PATIENT CARE SERVICES REPORT Submitted to the Joint Conference Committee, April 2011 Sharon McCole-Wicher, RN, MS, Chief Nursing Officer 1. March 2011 2320 RN VACANCY RATE: Overall 2320 RN vacancy rate for areas reported is 1% AREA RN VACANCY RATE NO. VACANT FTE TRAINING PROGRAMS Med/Surg (includes 4A/SNF unit and 4B/Step-down unit) 0.5% 1.0 FTE Ongoing recruitment. Critical Care (Includes 4E/5E/5R) 0.85% 0.9 FTE Ongoing recruitment. Perinatal (includes 6C Birth Center & 6H Infant Care Center) 1.8% 1.3 FTE Ongoing recruitment for experienced Infant Care RN. Perioperative (includes OR/PACU/Surgi-center) 3.64% 2.0 FTE Ongoing recruitment. Emergency 2.06% 1.5 FTE Ongoing recruitment. Psychiatry (includes PES & acute inpatient units only) 0% 0 FTE Behavioral Health Center 0% 0 FTE Clinics (includes Specialty clinics/ hospital-.based Primary Care). 0% 0 FTE TOTALS 1.0% 6.7 FTE CNO_JCC_Report Page 1
2. SFGH Ratio Staffing Data: By Number of Shifts 03/01/11-03/31/11 Critical Care PACU Step- Down Medical Surgical Telemetry Pediatrics Perinatal Psychiatry ED 1:2 1:2 1:3 1:5 1:4 1:4 Varies 1:6 Varies Area unable to meet minimum ratios Area unable to cover breaks Surgeries postponed related to ratios Admissions held related to ratios Beds closed / ED zone closed related to ratios ED diversion related to ratios 0 0 0 0 0 0 0 2 0 3. Professional Nursing Practice- March 2011 Retention/Professional Development: The current RN vacancy rate is an SFGH historically low rate of 1%. Nursing Excellence: Shared Governance: System Councils continue with monthly meetings focusing on project development and council member assignments. A document defining the SFGH Nursing 2011 priorities was approved by the Coordinating Council. This document will guide the work of the system councils for the next 12 months. SFGH Nursing Strategic Plan 2011-2012 Executive Summary: In January 2011 SFGH Nursing Administration (Nursing Directors & CNO) and Shared Governance CNO_JCC_Report Page 2
System Council Co-Chairs (Staff RNs, Nurse Managers, and Clinical Nurse Specialists) collaborated to create a Nursing Strategic Plan. This was the first step on our journey of Shared Governance at SFGH. Together we identified six nursing priorities to focus on for our first year. Within this document is the framework through which the Department of Nursing will achieve its goals for nursing related to: communication, leadership, service excellence, establishment of a nursing practice model, and continued professional growth and development. This plan supports the SFGH Nursing Values and SFGH Nursing Vision. Implementation of these goals is the shared responsibility of all members of SFGH Nursing including direct care providers, managers and directors. Identified in this document are the Systems Councils that will be one of the many nursing subgroups working toward these goals. The intent is to help identify structures in place to assist in accomplishing these goals. Overall progress will be monitored by the Shared Governance Coordinating Council through measurements of nursing indicators, continuous quality improvement initiatives, and compliance with regulatory standards. Leadership Academy: The second session of the Interdisciplinary Leadership Academy was held in March with session three scheduled for April 15. Currently, participants are meeting with their coaches for individualized sessions focusing on leadership development. RN Staff Satisfaction Survey Results: From October 4 through October 24, SFGH Department of Nursing participated in a second national RN satisfaction survey through NDNQI. Participation in this survey, by eligible clinical RN s, was 83% compared with 72% participation in 2009. SFGH exceeded the national participation response by 10%. Unit based RN champions were the driving force in the success of staff participation. All US Hospitals participating 10/4-10/24/10 Survey Response Rates for the 173 hospitals participating in the October 2010 RN Survey- all using the Practice Environment Scale Total Units Total Eligible RNs Total Survey Responses Average Unit Response Rate 3,920 97,149 68,357 73 % SFGH RN Staff Survey Response Rates as of 11/3/2010 5:26:15 PM Average Total Units Total Eligible RNs Total Survey Responses Unit Response Rate 39 899 690 83 % CNO_JCC_Report Page 3
Eligible RNs are full or part-time, regardless of job title, who spend at least 50% of their time in direct patient care, and have been employed a minimum of 3 months on the unit. Unit-based PRN or per-diem RNs employed by the hospital are eligible, agency or contract RNs are not eligible. (NDNQI, 2010) The survey instrument provided data for the following satisfaction indicators. Practice Environment Scale of the Nursing Work Index Hospital Affairs Quality of Care Nurse Manager Adequate Resources RN-MD Relations Job Enjoyment Work Context Items Nurse Characteristics Practice Environment Scale Practice Environment Scale Mean Scores 2006 2007 2008 2009 2010 Average of All Units In Your Hospital Hospital Affairs n.d. n.d. n.d. 2.56 2.62 Quality of Care n.d. n.d. n.d. 2.83 2.87 Nurse Manager n.d. n.d. n.d. 2.85 2.89 Adequate Resources n.d. n.d. n.d. 2.52 2.62 RN-MD Relations n.d. n.d. n.d. 2.98 3.04 Mean PES Score n.d. n.d. n.d. 2.75 2.81 These results demonstrated an overall increase for all of the Practice Environment indicators. (Scale 1-4) CNO_JCC_Report Page 4
Job Enjoyment Scale T-scale The job enjoyment results indicated a slight increase above the national T-scores. Both 2009 and 2010, the T-scale results were between the 25 th and 75 th percentile. Improved Perception of Quality in 2010 Perceived quality of care throughout the hospital indicated an increase since 2009 with a slightly higher than national results in 2010. Currently, staff RN s and managers are involved in evaluating unit activities that will improve survey results and patient outcomes. CNO_JCC_Report Page 5
4. ED Report - March 2011 The Emergency Department (ED) had a Diversion rate total of 27% (202 hours) for the month of March 2011. The ED used 20 (3%) hours of Trauma Override during EMSA Diversion suspension. The ED encounters for the month of March totaled 4351 patients, 854 of those were admissions. CNO_JCC_Report Page 6
5. PES Report - March 2011 PES Condition Red 400 350 Hours on condition red 300 250 200 150 2007 2008 2009 2010 2011 100 50 0 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Month 600 PES Encounters 500 400 300 200 100 PES Non-Admits Intakes PES Intakes Resulting in SFGH Admits 0 Jan-10 Feb-10 Mar-10 Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10 Jan-11 Feb-11 Mar-11 Apr-11 May-11 Jun-11 PES had 445 patient encounters during February and 497 in March, 2011. PES admitted a total of 127 patients to SFGH inpatient psychiatric units in March, 2011, an increase of 1 patient from February. In March, a total of 370 patients were discharged from PES: 30 to ADUs, 33 to other psychiatric hospitals, and 307 to community/home. There was an increase in Condition Red hours from February to March. PES was on Condition Red for 148.2 hours during 19 episodes in March. The average length of CNO_JCC_Report Page 7
Condition Red was 7.80 hours. In February, PES was on condition Red for 76.1 hours, during 14 episodes, averaging 5.43 hours. The average length of stay in PES was 24.29 hours in the month of March, an increase from 22.60 hours in February. CNO_JCC_Report Page 8