Background 75% of hospital working time is out of hours. The Department of Health recognises that patient safety in hospitals during these hours is a significant problem and recommends this as an area for change 1,2. Hospital at night (HaN) services have been implemented to address this concern. The HaN ethos aims to deliver safe patient care by utilising the skill mix and competences of a centralised multidisciplinary team 3. Senior paediatric nurses are often more experienced than junior doctors at managing paediatric patients and delivering clinical care and are therefore suited to undertake coordinator roles in such settings. This enables them to undertake work traditionally performed by doctors and also provide support to ward nurses 4,5.
Aim To evaluate the effect of a HaN clinical nurse coordinator (CNC) on the workload of the medical team.
Method 8 senior nursing staff with advanced skills were recruited to pilot a clinical nursing HaN role for 6 months, between the hours of 18.00–02.00 daily. The nurses held the medical SHO bleep and were responsible for triaging, undertaking procedures, performing reviews and coordinating escalation of care.
A proforma was developed to gain quantitative evidence of the bleeps received, jobs completed and jobs escalated which was then used as an audit tool to analyse the effectiveness of the role. This was entered into an excel database and analysed monthly.
A qualitative questionnaire was sent to medical and nursing staff to get further feedback on the role.
Results Data was collected for 174 consecutive days during each CNC shift. The total number of jobs received was 3209. The CNC performed 784/1148 (68%) of procedures, 347/983 (35%) reviews, 84/430 (20%) prescriptions and 144/643 (22%) other jobs.
719/1060 (68%) of jobs were completed in less than 30 min.
100% of doctors reported that they had more time to complete tasks. 76% of nurses felt it enabled more direct patient care.
Conclusion This pilot evaluation shows that the CNC was able to perform a significant number of medical jobs. The role was valued by both nurses and doctors enabling more time for patient care. Following the success of this pilot scheme a full time HaN team has been appointed.
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