The Use of the Clinical Resource Nurse to Solve the Eternal Dilema of Financial Responsibility Versus Staffing Requirements

Abstract: Clinical Resource Nurse

• Purpose for the program:

This pilot quality improvement project provides data to support a creative option involving the use of a clinical resource nurse to support units with high percentages of new to practice staff. While also improving nursing satisfaction, complying with new staffing guidelines set by a professional organization, and improving patient flow.

• Proposed change:

A two week pilot project of the clinical resource nurse was implemented on a Labor and Delivery floor in an academic medical center with 772 beds. This concept was tested for four main reasons: increased acuity, new staffing guidelines, high percentages of new to practice staff, high percentages of nurse turnover rates and low nurse satisfaction scores. In order to implement the pilot project, an extra RN was assigned as the clinical resource nurse on every shift (excluding weekends) resulting in over budgeting (meant one extra RN from 7a-7p and from 7p-7a) for a two week period.

• Implementation, outcomes and evaluation:

A core group of nurses were selected to continue the role of CRN 24 hours day 7 days a week. A powerpoint was created as a resource for all staff and education continued surrounding the daily responsibilities of this nurse by a clinical level IV nurse. During the trial period this role focus on the use of the CRN on the labor and delivery floor, but upon implementation the scope of this role was expanded to be a resource for the newly developed Ante Partum unit. This requires the CRN to assess the APU every 4 hours and prn and assist with admissions and overseeing the management of nursing care for patients.

A pre and post survey was given to 32 nurses based on the Likert scale. Results showed increased perceived quality of care provided to patients and increased feelings of having the resources need for help when they need as well as increased perception of improved quality of patient care with 50% of respondents rating their care as excellent post trial as opposed to only 16% pre-trial. Decrease in incident reports noted

• Implications for nursing practice:

This pilot indicated that a CRN may be useful in areas with high rates of new to practice nurses. . In the short period of time, nurses reported increased perceived quality of care along with resources needed for complex patients. Patient flow was improved as well as possible improved quality of care related to the decrease in incident reports filed.

• Keywords: Resource, staffing, acuity, nursing satisfaction