Fourth Floor Telemetry/Urology, Wesley Long Community Hospital, Greensboro, NC

Angela Moore, BSN, RN, almost didn't send her entry in to the ADVANCE for Nurses Best Nursing Team awards program. "That Saturday morning, I was thinking I had entered the contest before and didn't win, so I thought this time was no different," she said. "Then, I said 'we all worked too hard on this entry for me not to send it in.'"

Imagine her surprise when ADVANCE informed her the Fourth Floor Telemetry/Urology Unit at Wesley Long Community Hospital, part of the Moses Cone Health System, was judged the top team. She was literally speechless. "Just that day, my supervisor asked if I'd heard anything, and I said 'no,'" she recalled.

Persistence paid off for the unit that has made great strides in improving case management, patient education and decreasing length of stay.

About the Unit

Fourth Floor Telemetry/Urology is a 29-bed med/surg unit serving patients with an emphasis on urological care. Patients, whose average length of stay is about 5 days, may be recovering from GI or urology surgery or medical conditions. They may have type 2 diabetes with associated complications.

Recently, Moore and other nurses realized patients were not getting the in-depth education they needed to prepare for discharge. Amid all the monitoring, assessing and other patient care duties, nurses had little time to add patient education to the mix.

After brainstorming solutions to the problem, the team developed the role of progression nurse, who would identify patient needs, develop discharge plans, and communicate with the nurses and physicians on the team.

Developing the role was not easy, but hospital leaders were behind them every step of the way. "We had plenty of support from leadership, our deptartment director, our chief nursing officer," Moore said. "They were always willing to listen to ideas, and to throw ideas out there and help us build on them and push us in right direction. That's the great thing about this system."

In addition to the progression nurse, the unit developed a comprehensive education program for patients undergoing a prostatectomy. Ultimately, discharge preparation time decreased from 46 minutes to 17 minutes, and patient satisfaction scores went up.

A progression nurse and discharge education program are not enough to keep a unit running - its staff need to be healthy and fit to take on daily challenges. So, Moore and her colleagues initiated a Spring Into Healthy Habits contest. With the assistance of a dietitian and wellness coordinator, staff engaged in a Biggest Loser-type competition for weight loss.

To learn more about this amazing team, read their winning essay below.

Developing New Role

As nurses, self-evaluation is a daunting task. We are critical thinkers who tend to magnify our shortcomings and seldom pause to celebrate our strengths and recognize our successes. Providing exceptional care prompted the nurses to focus on how we could provide optimal education for discharge. On our busy telemetry med/surg nursing unit, the nurses had little time to actually spend with patients teaching. Our goal is that discharge planning begins on the day of admission. We began looking at opportunities to impact patient education and length of stay.

A new role called progression nurse was piloted and implemented. This role was very beneficial and was later adopted systemwide.

The progression nurse is the linchpin that pulls the team of nurses and physicians together to communicate needs of patients and make discharge plans that yield positive patient outcomes. The progression nurse leads the daily patient outcome progression rounds, which includes key players in the patient's care. Along with the goal of improving patient progression, we targeted a plan to enhance the patient-education process.

Creating the Plan

A meeting was set with the urology physicians, nursing leadership and staff nurses to identify a plan that could be implemented to better serve our urology patient population. The outcome of the work of this group included a preoperative class for patients undergoing a laparoscopic robotic prostatectomy. The new high-tech procedure shortens the recovery time for prostatectomy patients to a 1-day stay, in contrast to the traditional open radical prostatectomy with a typical 3-day stay.

The shortened hospital stay made it difficult for the nurses to find time to educate the patients adequately for discharge. The class is provided twice per month prior to a patient's admission, and includes preoperative information, hospital routine, catheter care, and postoperative care and instruction.

During the hospital stay, the nurses who teach the class visit each patient. They serve as a resource to the patient's primary nurse. Following discharge, patients are contacted by telephone to find out how they are progressing and answer any questions.

A year after implementing the class, it was determined that the time taken to prepare patients for discharge teaching had decreased from 46.9 minutes to 17.08 minutes. The best outcome was the patient was very satisfied with the quality of education and preparation they received. This concept was presented at the Society of Urologic Nurses and Associates annual conference in Philadelphia and through aposter presentation at the National Magnet Conference in Salt Lake City in October. The beauty of this example of initiative is that a group of caregivers came together to brainstorm, gather data, make plans and implemented those plans to make a positive difference in patient care. The improvement made in the progression of care, and patient education has allowed us to better serve our patients and families.