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NEW HANOVER COUNTY — Novant New Hanover Regional Medical Center is hiring more contract workers after cutting several contracts earlier this year, according to a recently released action plan.
The report shows that more than 120 travel nurses were hired between June 30 and July 22, with more likely to arrive.
Read more: Fed report confirms Novant’s understaffing, nurses’ list of PCD problem extends beyond ER
In the year On August 30, Novant released its action plan to address the “immediate crisis” situation at the Centers for Medicare and Medicaid Services. A federal agency has threatened to revoke NHRMC’s Medicare coverage for hospital conditions that could result in serious injury, damage, disability or death to a patient.
NHRMC’s immediate emergency status has been withdrawn.
The CMS findings follow investigators’ observations from June 21 to June 29, about a month after Novant decided to reduce its reliance on travel nurses. Novant did not provide PCD with information on how many travel nurses’ contracts were terminated. However, three nurses told PCD that the hospital relies heavily on travelers, staffing 30% to 50% of its wards with them.
Novant created an action plan to address security breaches at CMS. In several cases, the NHRMC has allegedly failed to provide adequate manpower in the emergency department and, as nurses have confirmed, other departments are also running understaffed.
At the core of NHRMC’s problem are: Staffing shortages affect the hospital’s ability to perform effectively in all areas. If a department is understaffed, it affects the connected ecosystem of the hospital.
Novant’s action plan details its efforts to increase contract labor.
In response to the dire situation — a 138:13 patient-to-nurse ratio in the ER on June 21 — Novant took steps to hire rapid response travel nurses.
According to the report, NHRMC’s chief nurse executive — who has not been named, although Amy Akers holds the position, according to the hospital’s website — on June 29 requested rapid response itinerant, temporary nurses to fill urgent and critical positions. A contract with the agency — which has not been named — was approved July 5 to provide emergency response personnel within 10 days.
On July 11, 20 traveling nurses arrived.
In the year In an Aug. 24 Novant press release reviewing the action plan, Akers said Novant had been “relentless” in its recruiting efforts. The report shows that since June 28, employees have participated in five local hiring events.
Novant improves contract worker incentives.
On June 24, a new travel agency was approved, including 18 specifically for the ER, to help find more clinical nursing positions. Novant has extended contract lengths to 26 weeks and up to 48 hours per week to attract candidates. Also, travel nurse rates have increased “depending on the area of operation.”
The report says contract rates for ER nurses have doubled in the past two months, while medical/surgical, labor and delivery and ICU rates have increased once, though the report does not specify by how much. Novant would not share salary numbers, according to a spokeswoman.
As of June 30, the report said NHRMC had 116 active travel nurse contracts, 25 other travel nurse contracts, but requested to hire another 182 travel nurses.
About a month later, on July 22, NHRMC received 46 active contracts and another seven pending contracts. According to the report, 70 more contracts have been confirmed with future start dates.
Still, NHRMC has asked to hire 72 more journeymen by the end of July.
Earlier, a Novant spokesperson told PCD, the hospital hopes to grow its contract work to 315 positions. Novant filled or applied for 291 positions, according to the report.
As for permanent staffing, on June 22, the Chief Nurse Executive requested eight more AR nurses and 16 medical/surgical nurses — two categories that are too low, according to Nurse Credentials.
According to the report, 88 nurse graduates started work on July 11, and 31 are scheduled to start work by the end of August. Between July 11 and 25, 10 care associates, three ED techs, nine nursing assistants and seven medical professionals were hired.
Inadequate staffing was only one area of improvement identified in Novant’s action plan, although inadequate staffing affects all aspects of the hospital. The plan also details corrections in other areas, including the hospital’s triage process, denial of care obligations, use of chemical restraints and other emergency department procedures.
The CMS report detailed several instances in which the hospital’s ER triage process was not properly followed.
A victim of that deficiency, a 77-year-old woman who coded in the ER waiting room, spent more than five hours in the admissions hall, and her vital signs went unchecked for four — a violation of the identification policy.
Novant’s plan involves re-educating nurses on the measurement process, including the so-called “ESI scale,” based on the severity of symptoms. An explanation of the triage policy is that patients presenting with 1 ESI will be seen immediately and 2 will be taken to the waiting room and reassessed at least hourly. ESI Levels 3, 4 and 5 are reassessed every four hours.
The new policy clarifies that vitals should be rechecked no more than every four hours as needed. The policy was last approved on July 15, 2022.
The report says an emergency department coordinator will review at least 20 people who wait more than four hours to recheck vital signs. This process continues for four consecutive weeks until compliance is achieved and the issues are resolved, moving to a monthly review for three consecutive months.
To monitor patient wait times, the charge nurse monitors a tracking board that shows how many patients are in the waiting room. The board helps inform when the patient’s baseline needs to be reassessed. Nurses and clinical team members are required to be on hand before starting a shift.
NHRMC is tasked with improving and reducing EMS turnaround time. The CMS report cited numerous delays in EMS unloading, with trucks sometimes waiting for hours to get their patients into the building. Improvements there include providing a charge nurse to oversee the return process between EMS vehicles and the ER. Updates will be reviewed monthly.
Hospital staff were also instructed to improve their response to patients who refused care. The CMS report found several cases where staff did not follow protocol when a patient was absent. The policy is reviewed and staff are educated on the requirements.
A weekly audit of 30 patients who went without being seen or against medical advice was started. From September 1, the sample size will be reduced to 60 charts per month and will continue to be observed for up to four consecutive months.
NHRMC also failed to properly document chemical restraint or sedation in several cases of combat patients. The facility is permitted to use certain medications to relieve a patient who poses a physical danger to staff or other patients, although the restriction must be documented.
Novant has updated its policy on the use of chemical restraints. Unless otherwise determined by the chemical control supplier, personnel shall be logged every 15 minutes per hour, every 30 minutes per hour, or every two hours per hour. The Patient Safety Manager completes a daily review of chemical restriction orders to monitor compliance. The policy came into effect from July 24.
Data on the use of chemical restraints will be reported for three consecutive months until compliance is achieved and then reviewed quarterly.
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