When she noticed RNs weren't always able to make patient discharge a top priority, Baptist Health Lexington's CNO created a new nursing position to improve the discharge process. The result has been a direct benefit for pay-for-performance indicators.
Do the worst first. That's advice my preceptor gave me when I was a new nurse.
It was her quick-and-dirty tip on how to prioritize patient care. Her point was that I should focus my attention on the patients with the highest-acuity levels or who were the most unstable. Post-op patients or those with drains, tubes, deep-brain electrodes, or changes in neuro status should have dibs on my time and care intensity.
A few years ago, Karen S. Hill, DNP, FAAN, chief operating officer and chief nursing officer at Baptist Health Lexington (KY) noticed nurses at her facility were also engaging in this type of prioritization.
"If they had an assignment and a patient was going to go to the OR or the cath lab, that patient rose in the level of priority," Hill told me, "and sometimes the patient who was more stable or going to be discharged was not the most important thing they were doing."
But, as she points out, healthcare has evolved and a greater emphasis is now placed on issues such as preventative care, quality outcomes, and continuity of care, which can all be affected by how well patients understand their discharge instructions.
"I've seen a huge transition in my nursing career from high-acuity hospital focused care to, now, a focus on wellness across the care settings," says Hill, who has been a nurse for 37 years. "As we've done that, one of the things that I've tried to do is to help develop a different way to look at hospital care."
That new perspective includes elevating discharge education, and education in general, to a top priority for nurses. To do this, Hill created the role of patient flow nurse.
Going With the Flow
Patient flow nurses are experienced RNs who supplement the regularly scheduled nurses on the units. They work with the primary nurses to educate patients, fill out discharge paperwork, and move patients along the care continuum in an efficient and expedient manner.
Hill created the position, originally called discharge/flow nurse, about six years ago for multiple reasons including to improve quality metrics, transition care, and staff retention.
Jennifer Thew, RN, is the senior nursing editor at HealthLeaders.