There ain’t no can’t.

That’s the motto of the medical and surgical nursing staff at St. Francis Hospital in Federal Way.

The group was recently chosen as one of 16 nursing staffs in the country to take part in the “Transforming Care at the Bedside Collaborative” project.

The project is sponsored by the Robert Wood Johnson Foundation, with support provided by The George Washington University Medical Center School of Public Heath and Health Services and the American Organization of Nurse Executives.

The program was started in 2003. Chosen hospitals participate for three years, and more than 130 hospitals across the country have participated.

The St. Francis team submitted a proposal in January and were selected in March.

They first attended a conference in Philadelphia with the other nurses around the country, hence the “Rocky” reference — and yes they did run up those stairs.

“It really hit home with us,” director Pam Cronrath said of the “there ain’t no can’t” motto. “The sky’s the limit for the opportunity for change.”

Trying new things

St. Francis nurses will try different ideas for improving bedside manner and report back to the other hospitals on what worked and what didn’t work. The ideas all come from nurses who spend their time with the patients. Each idea starts very small, with a trial that expands slowly until it is incorporated.

“The most exciting thing is I have a say now in the care, rather than being told,” nurse Lucretia Shafer said. “It creates job satisfaction and empowers patients.”

Currently the hospital is testing three different projects to improve bedside manner and care. The first, which has passed the preliminary test and is now implemented in all third-floor rooms, is a large whiteboard in each room with a patients’ information, plan for the day, any procedures they might have, their level of pain and a potential discharge date.

“The patients like them,” nurse Carrie Williams said. “They participate; they are more involved in their own care.”

“It’s been very successful,” clinical manager Kay Lanier said. “We’ve had patients transfered (to another floor) and ask, ‘Where’s my board?’ We’ve had calls come in of patients saying ‘No one’s written on my board yet.'”

Making the rounds

A trial in the beginning phase includes a new way of doing nurses’ rounds.

The rounds are more frequent now, and with a set schedule, Williams said.

“It’s hourly now,” she said. “Before it was too random, not set in stone.”

Nurses ending their shift and those beginning theirs now make rounds together. In the past the procedure has been to record notes for each patient on a voice recorder, then at the beginning of a shift, all nurses would sit together and listen to numerous patient updates. Now, by rounding together and giving bedside reports, nurses only hear about their patients and the patients get to hear their own medical update.

“The report was often taped for all patients,” Cronrath said. “It wasted time. The goal is to increase bedtime and spend less time on paperwork. Nurses are very burdened with paperwork.”

Another way nurses are increasing bedside time is a new change that puts commonly used supplies in each room, rather than in a supply closet or cart at various locations in the hospital.

“The hunt-and-gather technique has been perfected by nurses,” Cronrath joked.

Another new item that the nurses have put together is a booklet for each patient that has a first page for the patient to put in their information, then several black pages so patients can write down any questions they might have for a doctor later, or write down notes for when the doctor is there. The booklets also come with a pen so patients don’t have to search for one.

The hospital recently received some Capstone funding grant and created a patient orientation video, which gives visuals and the procedures they will use in the hospital — from ordering food to adjusting the bed. The videos will be given in advance to patients coming in for surgery, and will be shown to non-scheduled patients once they are in their rooms.

“It’s small tests of change,” Shafer said. “You tweak it, if it works, continue. That’s the beauty of it.”

“You don’t start with a massive change,” Cronrath added. “You develop the perfect plan, make small changes. It’s a huge shift in thinking and the product is more sustainable.”