Tampa General zones in on nurse efficiency

As hospitals evolve over time, their physical layouts often tell the story of their history. Tampa (Fla.) General Hospital, which opened in 1927 on Davis Islands, is no exception.

What started as an 198-bed hospital nearly a century ago has grown into a sprawling, 981-bed academic health system. Over the years, new buildings have been added, creating a flagship hospital campus with a diverse patchwork of inpatient units of varying sizes and layouts. This complexity has created inefficiencies for modern-day care workflows, with nurses often having to travel far distances between patient assignments. 

"A nurse would have an assignment in one hall, have another patient way down the hall and sometimes have another patient over on the other side of the hall. So the ratios weren't off, but the distance they had to travel in order to care for their patients was far," Yuri Mykoo, MBA, BSN, senior vice president and chief nursing officer for Tampa General Hospital Davis Islands, told Becker's.

To improve efficiency and allow nurses more time for direct patient care, Tampa General implemented a zone-based nursing staffing model across all adult inpatient units at the flagship hospital in three phases, the first beginning in the second quarter of 2024. 

The model segments nurses into smaller geographic zones within their units, allowing them to focus on a defined set of patients located near each other. The zones are staffed by a pair of nurses and a certified nursing assistant or patient care technician who work closely together. Nurse-patient ratios are 4-to-1 on the units, with each team caring for no more than nine or 10 patients total. 

Despite the common framework, Mr. Mykoo noted it was important for each unit to design and arrange their own zones.

"Don't expect it to be cookie cutter," he said. "Give them the laterality to investigate what pattern works well for them in their zone, and then let them do the advanced work to see that it fits." 

Mr. Mykoo and Wendi Goodson-Celerin, DNP, executive vice president and chief nursing executive at Tampa General Hospital, said the new model has created numerous staffing and operational benefits. 

In post-implementation surveys, nurses said they felt like they had more time to spend with patients and had significantly fewer steps in a day. As a result, nurses had more time to spend on direct care activities. Early results show bedside shift reports have increased by 2% and purposeful hour rounding has risen 4% under the new staffing model. The hospital's nurse communication scores have also increased slightly over the past 10 months of the phased roll-out. 

In the previous staffing model, nurses would need to brief three or four nurses about patients at shift change. The new model requires nurses to brief just one or two colleagues.

"We don't have nurses waiting in line to give report or get report. Now, you may talk to one or two nurses, generally, maximum," Dr. Goodson-Celerin said. "So that has helped in a satisfier for our team, as well."

While leaders are still assessing the model's effect on incidental overtime, anecdotal reports suggest nurses are able to end their shifts sooner, as they don't have to wait to brief multiple people. At the same time, nurses taking over the next shift don't have to wait as long for reports, allowing them to spend more time with patients. 

The care team structure also gives nurses more freedom to take their lunch breaks, the leaders said. Nurse pairs within each unit coordinate break times at the start of each shift, with their partner covering their patient assignments during that time.

"That way you have a back-up and people get a chance to get off the floor," Mr. Mykoo said. "A 12-hour shift is a long time not to get a break, and so [this model] really lends itself to making that more possible."   

While the model initially faced some hesitation among nurses, Dr. Goodson-Celerin noted that buy-in grew once they tested it. Nurses realized that, despite occasionally having higher patient acuity workloads, the new zones improved efficiency and saved time.

To further refine the model, the hospital is harnessing tools within its Epic EHR to help leaders see and adjust nurse assignments based on patient acuity to ensure balanced workloads. Leaders plan to survey nurses again in six months and ultimately scale the model across the system. 

Dr. Goodson-Celerin emphasized the importance of involving front-line nurses throughout the entire process, noting that their input is essential for success. She stressed that their feedback, whether positive or negative, is crucial since they are the ones directly implementing the model. 

"It's key to keep your ear plugged in to them and work through whatever barriers they feel there are," she said. 

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