EP11

 

Staffing and Resources EP11

 

Provide one example, with supporting evidence, when nurse(s) collaborated with a Nurse AVP/Nurse Director and/or Nurse Manager during budgeting to acquire new or redistribute existing resources.

 

 

Example: Paramedics in the Emergency Department

Resource Need

The Catholic Health Initiatives (CHI) St. Vincent Hot Springs (SVHS) Emergency Department (ED) is the busiest Level Two Trauma Center in Arkansas and is the referral center for the Southwest Region of Arkansas. The CHI SVHS ED had seen an increase in volumes of patients seeking emergent treatment. The ED had 23,025 visits from August 2022-December 2022, an average of 3,839 visits per month and 125 per day. In addition, CHI SVHS is out of real estate, which led to an increase in inpatient/boarding hours in the ED during this time. This totaled 24,851 hours from August-December 2022, an average of 4,141 per month and 135 per day.

 

Kayla Bullard, BSN, RN, ED Nurse Manager, was concerned about the volume of patients seeking treatment in the ED and the increase in patients who left without being seen (LWBS) by a provider. As volumes and holding hours increased in the ED, Bullard and Joshua Keithley, MD, ED Medical Director, got creative to provide care to patients who never make it out of the waiting room. In November 2022, they implemented a new process of placing an ED midlevel provider in triage from 12 p.m.-12 a.m. for patients in the lobby who have been triaged. Once triage is completed, the midlevel provider immediately evaluates these patients. The provider performs a medical screening exam and may place additional orders to expedite a plan of care and decrease the patient’s wait time.

 

With the new triage process and the assigned midlevel at triage, the ED struggled to designate an RN to assist the midlevel provider in completing the orders placed. This was because the high volumes and high acuity of patients required nurses to be in their designated patient care zones. The new process had proven to be working even without a designated person, as the LWBS percentage decreased drastically:

  • October 2022: LWBS = 7.28% (before the midlevel was placed in triage)

  • November 2022: LWBS = 7.42 (midlevel at triage implemented in the third week)

  • December 2022: LWBS = 3.72%

 

The resource that was needed was an additional care provider to be responsible for throughput in the ED waiting room.

 

Collaboration between Nurse and Nurse Director during Budgeting

During 2023 budgeting for the ED, Bullard collaborated with Renee Fechuch, MSN, RN, Clinical Director of Nursing, and requested that a new position be created and paramedics hired for it. During Bullard and Fechuch’s biweekly meeting on January 3, 2023, they discussed how the paramedics would partner with the midlevel provider to deliver care to these patients within their scope of practice. Bullard presented the current ED staffing plan to Fechuch. The ED staffed four patient care techs for both day and night shifts. Decreasing this to three on both days and nights would enable the ED to use a paramedic on each shift. (Evidence EP11-1, Bullard and Fechuch Biweekly Meeting Notes)

 

On January 10, 2023, Bullard created an SBAR for the acquisition of this new resource, bringing paramedics to the ED. Fechuch reviewed the SBAR and approved it on January 11, 2023. (Evidence EP11-2, ED Paramedic SBAR and SBAR Collaboration Between Nurse Manager and Nurse Director) On January 16, 2023, Fechuch requested a pay quote for the paramedic resource from the ED recruiter, Samantha McClard, RACR, PRC, CDR, CSMR, CSSR, Sr. Recruiter Talent Acquisition. (Evidence EP11-3, Pay Quote) On January 20, 2023, Fechuch verbally discussed this request with Teresa Lambert, MBA, BSN, RN, Vice President Patient Care Services/Assistant Chief Nursing Officer (role of CNO).

 

Acquisition of New Resources

Lambert approved the request on January 23, 2022. Fechuch completed the job description, and Bullard got the positions posted. The job description was updated with Human Resources Business Partner Dalindra Henson and approved. (Evidence EP11-4, JD Approval from HR and JD) The first paramedic position was created on January 23 and posted on February 1. Three paramedics, were hired, including Cheyenne Wright, with start dates of March 3, 2023. (Evidence EP11-5, Job Posting and Proof of Hire)

 

Nurse Manager Bullard’s collaboration with Nurse Director Fechuch during budgeting resulted in CHI SVHS acquiring the new paramedic resources in the ED. CHI SVHS has sustained the decreased LWBS percentage, which for calendar year 2023 was 3.3% as of November.