Piloting discharge nurse on med/tele floor

Posted
by Inquiringminds (New) New

My acute care hospital is considering implementing a "discharge nurse" role during pique time to expedite the discharge process. As of now the idea is one for each medical floor. I am looking for feedback from any who have worked with a hospital utilizing this role. How was it implemented; ie what hours/shift were worked, were there specific nurses who only worked in this position or did it rotate through all staff, how did this role impact the staffing budget and the patient to nurse ratio on the floor? Pros and cons? Also if anyone has any idea of impact on press ganey scores? And tips for outlining the duties of the discharge nurse.

Thank you!

Esme12, ASN, BSN, RN

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma. Has 42 years experience. 4 Articles; 20,908 Posts

HI! Welcome!

I have seen this....it was a position that was from 11a-7p. It worked well....that nurse worked very hard and got a lot of grief on busy days for not getting to all admissions. The administration made decision on where to send the nurse according to census and acuity. The nurses were required to take vitals and place on monitor. They did not admit to ICU or specialty units like OB/NICU.

I liked it.

firstinfamily, RN

Has 33 years experience. 790 Posts

We also had admission nurses at one time, however, I believe inquiring minds is asking about discharge nurses. I can see where this would be a really valuable position. It would expediate the discharge process, and ensure discharge planning/education was completed. How would this nurse be delegated to just one floor? The admission nurses were eventually let go, but I hope the need for a discharge nurse would be guaranteed to prevent frequent re-admissions and make the discharge process more smooth. Good Luck!!

flutist, RN

197 Posts

We have a discharge nurse who works 9-5 Mon-Fri. It's just one nurse and we are a 14 bed unit. We also have a CCAC (community care access centre) who helps to ease the transition from hospital to home (or LTC). One of my pts got discharge around 11 in the morning and I pretty much did nothing for the discharge as they were working in it while I was attending to my other pts. It was nice to have them working on it. The discharge nurse will also process many of the orders in the morning.

Rogueglitter

5 Posts

We have an admission/discharge nurse for the day and evening shifts. This nurse comes out of our baseline staff so the other nurses each have 1 extra patient then before. The majority of our nurses are trained in the role and take turns. I work on a 34 bed medical unit with an average of 3-5 discharges/ day.

nowim clean

296 Posts

I personally want to do my own admissions and discharges I think it is a waste of money and resources. Give the floor nurses what we really need another nurse on the floor taking patients so we all have less patient load it frees up time to actually educate your patients, care for them give meds on time, reduces falls and increases gainey scores because the patient and family members are taken care of and their needs are met. By the way I can do an admit in as little as 15 minutes and a discharge in 10 minutes so for me that admit/discharge nurse is not helping me.

Ayvah, RN

Specializes in Med Surg, Specialty. Has 10 years experience. 722 Posts

I agree with nowim that discharge nurses are not the best use of resources. When I've had random nurses do discharges for me, oftentimes they need to come to me to clarify one thing or another, and I feel that a lot of discharge education can be individualized based on me knowing the patient. Based on knowing the patient I have also spotted errors I would not have caught were I a discharge-only nurse.

However I disagree with nowim about admit nurses as I feel they are hugely helpful. I do not need to know things like if they have a family history of xyz or be bogged down with calling their PCP office if they have had a flu/pneumonia shot. I don't need to be bogged down with calling their pharmacy because they can't remember the name or dosage of the 'small white pill' they take. I don't need to halt care on my other patients to urgently do all this because the ER didn't give the new admit pain medicine before shipping them up and I have to go through a long process before med orders will load in our system. I have always loved admit nurses. They keep things flowing!

nowim clean

296 Posts

Well unfortunately at my facility even if the admit nurse does the admission it is the primary nurse who has to call the pharmacy, pcp ect so in reality for me it is quicker and cleaner if I do the admit and discharge. Most floor nurses if they were asked would rather have a nurse that takes patients so you have a less patient nurse ratio instead of having the admit/dc nurse.

Momma1RN, MSN, RN, APRN

Has 8 years experience. 219 Posts

We are piloting 'free charge nurse' on days and evening shifts- to help with d/c, admissions, etc. Honestly there are some charges who are helpful, and others who kind of just roam around aimlessly- which at that point I would rather have one less patient in my assignment. I am type A and like to do my own admissions because I feel incompetent (and probably look incompetent) to the next shift when it's time for me to give report. It is really helpful to have this RN free during med pass (which seems to also be when our admissions come up), because it's super helpful for her to pass my meds while i'm in an admission. I guess it really depends on the person, and the floor. We are trying to move toward all discharges by 11 am, which would make a discharge nurse on day shift valuable. But, like the above said, that RN probably doesn't know as much about the patient.

Ayvah, RN

Specializes in Med Surg, Specialty. Has 10 years experience. 722 Posts

Well unfortunately at my facility even if the admit nurse does the admission it is the primary nurse who has to call the pharmacy, pcp ect so in reality for me it is quicker and cleaner if I do the admit and discharge. Most floor nurses if they were asked would rather have a nurse that takes patients so you have a less patient nurse ratio instead of having the admit/dc nurse.

That's strange, I wonder why they can't make those calls? At my facility, when an admit nurse is available, the ER gives report directly to the admit nurse who fully assumes their care and completes all the paperwork, med reconciliation, order clarification and entry, performing initial orders, and giving initial meds. Only once everything is wrapped up in a neat bow, do they then give the floor nurse report.

Inquiringminds

3 Posts

Thank you for your helpful insight. Can you tell me a little about how your hospital is making discharges by 1100 possible? Our main obstacle to early discharges is having the doctors orders complete that early in the day.

flutist, RN

197 Posts

Our docs are usually in right around 8 or so since they all work over at the family medical centre during the day. They do their orders and the head into the office. We are a 14 bed facility so we don't usually have more than one or two a day (if that).