Waiting room nurse: Enhancing the patient experience
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Ciara Odle, MSN,; Zakk Arciaga, MSN, RN; Barbara Maliszewski, MS, RN, NEA-BC; Sharon Smyth, DNP, RN, CNML; Madeleine Whalen, MPH, MSN, RN, CEN
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Poster presentation
Session A presented Monday, September 30, 10:00-11:00 am
Purpose: Nationally, nearly half of Emergency Departments (ED) across the country are experience crowding, which has contributed to a decrease in the quality of care and a negative patient experience. Current workflows in our ED for waiting room patient reassessments are not optimal to identify threats to patient safety nor create a positive impression for patient [1]. Innes, et al., discusses the impact of a waiting room (WR) nurse role to improve decreased waiting times and improve risk mitigation [2-3]. Our two goals were to enhance detection of clinical deterioration and improve the patients’ experience while in the waiting room by implementing a WR nurse, as well as ensuring the feasibility and acceptability of the new role among staff.
Design: Quality Improvement project.
Setting: Adult Emergency Department in an urban, academic center treating over 60,000 patients per year.
Participants/Subjects: Patients in the WR and all emergency department staff.
Methods: We initiated a dedicated WR nurse from 11/1/2018 to date with 22 hour coverage. We evaluated three elements: Screened and Left Rates (SAL); Using Blank, et al. (2006) model for post-shift evaluation, nurses in WR nurse role were surveyed to determine perceived stress and collect comments; A pre/post 5-item Likert survey (1-negative to 5- positive) completed by all staff members of the Department of Emergency Medicine to evaluate perceptions of interruptions from patients in the WR, quality of patient interactions, and the overall mood of the WR. In addition to these questions, staff provided comments about the role.
Results/Outcomes: Screened and Left: In one month, mean SAL rates decreased from 12.5% to 10.2%. While this decrease was not statistically significant (p=.20), the clinical significance of deterring premature departure from the ED should not be discounted As we continue to collect data and increase our sample size, we expect this intervention demonstrate statistical significance. . Perceptions of staff in the role: 60 staff members were surveyed with a participation rate of 35%. A post shift evaluation survey showed the presence of a waiting room nurse did not increase the stress among the nursing staff. Free text comments gathered suggest that nurses felt they were able to identify and intervene on safety concerns in the WR. Pre/post likert of entire staff: After implementing a WR nurse, staff perceived patient interactions to improve from a mean of 1.3 (somewhat negative), on a 5-point likert scale to a mean 3.7 (somewhat positive). Staff also rated the overall mood of the WR improved from a mean of 1.4 (extremely dissatisfied) to a mean of 3.6 (somewhat satisfied). Free text comments gathered suggested that other roles were less burdened with the presence of a waiting room nurse.
Implications: Our role was implemented using current staffing projections and did not require an additional full time employee. Despite known staff resistance to implementing a WR nurse in our department, this pilot demonstrated a benefit to patient care while improving the perceptions from staff that implementing this role positively influenced positive patient experience and provides a layer of risk mitigation.
Type | Poster |
Format | Text-based Document |
Evidence Level | N/A |
Research Approach | N/A |
Keywords | Waiting Room; Patient Experience; Safety |
Name | Emergency Nursing 2019 |
Host | Emergency Nurses Association |
Location | Austin, Texas, USA |
Date | 2019 |
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