Experienced Resource Nurse:

Driving Quality and

Decreasing Cost

Barb Lawrie

Sharon Provost

Vancouver Coastal Health June 2014

Q

C

Who are We?

•We serve over 1M people; 25% of

BC’s population

•Approx. 20,000 staff; Budget 3.18B

• Per year over 2.8M patient days of

care & 356,000 emergency visits

•4 Urban & 6 Rural Acute Care Sites

•Full continuum of care:

Acute/Community/MH/Residential

Our story...

Why a New Role & Why Now:

The Driving Forces

New Grads

needing unit

based instead of

float positions

Impact on

Quality of Care

Need

experienced

relief

Increasing OT

Costs and

working short

Working Together to Align Capacity with Demand:

VCH Staffing Model

Baseline Staffing-

Master Rotations RFT & RPT

Long Term Leave Relief TFT & TPT

Annual Vacation Relief RFT & RPT

Predictable

Short Call Relief Resource Pools RFT & RPT

Peak Short

Call Relief Casuals and RPT

Correct

rotations to

meet

baseline

Vacation

relief

positions-

great for new

grads

Robust

resource

pools-

appropriate

for

experienced

RNS

Experienced Resource Nurse Role

Why • Right level of experience in

roles

• Decrease reliance on casuals

• Make float pools attractive & part of a leadership career path

• Decrease OT

• Increase support & mentoring for new grads

What • Level 2 permanent relief

positions covering 4-5 units

• Work all shifts with a set master rotation

• 5% of shifts supernumerary for mentoring/ education

• Minimum 3-5 years experience

Direct

Care

RN

High

Acuity &

Specialty

RN

Critical

Care RN

Level 2

Clinician

Level 2

Educator

Level 3

Head

Nurse

Clinical

Nurse

Specialist

Nurse

Practioner

Level 2

ERN*

* Experienced Resource Nurse

How We Got There….

• Work with Unions over 2 years

• Focus groups with stakeholders

• Clear Job Description

• Pilot

• Communication plan

What We Did • Sized the need using relief data from

previous year

• Created master rotations providing smooth

coverage

• Aligned the new grad nurse educator and

program with supporting the ERN team

who then supported new grads

We Measured

Turnover/Retention

Mentorship

Leadership Education

Experience level of relief

Cost of relief

Overtime

Satisfaction

Perception of impact on quality of care

1 year 9+ years

ERNP 2

Reg Pool

Turnover

Experience

Level ERNP 1

New Grad Nurses Hired by Calendar

Year: All VCH by Status

New Grad Nurses hired by calendar year:

Regular Positions for ERN sites

“They travel throughout the hospital and share best

practice with our staff-and what’s going on with other

units.”

“They have really stepped up to the plate with new

projects. They are often willing to help initiate new

projects and get staff engaged. They now know the

units and the idiosyncrasies of the nurses and units

and how to sell things.”

“…often are a good resource on units, especially at night if the team leader is not there. They can often intervene and diffuse potentially volatile situations…”

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“We’ve been getting busier and busier on the units. They

may have a very heavy patient workload and can’t

provide much support—it’s a balance.”

“There was a rocky start because there was a lot of

misunderstanding about the role when it first started. There

were misconceptions about what they were doing here. Some

people felt disrespected by the process of bringing in others.”

“I see the value in the ERNPs-but I need to see the results

now. When they were put in place, we wanted them to

reduce overtime by helping to fill short-term needs-not

chronic vacancies. I will be very eager to see the results

financially.”

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“The 1st group we hired had 3 years, but it turned out that was

probably not enough-or too narrow, too specialized. It would

have to be a broader background, higher acuity programs”

“They have to be able to think critically and

communications a big thing-especially on nights..and

conflict management.”

“ We need to integrate all the DC2s and ERNs in the hospital so that

they have common goals and common times for coming together to

strategize what we would like them to do.”

Fo

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ion

s

Lessons Learned

Involve

Communicate

Ensure Support

Find Champions

Evolve

**Manage Change**

# 1 Issue

Lesson 1: Never Underestimate the Challenge of Change Management in Healthcare

# 2 Issue

Status Relative importance to others; ‘pecking

order’

Certainty Concerns being able to predict the future

Autonomy Provides a sense of control over events

Relatedness A sense of safety with others, of friend

rather than foe

Fairness Perception of fair exchanges between

people

SCARF – brain based model for collaborating with and influencing others (David Rock)

27

Reward Threat