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Researchers recommend using ‘circulating nurse’ on neurological critical care units

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A “circulator” nurse position should be introduced on neurological critical care units to ease pressure on other staff from accompanying patients for screening, according to US nurse researchers.

The study authors noted that such specialist units cared for patients with diagnoses like stroke and brain or spinal cord injuries, who required frequent neurological assessments and diagnostic tests.

“When a nurse travels there is a patient left behind for another nurse to care for”

Michelle Hill

They highlighted that, for specialist nurses on neurocritical care units, accompanying patients for imaging scans and other procedures could have a major impact on nurse staffing ratios.

“These imaging and diagnostic examinations are often time sensitive and may happen at any time,” said Michelle Hill and Jessica DeWitt from the Riverside Methodist Hospital in Columbus, Ohio.

During a period of multiple changes, they observed that the 32-bed neurocritical care unit at the authors’ hospital was experiencing high nurse turnover rates.

They said: “This started us asking the question, ‘Are neurocritical care nurses performing 14 hours of work on a 12-hour shift?’”

As a result, the two nurse researchers looked at assess relationships between various nursing tasks – neurological assessment, documentation, and traveling with patients for diagnostic tests. Their study also looked at the effects of patient acuity and nurse experience.

Over 30 days, observations showed that neurocritical care nurses spent more than 226 hours traveling with patients. The main tests and procedures involved were computed tomography and magnetic resonance imaging scans and vascular interventional radiology procedures.

“Approximately 4.5 hours of a 12-hour shift were spent off the unit traveling for these tests, indicating that at least one nurse was off the unit for 38% of the shift,” said Ms Hill and Ms DeWitt.

Ms Hill added: “When a nurse travels there is a patient left behind for another nurse to care for. This alters the staffing and requires ‘flexing up’ – meaning that the nurse-patient ratio increases 33% to 50% during those times.”

“Approximately 4.5 hours of a 12-hour shift were spent off the unit traveling for these tests”

Study authors

On its own, the nurses’ level of experience was not significantly related to the amount of time needed to perform and document the results of neurological assessments, said the researchers.

However, they found less-experienced nurses spent more time documenting the status of higher-acuity patients, compared to experienced nurses.

The study also identified an average of 2.5 high-acuity patients per day who required a dedicated one-to-one nurse assignment for procedures and recovery time.

Based on their workflow analysis, the authors recommended a new “circulator” nurse position, who would travel and assist with scans, freeing primary nurses on the unit to stay with their own patient.

They also recommended three new “one-to-one” staff positions, allowing high-acuity patients or those with multiple diagnostic tests scheduled to be assigned to a dedicated nurse.

The study authors said: “Implementing additional staffing will counteract this unique characteristic of neurologic critical care patients and provide a possible tool to enhance retention.”

The findings from the study have been published in the Journal of Neuroscience Nursing, which is the official journal of the American Association of Neuroscience Nurses.

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