Even prior to passage of the Patient Protection and Affordable Care Act in 2010, pay-for-performance was coming into vogue, Hill says, and the number of quality indicators that needed to be met for specific diseases was on the rise.
"There were a lot of indicators being added every year and it was difficult for staff to always keep up with those things and know what the expectations were," Hill says.
"When we went into this program with the discharge flow nurses, our expectation was that within a subset of, [for example] congestive heart failure patients, to be successful, all of the indicators that applied to that patient would be met."
Ensuring that care standards—such as heart failure patients being discharged on specific medications—are achieved is an important function of the patient flow nurse position. These nurses have received intensive training on nationally reported public quality indicators Hill says, and are now recognized as "content experts" by their colleagues.
"The other thing the discharge flow nurses have done is as those indicators have been added, they help us educate the medical staff when they're upstairs seeing those patients, too," she says, "which is good team work and collaborative."
Retaining Nursing Knowledge
In addition to meeting quality standards, Hill also wanted the patient flow nurse role to be a tool to foster retention and satisfaction of senior nursing staff.
"I've always been a big believer in trying to keep experienced nurses at the bedside because we have such great wealth of experience in nursing," she says. "And, yet, if we're very traditional, they either have to do a 12-hour shift or we don't have anything for them so they end up leaving the bedside, or going into all sorts of alternative roles or retiring."
Hill wanted to entice experienced nurses to stay at the bedside.
"We tried to do some shorter shifts," she says. Patient flow nurses work 8-hour shifts. "We made it Monday through Friday, so we incentivized the more senior nurses to get their weekends off."
Jennifer Thew, RN, is the senior nursing editor at HealthLeaders.