus was born the Acute Care Assistance program, which since 1995 has cut nursing costs by nearly $200,000.
Everyone is a trained CNA
"We decided to train everyone to assist on the floor," Parrish explains. The entire staff of the hospital went through training to become certified nursing assistants.
"There are 16 people who are not usual caregivers who are trained as acute-care assistants," he says. Everyone from the chief financial officer and Parrish to X-ray technicians and telephone operators receives training.
They do everything a nurse’s aide can do: take people to the restroom, give bed baths, distribute meals, feed patients, clean rooms, make beds, change adult diapers, and take vital signs, he points out.
The only exceptions made to the training were the lab technicians, who have enough work to keep them busy at all times, Parrish says, and three people who were exempted for health or personal reasons.
The trained staff — with the exception of Parrish — all received a 50 cents per hour bump in their pay for taking on the new role. Everyone is required to be on call as a nursing assistant for three shifts of less than eight hours per month.
Just how well the program can work was made clear last summer, when a two-bus accident brought 11 patients to the hospital, Parrish says.
"We had a certified nursing assistant for each of those patients while the doctor on call assessed them," he says. "We can have 10 caregivers in the emergency department within minutes. Before, the most we would have had was three."
Initial fears calmed
Parrish says that there was little concern — even among the nurses — that the program would lead to diminished care.
"They weren’t worried about providing high-quality care, but about what would happen if we got slammed’ with four or five patients at once," he says.
"They were able to alleviate those concerns by pointing out that three days a week, there was an additional nurse in the facility working at the primary care clinic, as well as a backup nurse who was never more than 30 minutes away from the hospital and always available by phone," Parrish adds.
"Nursing here isn’t a matter of having someone at the bedside constantly," he says. "We don’t have open-heart surgery here. We are a med-surg facility. Do you really want to pay someone $30 an hour to sit around for part of the day?"
Parrish says about three-quarters of what nurses at East Adams Rural Hospital were doing before the program started wasn’t nursing care. "Do you need a license to deliver ice or get someone water?" he asks.
"Those mundane duties are better done by someone who is lesser-paid and lesser-trained." Indeed, he thinks he has improved the working conditions of his registered nursing staff by eliminating those kinds of tasks.
If the hospital hadn’t cut the nursing aide and second nurse back in 1995, he estimates the 2000 budget for nursing would have been a little more than $600,000, rather than the $295,000 he spent.
The program easily could be copied in other small rural hospitals, but does Parrish think a bigger hospital could mimic it? "You bet," he says.
"They could do this on med-surg units. If you look at most patients on those wards, about 70% of them are like our patients and can be taken care of well, safely, and with more attention than if they use only RNs. Expanding the non-nursing base of people who can take care of folks also frees up nurses to do more of what they are supposed to do," he says.
"They didn’t spend $70,000 on four years of schooling to change adult diapers," Parrish says.
Over the seven years the program has been in place, there has been no claim or lawsuit from any patient, no injury claims from employees, and no settlements made, he adds. "People who say you can’t do this and be safe only have to look at our seven years of experience. We have excellent state surveys and great patient satisfaction reports from our in- and outpatient population."
[For more information, contact:
• Jim Parrish, FACHE, Administrator, East Adams Rural Hospital, 903 S. Adams, Ritzville, WA 99169. Telephone: (509) 659-5402. E-mail: [email protected].]
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