Nurse-patient ratios can increase by 50% when neurocritical care RNs travel off the unit to accompany patients to tests.
After a period of multiple changes and high nurse turnover in the 32-bed neurocritical care unit at Riverside Methodist Hospital in Columbus, Ohio, two of the organization's RNs began pondering the question, 'Are neurocritical care nurses performing 14 hours of work on a 12-hour shift?'
As a result, Michelle Hill, MS, RN, AGCNS-BC, CNRN, CCRN, SCRN, and Jessica DeWitt, BSN, RN, conducted a workflow study to assess relationships between these various nursing responsibilities:
- neurological assessment
- documentation
- traveling with patients for diagnostic tests
The study, published in the Journal of Neuroscience Nursing, also measured the effects of patient acuity and nurse experience.
The study found that for nurses on neurocritical care units, accompanying patients for imaging scans and other procedures significantly impacted nurse-patient staffing ratios.
Traveling Impacts Ratios
Over 30 days, observations showed that neurocritical care nurses spent more than 226 hours traveling with patients. The main tests and procedures involved were CT and MRI scans and vascular interventional radiology procedures.
The study found:
- About 4.5 hours of a 12-hour shift were spent off the unit traveling for these tests
- One nurse was off the unit for 38% of the shift.
"When a nurse travels there is a patient left behind for another nurse to care for," Hill says in a news release. "This alters the staffing and requires 'flexing up' – meaning that the nurse-patient ratio increases 33% to 50% during those times."
Nurses' experience levels were not significantly related to the amount of time needed to perform and document the results of neurological assessments.
However, less-experienced nurses spent more time documenting higher-acuity patients' statuses compared to experienced RNs.
New Positions Created
"Patients in a neurologic critical care unit require more staffing to account for the frequent neurologic assessments, charting, and traveling," the researchers write in the study.
Based on the workflow analysis, the authors recommended a new "circulator" nurse position to travel and assist with patients. Adding this position would, free primary nurses on the unit to stay with their patient.
Because the study identified an average of 2.5 high-acuity patients per day requiring a dedicated one-to-one nurse assignment for procedures and recovery time, Dewitt and Hill also recommended three new "one-to-one" staff positions to enable high-acuity patients or those with multiple diagnostic tests scheduled to be assigned to a dedicated nurse.
"Implementing additional staffing will counteract this unique characteristic of neurologic critical care patients and provide a possible tool to enhance retention," they write.
Jennifer Thew, RN, is the senior nursing editor at HealthLeaders.