Who Has Time to Admit?
from Caring For Our Future, Fall 2003
By Susan Hancock, BSN and Jan Kersey, MS, BSN
The Role Of the Admission Facilitator Nurse
This project was a poster presentation at the 13th annual conference of the Society of Pediatric Nurses in Kansas City in April.
Background/Purpose
Many hospitals are faced with nursing vacancies and the difficulty of meeting staffing needs. In addition, shortened lengths stay may result in patient turnover. Thus, the admission process becomes very time-consuming and is an added stressor to the already high activity of any nursing assignment. Patients may wait in the ED, PACU and clinics due to lack of beds. Flexible options to respond to these challenges were explored, and a new position, the Admission Facilitator Nurse (AFN), was created and piloted on a system-wide basis.
The purpose of the AFN is to provide busy hospital units assistance with the admission and transfer of patients. AFN responsibilities include:
- Ensuring that the available room is prepared for the patient being admitted;
- Assisting with the transfer of patients to their assigned units;
- Completing initial assessment, vital signs, height, weight, and documenting this information;
- Orienting patients and families to the hospital admitting unit;
- Responding to the immediate needs and concerns of the patient and family;
- Introducing the patient and family to their patient-care nurse and giving the assigned nurse an admission report.
Implementation
The role was initiated in February 2002 during a typically busy time of year. Two experienced pediatric nurses share the AFN position. These nurses carry pagers and portable phones so they can be accessed by any of the units. The highest admission and discharge times were determined to be between 10:30 a.m. and 9 p.m. The AFNs begin their shift by attending “Bed Meeting” to identify and prioritize assistance and to maintain open communication throughout the shift with the nursing supervisors who coordinate patient placement. The AFN admits some of the patients; others continue to be admitted by the patient-care nurses.
Evaluation
Daily tracking logs are kept of activities and trends in utilization of the role. A formal evaluation at nine months included staff satisfaction surveys and analysis of the tracking logs. Initial response indicated the position is strongly supported and appreciated by the nurses. Specific strengths of the AFN cited by staff include: excellent communication, willingness to help, quicker admittance for patients, and a consistent admission process. Patient-care nurses reported being able to spend more time at the bedside and immediate intervention is provided for unstable patients. There is also a smoother transition for patients and families from the holding unit to the admitting unit.
Analysis of utilization of the role showed 78 percent of the AFN’s time is spent on direct patient care, with 7 percent spent on rounds, 5 percent at bed meetings and 9 percent on other tasks. Of the units using the AFN for admissions/transfers, patients originated predominantly from the PACU (35 percent) and ED (33 percent), while the destination units primarily were 3 North (46 percent), 4 North (27 percent), and 5 North (20 percent).
Challenges with the AFN role can be communication between units, assistance requested for activities unrelated to patient care, availability/readiness of patient rooms, and the actual time consumed by one admission/transfer, making the AFN unavailable to other units for long periods. Suggestions for improvement included having more than one AFN available every day and having an AFN on weekends, especially during respiratory season
Significance
Assisting with the admission process does more than ease the workload for the bedside staff nurse. Patients and families are able to receive the individual time and attention they want and need when faced with the stressful situation of a hospitalized child. The AFN also serves as the hospital ambassador who gives the first impression to the patient and family.
