P-148 Innovations for IBD RN Role Development Using

Abstract

BACKGROUND: Without a conscious effort to define nursing practice, the RN contribution to care may not reach its full potential. Due to staffing limitations, nurses have to set clear priorities and implement strategies to optimize their practice. In our GI department, several clinical practice innovations over the past 3 years have promoted increased efficiency and effectiveness of the IBD RN role. The first innovation was the reorganization of RN work assignments which promoted continuity of care. Instead of working to support clinic or answer phone calls, we now work with a select patient group. We work in clinic seeing patients with the providers simultaneously with taking phone calls and managing other between clinic tasks for our patient group. The second innovation was the development of the IBD Center which increased interdisciplinary collaboration. Our IBD team includes an IBD Psychologist, a Social Worker, Registered Dieticians, Advanced Practice Providers, and Medical Assistants in addition to the Gastroenterologist and IBD nurse. The third innovation was the clear definition of the IBD RN contribution to care. Our short term goal of practice is patient safety and compliance which includes clear communication and education. The long term goal for our pediatric patients with IBD is promoting life long positive attitudes. To implement our goals on a daily basis, our hospital's chosen care delivery model, “Relationship based Family Centered Care,” works well with the addition of targeted case management. METHODS: Each innovation will be outlined so that RNs can examine their own setting and apply the principles we used to develop their own practice. To address the reorganization of work assignments, RN FTE allocations will be discussed with respect to provider FTE and patient visit volumes. For optimal continuity in our practice, we combined the traditional office work with clinic work. We prioritize meeting patients and families in person. The strategies used in our daily time management will be shared. Having a focus to the RN contribution is the RNs' value system for setting priorities on a minute to minute basis so the difference between a defined work process versus a job focus will be outlined to help RNs put theory into practice RESULTS: Getting to know individual patients and their families, working personally over time dramatically increased efficiency, effectiveness of communications, and understanding of family needs. Establishing a valued relationship is a powerful tool to influence. Working together as an IBD center allowed us to know the patient and family more completely. The RN is essential on the team to aid in identification of patients with poor compliance, dissatisfactions, and misunderstandings which can develop into poor health practices without support and education. CONCLUSIONS: Children with IBD have a life long condition which will benefit tremendously by establishing positive attitudes and behaviors towards health maintenance. By consciously defining how we implement our RN jobs we have become more effective in working with our patients. Maintaining continuity in our practice and using targeted case management strategies promotes working closely with families at critical time periods to establish positive patient outcomes.