Minnesota hospitals ask nurses to find efficiencies to cut labor strain

Fresh off the news that supply management techniques from the factory floor are moving into hospitals, we now learn that some Minnesota hospitals are involved in a project to get their nursing staff to make more efficient use of their time so they can focus on patient care. Thousands of Minneapolis/St. Paul nurses were recently involved in a well-publicized contract dispute with 14 hospitals regarding their stance that the hospitals should institute mandated staffing ratios to improve patient safety--a move the hospitals spurned, saying ratios would add millions in labor costs with no proven benefits.

While mandated staffing ratios haven't found traction in the state, a number of Minnesota hospitals are approaching the problem from the opposite direction and finding ways to improve the efficiency of the nurses they already have on staff, reports the Star Tribune. Gillette Children's Specialty Healthcare in St. Paul is among the hospitals participating in the Transforming Care at the Bedside Collaborative, a national initiative spearheaded by the Institute for Healthcare Improvement (IHI) in Cambridge, Mass.

"One theory is, if the quality of care is better with more nursing care, let's hire more nurses," IHI Vice President Pat Rutherford told the Star Tribune. However, "it's irresponsible to just add numbers without getting rid of the waste," she said. And the "chaotic, inefficient" systems at most hospitals result in nurses typically spending more time on peripheral duties (e.g., making phone calls, finding supplies and checking medications) than on direct patient care. In fact, most hospital nurses spend an average of only 20 to 35 percent of their shifts providing direct patient care, she pointed out.

But the Collaborative recognizes that there is a vast difference between reducing supply waste and improving the efficiency of nurses, so the program focuses on getting front-line nurses and nurse managers to tackle problems rather than imposing efficiency techniques from the outside in.

The common theme at hospitals participating in the project is less overtime, less turnover and higher nurse and patient satisfaction. For example, a participating unit at Gillette was able to save nurses time simply by using the nurses' suggestions to relocate supplies they use frequently. And nurses on the medical-surgical units at ThedaCare in Appleton handle an average of one more patient per shift since they have been assigned to teams that allow them to provide patient assessment and education while nursing assistants handle the basic personal care services. "They are still tired at the end of a shift, because nursing is demanding work," said Jamie Dunham, a nurse leader on the project. However, "they have [more] satisfaction with the work that they do."

To learn more:
- read this Star Tribune article
- find out about the IHI's Transforming Care at the Bedside Collaborative here
- view the Robert Wood Johnson Foundation's Transforming Care at the Bedside toolkit here

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