Healthcare News & Insights

New approach to nursing boosts patient care

Nurses spend about 75% of their shift away from patients. If hospitals increase the amount of time their nurses spend with patients, they lower their number of patient falls and bed sores  — and increase both patients’ and nurses’ satisfaction levels.

Thirty hospitals did just that by uniting and sharing information, experiences and ideas as part of a VHA-sponsored virtual group, called Return to Care, that focused on evaluating what nurses do on a daily basis and how they can increase time spent with patients.

How did they do it?

They returned nurses to what they love to do — care for patients.

This wasn’t easy seeing that patient care activity, including assessments and obtaining vital signs, only accounted for 26.5% of total nursing practice time. Reason: Nurses were too busy dealing with hassles and interruptions, as well as hunting and gathering supplies.

In fact, it was found that nurses travel 2.5 to 3.5 miles per shift searching for resources (equipment and medications), as well as coordinating care with physicians and other practitioners. VHA also discovered that during a 12-hour shift, 70% of nurses spent 30 minutes to 2.5 hours searching for supplies.

Experts at VHA recommend that nurses spend at least 60% of their time with patients.

Return to Care teaches its members how to design and implement leading practices that improve direct patient care time. Some of these practices include the following:

Hourly rounds

This is one way to reduce patients’ stress and anxiety, because they see the nurses in their rooms more. And since they see their nurses more, they use their call buttons much less, freeing up the nurses time.

Guided by pre-defined questions and hourly logs, as well as interacting with patients and their families on a regular basis, hourly rounds are more efficient and purposeful, and allow nurses to prevent falls and skin breakdown incidents, as well as provide a better overall patient experience.

At the University Health Systems of Eastern Carolina, which implemented Return to Care, hourly rounds helped increase nurse time at patients’ bedside by 51% on average across its seven hospitals. The icing on the cake: There’s been only one fall with an injury since implementing the program.

Bedside shift reports

Traditionally, when nurses change shifts, they record their reports at their stations. With Return to Care, nurses  make their change of shift reports at patients’ bedsides with patients participating in the conversations.

While this may seem like a bad idea — making the reports longer because patients would engage in endless conversations and questions — that’s not what happens. In actuality, the reports are shorter. With the patients participating, the information is more accurate and clear, and as a result patients absorb the information better and ask fewer questions. Plus, since the nurses are at the patients’ bedsides, they stick to the pertinent facts.

Upper Chesapeake Health System uses Return to Care. When its nurses learned about the shift to bedside reports, they were nervous about giving up taped reports. So to help with the transition, scripts were created to make bedside reports easier and more thorough.

Since the change, the unit has added one hour per shift of bedside care and hasn’t had an incident of a pressure ulcer.

An added bonus: Patients get to meet their new nurses at every shift change.

Communication white boards

Another communication innovation of Return to Care: A white board in each patient’s room. The boards contain patients’ daily goals  and each day’s plan of care. The boards also offer a central place for patients’ pain levels, allergies, and nurses and physicians names to be listed. And for children, their favorite toys and television shows can be added.

Patients are also free to write notes on the boards.


To reduce the time nurses spend searching for and gathering supplies, many VHA-member facilities moved their supplies closer to patient rooms. Others reorganized supplies in patient rooms by purpose, such as having all the respiratory items in one area and wound care in another, clearly labeled and consistent from room to room.

Has your facility implemented a new program or procedure to give nurses more time with patients? If so, share it in the comments box below.

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