TL4b
Advocacy and Influence TL4
Provide one example, with supporting evidence, of a Nurse Manager’s advocacy for resources to support a unit goal.
Example b: A Nurse Manager’s Advocacy for a Bladder Scanner to Support a Unit Goal
Unit Goal
At Catholic Health Initiatives (CHI) St. Vincent Hot Springs (SVHS), there is a heightened focus on indwelling catheter utilization and catheter-associated urinary tract infections (CAUTI) to maintain the safety of patients through the prevention of hospital-acquired infections. Having an indwelling catheter is the number one reason patients get CAUTIs.
In May 2022, the unit goal for 4 West Medical/Surgical Pediatrics indwelling urinary catheter utilization was under 20%, and they had many days where they were above the average, documented in huddle reports. (Evidence TL4b-1, 4 West May 2022 Unit Meeting Minutes)
Nurse Manager Advocacy
In the spring and summer of 2022, staffing of nurses on the CHI SVHS medical surgical floors was very difficult. The COVID pandemic had created staffing situations that the hospital had never incurred. The nurse managers were working the floors, taking direct care of patients regularly.
Richard Pope (formally named James), MSN, RN, Nurse Manager, 4 West Medical/Surgical Pediatrics, was working multiple day and night shifts in direct patient care. Pope led a unit staff meeting in May 2022, and one of the topics discussed was decreasing CAUTIs. Pope discussed with his team the need to decrease indwelling catheter utilization, as the unit had been running above the unit goal of less than 20%.
As Pope provided direct patient care, he realized the need for bladder scanners, due to personal experiences working the floor and coworker feedback. The barriers to improving indwelling catheter utilization included not having the resource available, taking extended time looking for a working bladder scanner, and delays in patient care.
The protocol guidelines for each indwelling urinary catheter placed for retention is to complete a bladder scan twice prior to completing two straight catheterizations before placing the indwelling catheter. This process decreases CHI SVHS indwelling urinary catheter utilization and ensures that indwelling urinary catheters used for retention are justified.
This ultimately decreases CHI SVHS CAUTIs, as the number one reason for a patient to get a CAUTI is having an indwelling urinary catheter. Pope was advocating for more bladder scanners, as without them, staff cannot follow the protocol guidelines of checking for urinary retention without accessible working bladder scanners.
Obtain Quote
Pope discussed with his team and shared how he had acquired a bladder scanner quote to take steps toward advocating for a new bladder scanner from leadership. Pope reached out to USMED-Equip via a phone call on Friday, May 20, 2022, and requested a quote for a bladder scanner. Michael Crowder, Business Development Representative, sent a quote to Pope on Monday, May 23, 2022, via email. (Evidence TL4b-2, Bladder Scanner Email and Quote)
Obtain Approval
Pope shared this information with Kaitlyn Atkins, MSN, RN, CPN, Clinical Director of Nursing, and advocated for a new bladder scanner at the June 7, 2022, Inpatient Nurse Manager Meeting. Atkins approved getting a bladder scanner and told Pope she would assist him in getting a purchase requisition to purchase one.
Complete Purchase Requisition
Pope and Atkins sent the quote forward to Central Supply. Central Supply found a better quote from Laborie. Pope and Atkins put in a purchasing requisition for a bladder scanner in June 2022. (Evidence TL4b-3, Purchase Requisition)
Acquisition of Resources
The bladder scanner arrived on November 21, 2022, to the 4 West Medical/Surgical Pediatrics Unit, and the staff started using it immediately. (Evidence TL4b-4, Bladder Scanner Acquisition)
Pope’s advocacy for resources for the 4 West Medical/Surgical Pediatrics Unit supported the unit goal of indwelling urinary catheters utilization of less than 20%. Since the purchase of the bladder scanner, the indwelling catheterization rate dropped to 12.1% (November 2022 to October 2023). (Evidence TL4b-5, 4 West SUR and Utilization Rate)