'Stat' nurse program puts expertise where it's needed
'Stat' nurse program puts expertise where it's needed
Prevents call-ins and agency nurses
When an ICU at the University of Missouri Hospitals and Clinics in Columbia needs a fill-in nurse, it doesn't dial its favorite agency. Staff simply dial up one of the "stat" nurses who continually rove the hospital assisting during staffing crisis.
The program provides managers of the hospital's nine ICUs with experienced trained hands, and it also saves about $67,000 annually, says Harold Stearley, RN, BSN, CCRN, a former stat nurse who developed the program.
"Because of stat nurses, other nurses don't have to float between units, call in additional nurses, or employ agency nurses," he says. A stat nurse on the day and evening shift covers every intensive care unit except neonatal "because it is such a highly specialized area," he explains.
About 70% of their time is spent in transporting, monitoring, and stabilizing patients who are undergoing specialized radiological procedures, and about 30% with other duties. This can include helping with postoperative recoveries, bedside procedures, admitting patients, and general trouble-shooting. Stat nurses also provide assistance with code blues, drug formulation, and IV therapy throughout the facility. (See related story on transport, p. 104.)
Special certifications required
Stat nurses, who receive a 20% pay differential, are selected based on their critical care and postoperative experience. "They have to be certified in advanced cardiac life support, and both a BSN degree and CCRN certification are preferred," says Stearley.
In addition to experience, stat nurses must be "extremely flexible and energetic," he adds. "So many things can go wrong very rapidly. You have to be familiar with a variety of environments and know where supplies and equipment are located," he says.
A typical shift may find the stat nurse working in six to eight different units. "The number of transports depends on the length of the procedure," he says. "The maximum number in an eight-hour shift is seven."
The proportion of transports during a stat nurse's shift is increasing, he notes. "In the beginning, we were doing about 20 transports a month, and when I left, we were doing an average of 60," he says.
Today it is routine for the medical center to receive calls from other hospitals that want to use the stat program for benchmarking purposes. In fact, the medical center has an information packet it sends out. But 10 years ago, it was strictly an "experimental" concept, Stearley recalls.
"An increasing number of post-op recoveries were being sent to ICU and this taxed the load on the staff, so we decided that I would serve as the stat nurse on the evening shift to see if the idea would work," he says.
In preparation for an eight-week pilot program, Stearley spent one day in each intensive care unit to become familiar with the patient populations, staff routines, and supplies.
He also took time to explain the idea to the regular ICU nurses. "It took some persuading at first because nurses are generally caregivers not caretakers," Stearley says.
ICU nurses don't want to roam
But inertia was on his side. "The majority of nurses don't like to do transports because it gets them out of their element. They don't know where supplies or equipment are," he says.
He also adds that critical care nurses often underestimate the time radiological procedures will consume, thus straining the resources in the intensive care unit. "When nurses would tell me they'll see me in 30 minutes, I'd say, 'No, you'll be back in three hours,'" he says.
After two months of advocating the program, Stearley had more requests for help than he could manage. "Initially I did a hodgepodge of things - if I was there and I was needed, I did it. But then we had to set post-op recoveries and transports as priority," he says.
After nine months, a stat nurse was added to the day shift, and in another nine months, a third stat nurse was assigned to the evening shift.
Even though the program was popular with intensive care staff, it struggled for survival at the administrative level. After four years of intense data collection (and publishing of the data in various nursing journals), the stat nurse program was cut back to one nurse each on the day and evening shift.
"It was ironic that the stat program was the only one that had data collected to justify our cost-effectiveness and ours was the one that got cut," he says. "The challenge with such a program is that you can't go to administration at the end of the year and say 'This is how much money we brought in.'"
In the first cost-effectiveness study in 1989, Stearley isolated one area of stat nurse care - transportation to radiology - and determined the nursing care hours saved by the stat intervention.
He based the calculations on these two hospital policies:
1. If an ICU nurse is to be gone from his or her unit for more than one hour, an addition nurse must provide coverage.
2. If a nurse is called in, that person is paid for a minimum of three hours. "Floaters" are paid for four hours, even if the workload fluctuation is shorter.
After examining actual floating and call-in patterns, Stearley found that each ICU transport lasting more than an hour cost the hospital an average of three additional hours of nursing care.
Each full-time equivalent (FTE) in the stat program was equivalent to 1.25 FTEs of the regular nursing staff. "I considered this to be a low equivalency estimate because the study was limited to just one variable," he adds.
So in 1992, he performed a total cost analysis by examining the other stat functions that stat nurses perform. These include:
r extended ICU postoperative recoveries;
r ICU admissions;
r extended time spent with critical patients requiring one-on-one nursing care;
r staffing relief for inservices and staff meetings;
r IV therapy hours from 7 p.m. to 7 a.m. throughout the facility;
r assistance with ICU bedside procedures.
By combining the daily logs of the day, evening, and night shifts for one month, Stearley was able to break down all the individual patient care activities performed by each stat nurse. Then he examined each activity to determine how many stat nursing hours were required, as well as the equivalency ratio, to compare the nursing care hours that would have been required if the stat nurses were not available.
The results indicated a larger cost savings than the initial study. "Each stat nurse position saves an average of 46% of an additional staff nurse FTE or had the productivity of 146% of one FTE," he says.
The cost savings more than compensate for the accelerated pay, he adds. "Each position saves 46% of one FTE but receives a pay differential of 20%," he says. "It clearly is the way to provide support for any unit on a moment's notice."
For more information on the stat nursing program contact: Jean Howell, House Manager, University of Missouri Hospitals and Clinics, 1 Hospital Dr., Columbia, MO 65201. Telephone: (573) 882-1702.
Harold Stearley, 2070 E. Northword Dr., Columbia, MO 65202. Telephone: (573) 474-5074.
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