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How to make a big change at my hospital

by skinny_murse skinny_murse (New) New

I've been working as an RN for about 3 years now and currently I work at a large 400+ bed hospital. A couple of years ago my hospital realized that the ED was getting backed-up with patients and so they created a unit called the "transition unit". The transition unit basically serves as a patient limbo where patients go after being in the ED so that more ED beds can be freed up. Transition nurses are responsible for completing all the admission requirements including: med rec, admission orders, calling consults and beginning drips/meds, etc. so that the patients will be completely ready to be admitted to the floor once the orders are complete. However, I feel there a lot of obvious issues regarding this unit. I'm not going to go into all the details, but most of the nurses in the hospital agree that having this unit negatively affects continuity of care, patient safety, patient satisfaction and even budget. My question is, should I say something about this? And if so, who should I talk to? I actually have ideas on possible improvements, but I'm just a measly nurse :p... I just don't want my concerns/suggestions to fall on deaf ears. Thanks!

"should I say something about this?"

Do what you want but consider this before you leap. This idea was undoubtly advocated by nursing executives and is their 'baby'. You will be heard but not your ideas and you will be labelled a non team player and trouble maker.

llg, PhD, RN

Specializes in Nursing Professional Development. Has 44 years experience.

There is an art to knowing how to be a change agent. Knowing exactly where and how to initiate change productively takes expertise. Do you know anyone at your hospital (your manager? your educator? the chairman of a committee you serve on? etc." who you could talk to confidentially? You could share some of your concerns privately and get their advice on how to address some of those issues. It would have to be someone who knows the hospital and its culture and politics well. Such advice (and support) would be valuable.

If you don't know anyone like that ... then your first task is to start networking. Establish relationships with your department leadership and others in positions above your pay grade. Join committees, etc. and get to know people outside of your limited circle of peers. Most politics (and change is political) is relationship-based. To be an effective change agent, you'll need to have those relationships. So start there.

tokmom, BSN, RN

Specializes in Certified Med/Surg tele, and other stuff. Has 30 years experience.

I have to echo llg. Take it in baby steps. First..find out the culture. Is your hospital ready to hear new ideas? My organization actually encourages people to send in ideas, so there is no repercussion, only encouragement to do so. If they use your idea, you get money.

Join committees. Get to know management in a positive way. Once you are in their good graces, present your ideas in a positive way. You don't come out and say "This unit sucks, but I can make it better." Tell them all the positives and then the way to save money.

Good luck!

tewdles, RN

Specializes in PICU, NICU, L&D, Public Health, Hospice. Has 31 years experience.

Like the others have said, know your work culture. If you are working for a hospital that does not empower their staff nurses to participate in processes of change, you might as well save yourself the trouble and heartache of initiating that "battle". However, if your management team is open and receptive then, by all means get involved. tokmom gave you some good pointers...it is imperative that you are not critical of the current program but that you acknowledge the good while you suggest improvements. Make sure that patients and outcomes are the focus of your plan. Try to come up with measurable goals.

good luck!

BostonTerrierLover, BSN, RN

Specializes in Adult/Ped Emergency and Trauma. Has 16 years experience.

I have no idea what the issues are that are causing continuity of care issues, or what you see as problems with that model. So please don't think I am criticising what you want for your facility. For mine, an acute care holding unit was a blessing.

There are often times of the year where the hospital is cram packed, so is the ER, and with a closed down "B WING" on 1st floor, I begged the idea of a "Holding Unit." I think it betters care, and moves the patient along "our" system better.

In the ER, only one family member can be present per patient. In AHU (Acute Holding Unit) they have even visiting hours 8am-10pm. Visiting lasts for 30 minutes, and it is strict, but I let new admits to the unit have 1 hour initially.

In the ER, you are only going to get fed if it's a DM issue, or similar. In AHU, if your not NPO for a test, you can have whatever Ordered Meal, and there are nice standby trays for After Hours-not in the ER.

In the ER, your laying on a stretcher. I think its cruel to leave the elderly on those things, lucky to have a pillow and blanket, and even luckier to have your curtain pulled for privacy. In AHU, you have a television, telephone, Brick walls beside you for privacy, and a Curtain in front of you. I turn the lights to dim at 10pm, so the unit is much quieter, much more stable feeling, and they have a bed, pillow, and all the ammenities of a room except a public bathroom that I make sure is spotless. It is cleaned on the hour even at night.

Since ALL floors have Universal Charting, (except ER), when one of my patients gets ready for a room, all their paperwork is done, and since ER lab does our labs, we get them quick (we draw all our labs). Its nothing for a patient to go to the floor 10-15 hours later with EVERYTHING DONE, all admitting lab, orders, and it just a simple pass off.

Furthermore, since we are attached to the ER, the ER benefits in less wait times, because you know how long a pt. can tie up a room waiting on a bed. We take ALL 24 hour ops. We are staffed for up to 3 1:1s, All tele capable, and 3 ICU wait beds (ICU nurse on unit comes from the unit), and it's amazing for cardiac patients who can be d/c'd usually after 3 neg Cardiac Enzymes without further orders. (imagine that patients experience if stuck in ER 15-20 hours! I Love It! And, even though the patients complain at first usually (not all), they appreciate it once they are admitted there, get food, a shower, and are in a quieter atmosphere with all their orders moving.

I know this isn't for everyone, but our ED was drowning, wait times were getting out-of-hand, and patient satifaction with our Emergency Department has gone up 49% The ER Docs like the unit (though they never get the name right, Lol! I would be so sad if we lost these 40 spaces to give our patients a better experience than ED.

Good Luck!