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University Hospitals Needs More Nurses As Patient Count Rises

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IOWA CITY - Big increases in patient numbers in recent months left University Hospitals scrambling to add nurses to the front lines of patient care.

New hires must go through orientation from six to 12 weeks, depending on the unit and experience of the nurse so that has meant overtime and extra shifts for existing staff, as they wait for more nurses to come through the pipeline.

Hospitals in Cedar Rapids haven't seen patient growth to the extent University Hospitals has, though St. Luke's is seeing about 15 to 30 more patients a day in recent months and overall hiring is up slightly compared to last year, officials there said.

At University Hospitals, the increased patient volume led officials to implement the hospital incident command system, a designation for emergencies that allows them to hire and get nurses on the job quicker.

Several nurses said at first the overtime was welcomed, coming off a year when patient numbers were down, overtime was scarce and there was a hiring freeze. The increased load of the past months left some frazzled, though.

"As the overtime needs increased, it was stressful. People were getting burned out on working the overtime," said Dawn Sander, a medical surgical oncology nurse.

It was rare for Debra Akerly, a nurse in the surgical intensive care unit, to have a day off without getting three or four calls about covering an open shift, she said. The stress has let up in the past few weeks with the addition of new hires on her floor.

"Our whole division was at a disadvantage because we had a hiring freeze for so long, so nurse numbers were down," she said.

By the end of this month, University Hospitals will have hired 142 nurses since July 1, the start of the fiscal year. That's compared to 19 nurses hired in that four-month period last year and 116 nurses hired in all of fiscal 2010.

The hiring stems mostly from increased patient numbers, a trend that began during the summer months. Officials attribute that to declining unemployment, which is typically followed by more hospital visits, and a hospital push to expand certain specialties.

The daily inpatient census is up about 50 to 70 patients so far this year, Chief Nursing Officer Ann Williamson said. The average daily census was 556 in fiscal 2009 and 533 in fiscal 2010. So far this year, daily numbers run 540 to 630, she said.

'We have met our staffing needs ... it was just the difficulty in doing so," she said. "Many of our nurses are working extra hours to help out while we 'onboard' new hires. They're grateful for the extra work and extra money, but then everybody gets tired."

By Nov. 1, hospital officials expect three-fourths of new nurses will be through orientation.

St. Luke's in Cedar Rapids also has seen higher patient volumes the past several months, with the daily census up about 15 to 30 patients, said Carmen Kinrade, director of nursing operations.

"It's so up and down. It's very, very busy during the week. Then the weekend slows down," she said, "but the feel is that the volume is much different."

St. Lukes hired more nurses in targeted areas and in the float pool, she said. Overall, hospital hiring so far this calendar year is 30 people ahead of total hiring last year, she said.

At Mercy Medical Center in Cedar Rapids, the daily census has seemed more volatile than usual, but it likely will average out to about normal, said Laura Reed, operations director for inpatient services. Mercy continues to hire, but it hasnt been beyond the norm, she said.

University Hospitals boosted the voluntary overtime incentive for nurses, from an extra $10 per hour to an extra $15 per hour. Nurse managers also are working shifts, and the hospital brought in a dozen traveling nurses, who travel the country and work for weeks at a time at a location. Using traveling nurses is unusual for the UI hospital, Williamson said.

St. Luke's in Cedar Rapids has four traveling nurses.

The general medicine floor at University Hospitals, where nurse Anne Gentil-Archer works, is always busy these days, she said. Instead of caring for four or five patients during a 12-hour shift, she said, a nurse might have six. Her floor has seen an increase in patient falls, she said.

"The big change for us is that our rule of not having six patients sometimes goes by the wayside, just because we don't have enough nurses," Gentil-Archer said. "It makes it very difficult."

Williamson said the nurse-to-patient ratio at University Hospitals ranges from 1-to-1 in intensive and critical care units to about 1-to-5 in other units. She said the patient experience remains a priority. The hospital had planned to add nurses in a few units to boost the patient experience, even before the census numbers climbed, Williamson said.

While patient satisfaction rates vary by department, overall patient satisfaction with University Hospitals has been on an upward trend in the past two years, officials said. In July 2009, 87.8 percent of adult patients surveyed would recommend the hospital; that score was 89.1 percent this July, though it was 87.4 percent in August.

"This July was one of our highest months ever for likely to recommend," Williamson said. "We are constantly looking at our satisfaction results."

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