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Barnes-Jewish Hospital Puts Nurses Back at the Bedside

Aggressive Plan Lowers Patient to Nurse Ratios

November 30, 2004, ST. LOUIS, MO — Coreen Vlodarchyk knows nurses want to spend more time with their patients – a desire that has become increasingly challenging for hospitals. Vlodarchyk, RN, VP patient care services at Barnes-Jewish Hospital, is rolling out a plan that will reduce the number of patients cared for by each nurse, allowing more time spent on direct patient care and education. This model of patient care took almost a year in the making, with the entire nursing leadership of the hospital intimately involved in bringing it to fruition.

"We found that during a nurse's typical 24-hour day, he or she was spending around 44 percent of their time on documentation and medication activities," explains Vlodarchyk. "We need to help nurses feel there is enough time to manage a patient's care, consult with physicians and other staff, help in educating their patients and family members, as well as continue with the important work of documentation and medication administration."

Nationally, the patient care staffing mix has run approximately 50 percent RN to 50 percent patient care technicians. The new staffing plan at Barnes-Jewish calls for a 70 percent RN to 30 percent patient care technician model.

For a hospital as big as Barnes-Jewish, with a licensed bed capacity of 1,371 that makes it the biggest in the state, adjusting the nursing ratio is no easy matter. It means hiring more nurses in the midst of a nursing shortage that is affecting the entire country. An aggressive bonus plan is in place until Dec. 31, that awards $6000 to any current employee who refers a nurse, plus $6000 for each newly hired RN. The bonus has been very successful with over 30 employees referring new hires since the plan started in September.

To accomplish a staffing change of this magnitude, the program is being rolled out first in the medicine units, which make up roughly half of all admissions. The goal is to have a 1:5 average nursing ratio with a free charge nurse to facilitate patient throughput per unit. The "free" charge nurse, known as the "care traffic controller" will not have patients under his or her care during their shift, allowing them to coordinate care.

"The nurse-to-patient ratio and new charge nurse role is a change of mindset for nurses, but it allows them to interact more with their patients," says Diane Jackson, RN, clinical nurse manager of medicine units 10100/10200 where the new staffing model has been implemented since September. "They are excited because they are spending more time at the bedside to assess and plan for their patients and are able to really teach their patients, which is so important to a staff nurse."

Over the past decade, nursing care has become more task-oriented as technology has taken on a greater role in healing. While acknowledging the importance of technology, Vlodarchyk knows nurses at Barnes-Jewish understand the vital role of personal interaction with patients.

"No one is better at the bedside than the professional nurse using her or his critical thinking skills. This new primary care model makes the nurse accountable for the direct care, not relying on multiple caregivers," adds Vlodarchyk. "In addition, we will continue to have exceptional patient care techs at the bedside and enhance their roles as part of the team."

"We believe this will one day be able to roll out across the hospital," says Missy Bax, RN, consultant, operations engineering. "The biggest challenge is recruitment, but we hope that when others see the success of this, they will want to work here."

Recruitment will be essential to the success of the new staff plan, and retention of those new nurses will be vital. "This staffing plan will not just benefit the patient, " says Shawn Ray, RN, chief retention officer, "it will make nurses want to work here." Spending more time with each patient is what nurses want, Ray adds, and a lighter patient load will allow them to give one-on-one personal care.

Barnes-Jewish Hospital nurses were awarded Magnet accreditation, the highest honor given by the American Nurses Credentialing Center, becoming the first adult hospital in Missouri to receive Magnet status. Among the many considerations in receiving the award are quality of care and patient safety, which were key factors in developing the new staffing ratios.

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