Expert Insight

Top-of-license nursing: 3 strategies to protect nurses' time

Amid rising healthcare costs and increasing patient complexity, top-of-license nursing practice is more important than ever. Discover three practical strategies your organization can implement to help protect nurses from avoidable time sinks and enable them to practice at the highest level.

As patient care becomes more complex, nursing hours have become more valuable. However, nurses often spend a significant part of their shifts on work that can either be automated or completed by other members of the care team. These three strategies will help protect nurses from avoidable time sinks and allow them to care for patients while practicing to the full extent of their education and training.

1. Streamline nursing documentation

Studies show that nurses spend anywhere from 25% to over 40% of their time on documentation, including EHR/paper charting and review. To streamline the documentation process and free up nursing time for patient care, implement these three practices:

Right-size upfront patient assessment

Patient assessment forms often include outdated or unnecessary questions, which then lead to more work for nurses. Removing questions already documented by other caregivers or identifying populations where some questions may be irrelevant will help streamline initial patient assessment documentation.

Safety sign-on screen

Oftentimes, nurses must click through multiple screens in the EMR to find key patient information. This increases documentation time, as well as the potential for nurses to overlook critical patient safety information.

Summarizing the most critical patient data on a single screen will reduce the time nurses spend searching for information in the EMR.

Med/surg biomedical device integration

Documenting patients' vital signs can take significant nursing time, but entering all the data at the end of a shift can increase the risk of transcription errors.

By using mobile devices and biomedical device integration software together, personal care assistants (PCAs) can quickly validate patient data and transfer vital signs to the EMR wirelessly, reducing documentation time and avoiding double documentation.

2. Normalize support staff workflows

Nurses spend over a third of their time at work on "non-core responsibilities," or work that could be safely done by other care team members, like PCAs. These two practices can help you adjust the timing and structure of PCA shifts, allowing them to better support RNs:

Staggered shift start times

Because PCAs must assist off-going and on-coming nurses and respond to immediate patient needs at the start of their shifts, they may not always be able to complete some time-sensitive tasks, such as checking patients' blood sugar before meals.

To help PCAs complete these routine activities more consistently, some staff should be assigned to shifts that begin 30 minutes before on-coming nurses arrive. This will make PCAs more available to assist nurses with immediate patient needs when they arise.

Specialized PCA roles

Unexpected, time-sensitive needs often interrupt PCA workflows, which means they may not have time to consistently complete routine care activities. Creating specialized roles for certain PCAs leads to more consistent work streams for all nursing support staff and improves the reliability of the entire support 

3. Encourage nurses to delegate responsibilities

Nurses often don't know how to or are unwilling to delegate responsibilities. To encourage nurses to delegate their responsibilities more often, implement these four practices:

PCT clinical ladder

Patient care technicians (PCTs) typically have few opportunities for advancement and only remain in their roles short term. This often leaves nurses unfamiliar with an individual PCT's experience and skills. Having PCTs advance through the clinical ladder allows them to demonstrate their growing skills, which helps nurses feel more comfortable delegating work to them.

Nurse-led PCT training

Oftentimes, PCTs are unaware of how their work impacts patient care, and they may not complete their delegated work thoroughly or accurately. To address this issue, nurses can teach PCTs and evaluate their skills on a routine basis.

RN delegation buddies

Nurses are often hesitant to delegate to peers because they don't want to add to a colleague's workload or admit they need help with their own work. By formalizing peer delegation with a structured process, nurses will be more willing to delegate to peers.

Automated patient request triaging

With a standard call light system, there is no way to differentiate between patient requests that require RN expertise and those that can be addressed by other members of the care team. A system that automatically triages patient requests to the most appropriate care team member can help prioritize nurses' time for work that requires their expertise.

What's next?

These three strategies can help you overcome one of the barriers to achieving top-of-license nursing practice. Advisory Board also offers several strategies to help organizations combat interprofessional barriers that may be limiting collaboration among nurses and healthcare professionals, as well as the scope of nursing practices.


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INTENDED AUDIENCE
  • Hospitals and health systems

AFTER YOU READ THIS
  • You'll understand why top-of-license nursing practice is needed now more than ever.
  • You'll be able to identify the main barriers to achieving top-of-license nursing practice.
  • You'll have two broad actions to help you address issues preventing nurses from practicing at the top of their licenses.

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