Workplace Accommodations Best Practice Rush-Copley Medical Facility

By: AARP Outreach & Service | Source: AARP.org | February 16, 2009

More on This Story

Organization Profile

Rush-Copley Medical Facility, located in Aurora, Ill., has 1,200 employees at the organization's six institutes of advanced medicine: the heart and vascular institute, cancer care, the women’s health center, emergency services, and the neuroscience center. The facility’s medical campus will soon expand to nearby Yorkville, Ill., where an occupational health and express care center will offer imaging and diagnostic testing.

Overview

Finding qualified nurses has been a difficult challenge for recruiters at Rush-Copley because of the country’s nursing shortage. According to the American College of Nursing Association, the shortage of registered nurses could reach 500,000 by 2025. At the same time, more experienced nurses are leaving their jobs, because their work has grown too physically difficult to perform.

To prevent its top nursing talent from leaving, the organization researched assistive devices and other alternatives that minimized many of the physical responsibilities of the job, such as lifting or moving patients. The facility implemented a variety of workplace changes that not only affected its turnover rate, but that also helped nurses better focus on what they were hired to do: deliver quality heath care.

Business Challenge: Finding Qualified Nurses

The nation’s nursing shortage is a real challenge for any medical facility. Here are the grim facts:

The U.S. Bureau of Labor Statistics states that more than 1 million new and replacement nurses will be needed by 2016.
According to a 2007 American Hospital Association report, U.S. hospitals need approximately 116,000 more RNs to fill vacant positions nationwide. This lack is causing an 8.1 percent vacancy rate.
Based on a 2006 study conducted by the Bernard Hodes Group, 55 percent of surveyed nurses plan to retire between 2011 and 2020.

Several years ago, the turnover rate for nurses at Rush-Copley Medical Center climbed as high as 17 percent, said Shawn Tyrrell, the organization’s vice president of nursing. And almost 100 (or 30 percent) of its 333 RNs were age 45+. These experienced nurses were not as satisfied with their jobs as younger nurses, according to results from the hospital's annual employee survey.

The future didn't seem bright. Tyrrell reported that the hospital began bracing itself for a massive retirement of nurses that would start within the next three to five years.

At the same time, the hospital was experiencing a problem with staff injuries. Worker's compensation claims were rising. Many were related to nurses with back injuries. "It's not just a one-time injury," related Tyrrell. "Chronic movement wears out their back[s]."

Other nurses complained about different aspects of their jobs. Besides lifting or moving patients, nurses were required to walk much of the day, especially down long corridors between a central-nursing station and patients' rooms. Tyrrell said that her department was studying the process of medication administration and asked nurses on two of the hospital's busiest units to wear pedometers. During just one shift, she reported, the nurses walked an average of three miles.

Another concern was safety: Tyrrell explained that during a sluggish economy, many nurses picked up extra hours or shifts to meet their financial needs. But they may not have been physically able to handle the extra work. Fatigue was a common complaint and poses a real health risk for both nurses and patients, especially considering that the average length of stay for patients at Rush-Copley was 3.4 days, compared to the national average of 3.7 days. More patients mean more paperwork, treatment, and services.

"On days where we had high volume of patients coming in, the nurses weren't able to capture and spend enough time, getting the full picture of their patients," Tyrrell reported. "Ultimately, it would become a safety issue for patients."

Business Solution: Minimize the Job’s Physical Challenges

There were numerous challenges the hospital had to address. It started to do so in 2004, by experimenting with a new RN position called "admission coordinator." The coordinator was devoted to new hospital patients, spending time with them at bedside, processing their paperwork, fully recording their medical history, and assessing their condition. But most important, the admission coordinator enabled other nurses to fully care for existing patients.

"Other nurses don't want this position to go away," added Becky Runkle, who was the first RN to fill the admission-coordinator position. "They don't have to stop what they're doing, run in to see if a patient is comfortable or leave them sitting by themselves, feeling nobody is taking care of them."

In 2006, the hospital won a competitive $75,000 grant offered by the Robert Wood Johnson Foundation, called "Wisdom at Work: Retaining Experienced Nurses." The program focused on ways to retain older nurses by the patient bedside and as employee mentors, so the hospital could achieve higher outcomes related to the quality of patient health care.

The funds were used in multiple ways. For example, Tyrrell and her staff began studying the impact of the admission coordinator position. It seemed to be working, but how well? Was it accomplishing its goal?

Although there was no hard data, preliminary survey results indicated that the position improved employee satisfaction. So the hospital hired four more admission coordinators during the next two years, then used a portion of the grant money to purchase laptops attached to lightweight carts that the RNs could easily roll between patient rooms to enter data at the patient’s bedside.

Next on the list came the replacement of patient beds.

“With the obesity problem in our country, our patients are sometimes heavier, so that makes rolling them [on gurneys] down carpeted hallways a little bit harder,” added Judi Bonomi, director of inpatient nursing at Rush-Copley.

Now the hospital has self-propelled patient beds that require very little strength to move patients of nearly any size.

Still, lifting patients on or off their hospital beds was a nagging problem. To solve this challenge, the facility used grant money to purchase an inflatable mat for every unit to help lift, turn, or transfer patients from their beds to a gurney or operating table. Tyrrell said that the mat fills with air, displacing patients' weight so they can be easily moved. The mats are placed on the patients' beds when they're admitted and remain with them until they're discharged.

Still more accommodations had to be implemented. To eliminate unnecessary steps, Bonomi said that two more changes were introduced: The hospital added approximately 10 computer workstations to each nursing station. This way, nurses could sit down and take breaks from standing while entering patients' data outside their rooms, instead of walking back and forth between rooms and computers at a central nursing station.

Another change in the works is installing locked medicine cabinets in each patient's room. This means nurses will no longer have to travel back and forth between a patient's room and the onsite pharmacy or medication rooms.

Meanwhile, another area of the hospital is being studied: flooring. Nurses report that it is difficult to push or pull patients in wheelchairs on carpeted floors. So the hospital is replacing carpeting is with laminate flooring on two units—intensive care and day surgery. If the experiment works and the laminate floor is still aesthetically pleasing to patients, the hospital will replace the carpeting in all inpatient units by 2010.

Outcomes: Happier Nurses, Improved Patient Care

While there’s no hard data yet to directly link the workplace accommodations to employee satisfaction, Tyrrell said that they have contributed to the facility’s lower turnover rate. It has dropped from 17 percent to 12 percent.

She pointed to the new admission coordinator position as an example. It has proved to be a huge time saver and a more efficient way of recording patient information.

The accommodations also offer an added bonus that no one realized until recently. Injured nurses may be able to come back to work more quickly than expected, because their work responsibilities are not as physically demanding as they were in the past.

Consider Runkle, who recently had a microdiscectomy, in which part of a disc in her back was surgically removed. Under previous circumstances, she said, she would have required between four and six weeks to recuperate. But because of the nursing accommodations at Rush-Copley, she was able to return to work in two weeks.

Perhaps the best outcome of all is how the accommodations may have enhanced Rush-Copley’s community image as an employer of choice.

"It certainly can't hurt for [nurses] to realize that we understand the challenges they face," said Bonomi. "This situation is a win-win for everyone. We were fortunate enough that our administration supported us in helping the nursing staff improve their ability to get the quality outcomes and patient outcomes we wanted," she reported.