Purpose for the Program
This pilot quality improvement project provides data to support a creative option that involves the use of a clinical resource nurse to support units with high percentages of new-to-practice staff, and also improves nursing satisfaction, complies with new staffing guidelines set by a professional organization, and improves patient flow.
A 2-week pilot project of the clinical resource nurse (CRN) was implemented on a labor and delivery floor in an academic medical center with 772 beds. This concept was tested for five main reasons: (a) increased acuity, (b) new staffing guidelines, (c) high percentages of new to practice staff, (d) high percentages of nurse turnover rates, and (e) low nurse satisfaction scores. To implement the pilot project, an extra registered nurse (RN) was assigned as the clinical resource nurse on every shift (excluding weekends) resulting in over budgeting (one extra RN was needed from 7 a.m. to 7 p.m. and from 7 p.m. to 7 a.m.) for a 2-week period.
Implementation, Outcomes, and Evaluation
A core group of nurses were selected to continue the role of CRN 24 hours per day, 7 days per week. A PowerPoint presentation was created as a resource for all staff, and education continued surrounding the daily responsibilities of this nurse by a clinical level IV nurse. During the trial period this role focused on the use of the CRN on the labor and delivery floor, but upon implementation the scope of this role was expanded to be a resource for the newly developed antepartum unit (APU). This requires the CRN to assess the APU every 4 hours and assist with admissions and overseeing the management of nursing care for patients.
A preimplementation and postimplementation survey was given to 32 nurses based on the Likert scale. Results showed increased perceived quality of care provided to patients and increased feelings of having the necessary resources for help when they need them. Furthermore, the results showed an increased perception of improved quality of patient care with 50% of respondents rating their care as excellent posttrial as opposed to only 16% pretrial. A decrease in incident reports was also noted.
Implications for Nursing Practice
This pilot indicated that a CRN may be useful in areas with high rates of new-to-practice nurses. In the short period of time, nurses reported increased perceived quality of care along with resources needed for complex patients. Patient flow was improved as well as possible improved quality of care related to the decrease in incident reports filed.