Award Date

5-1-2024

Degree Type

Dissertation

Degree Name

Doctor of Nursing (ND)

Department

Nursing

First Committee Member

Dieu-My Tran

Second Committee Member

Kathleen Thimsen

Third Committee Member

Soumya Upadhyay

Number of Pages

71

Abstract

Background: Patient turnover refers to when patients are admitted, discharged, or transferred to or from a clinical unit or another facility. Rapid patient turnover compels nurses to provide care in an environment where clinical demands exceed nursing care capacity. The excess of clinical demands can lead to rationing of nursing care and culminate in nursing stress and dissatisfaction. These negative effects on the nursing workforce subsequently have undesirable implications for patient and hospital outcomes. Implementation of a dedicated admission and discharge nurse (ADN) position can optimize patient flow, improve nursing satisfaction, and ultimately promote positive patient outcomes. Purpose: The purpose of this DNP project is to perform a needs assessment to determine if creation of a dedicated admission and discharge nurse position is needed for medical-surgical units at a 300-bed teaching hospital in Southern Nevada. Methods: The needs assessment consisted of a survey of nursing perception of admission and discharge practices as well as a retrospective assessment of patient flow data to evaluate unit performance. The admission and discharge survey was administered in July and August 2023. Retrospective data from May 2022-2023 was reviewed to identify opportunities for improvement in nine patient flow measures: ED boarding hours, ED rate of patients who left without being seen, unit rate of early discharges, unit discharge turnaround time (DTAT), unit length of stay (LOS), and unit discharge HCAHPS scores. Results: Only 17% (n = 4) of nurse respondents reported satisfaction with the admission and discharge process. Approximately 91% (n = 20) of nurse respondents believe that patient turnover significantly contributes to workflow disruptions. About 86% (n = 19) of the nurse respondents felt that frequent admissions and discharges limit their ability to perform other priority nursing interventions and care for existing patients. Almost all nurse respondents (95%, n = 21) are in support of the creation of a dedicated admission and discharge nurse position. For May 2022 – May 2023, two medical-surgical units did not reach facility goals for unit LOS (< 5.1 days), discharge turnaround times (< 120 minutes), rate of early discharges before 1100 (25% of home routine), rate of early discharges before 1400 (50% of home routine) and have poor discharge HCAHPS scores. The ED did not reach facility goals for ED boarding time (< 195 minutes) and ambulance diversion time (0 hours). Conclusions: The results of the nurse survey and patient flow data review support the need to implement a dedicated ADN position. Review of current patient flow performance has identified areas in which the ADN position can target. Specifically, there is potential for the ADN position to improve unit discharge turnaround time and rate of early discharge which may consequently reduce ED boarding times and unit LOS. The literature review indicates that the ADN position can enhance nursing productivity, bolster teamwork, and offset heavy nursing workload associated with patient turnover. Nurse leaders should consider implementing the ADN position which will enhance patient flow and improve the nursing team’s capacity to overcome increased work demands associated with rapid patient turnover.

Controlled Subject

Nursing; Nurse and patient; Hospitals--Admission and discharge--Planning

Disciplines

Nursing

File Format

pdf

File Size

1089 KB

Degree Grantor

University of Nevada, Las Vegas

Language

English

Rights

IN COPYRIGHT. For more information about this rights statement, please visit http://rightsstatements.org/vocab/InC/1.0/

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Nursing Commons

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