The Sentara Health team creates nursing tools to distribute workload more evenly, combating burnout

The charge nurse is responsible for establishing daily nurse/patient tasks, which are informed by the patient’s location on the unit and the charge nurse’s clinical judgment.

PROBLEM

Exercises often do not incorporate objective assessment of workload or patient acuity. As a result, nurses may be responsible for caring for many patients in poor health at the same time.

Nurses at Sentara Leigh Hospital are interested in a more objective approach to nurse/patient assignment. They began evaluating nursing workload tools used in real time to guide these decisions.

“The existing literature provides numerous examples of nursing workload measurement tools,” said Sentara Health Patient Vision Nursing Tool (PANT) Project Coordinator Kelsey Jones, RN. . “Each of these tools has its own strengths, such as using electronic health records, identifying key elements of patient care, and identifying both direct and indirect elements of care.

“However, several limitations have prevented the implementation of these tools at Sentara Leigh Hospital,” she noted. “These limitations include redundant manual data entry, assessments based solely on retrospective data, and infrequent updates to workload assessments.”

Because patient census and required workloads are constantly changing, nurse assignment models must be flexible and update patient information in near real-time to inform support tools. Daily decision support. As a result, nurses have not found an appropriate evidence-based system to determine workload and patient status driven by objective data.

PROPOSE

Historically, nurses have lacked a reliable method to measure and manage the complexity of care. Charge nurses assigned nursing duties based on judgment, daily patient census, and staffing numbers at the beginning of each shift. This inconsistently accounts for nursing workload and patient care needs.

“In 2016, two medical-surgical clinical nurses approached the hospital’s nursing research forum with a proposal to create a tool to quantify patient workload and ensure Ensure equitable distribution of patient care needs among nursing staff. “Project approval was obtained from the system’s chief nursing officer and the Nurse Executive Council.

“The CNO serves as the executive sponsor of the project and incorporates the nursing workload algorithm into the nursing strategic plan, with time and resources allocated for development, testing, and integration.” within the health system.”

A team of interpreters created an automated rules-based algorithm (Patient Vision Nursing Tool or PANT) to capture the time needed to provide safe, quality patient care in almost real time. The PANT development team includes clinical nurses, nurse project managers, EHR systems analysts, health services researchers, biostatisticians, and nurse scientists.

MEETING THE CHALLENGE

PANT is an algorithm developed in-house specifically for Sentara Health.

“The PANT team followed a quality improvement approach to designing the PANT algorithm, involving clinical staff during each stage of development,” Jones explains. “First, the team identified nursing workload categories based on nursing care standards and internal competency tools.

“The team collaborated with nursing staff and IT team members to determine the amount of time and EHR documentation associated with each workload category,” she continued. “IT team members built the PANT algorithm and performed testing to confirm the algorithm worked as expected. PANT team members collaborated with clinical nursing staff to validate the dedicated PANT score for each patient reflects the amount of nursing work being performed.”

Data analysis team members performed a series of descriptive analyzes (basic descriptive statistics describing the distribution of workload data, normality, missingness, and outliers) to validate the functionality of the algorithm.

“PANT is now deployed in more than 100 inpatient units across all 12 hospitals in the Sentara system,” Jones reports. “The development of PANT educational materials – for example, instruction sheets and computer-based learning modules – and the incorporation of PANT in the orientation process for nurse, charge and management roles theory has increased awareness, knowledge, and usage of algorithms.

“PANT scores are used by the charge nurse team to more equitably distribute daily tasks to patients,” she continued. “Staff continue to use clinical judgment and a deep understanding of the needs of both patients and staff combined with objective PANT scores.”

Nursing leaders use PANT scores to better represent nursing workload at the patient and unit levels. PANT data has been integrated into multiple dashboards, allowing operations leaders to view real-time and historical or trending data.

RESULT

Unbalanced or unevenly distributed workloads and perceptions of insufficient time to complete nursing tasks may increase the risk of burnout and turnover. As the national nursing shortage continues, PANT is a data-driven tool to maximize patient and nursing outcomes, Jones said.

“The PANT tool has been widely validated and determined to accurately reflect nursing workload for medical surgical, oncology, intermediate and critical care patient populations,” Jones reports. . “This workload score is used by clinical staff and leadership to make operational-level decisions.

“The PANT workload score is converted to nursing hours per patient day (NHPPD) and compared to a predetermined NHPPD identified in the staffing grid,” she continued. “Comparing PANT to the NHPPD staffing grid provided information about the overall functionality of PANT. This is a unique attribute of the tool and provides clarity on nursing unit differences within the same a census-personnel matrix.”

ADVICE TO OTHERS

“Interdisciplinary collaboration is key,” Jones exclaimed. “Forming a team that spans all disciplines – IT, data analytics and clinical – brings in a variety of perspectives. Involving frontline team members in the design and development of the technology Tools are essential to establishing user-level engagement and ultimately project success.

“In addition, connecting the project to the organization’s strategic plan is also important,” she added. “This ensures the project receives organizational support and resources, promoting success.”

Nursing workload tools help show clearly the intensity of work performed by direct care staff, she said.

She concludes: “The ability to articulate this helps promote understanding with non-clinical teams, informing conversations related to patient needs, clinical workload and traditionally designed census-based HR systems.”

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