Melanie Jessup1, Paul Fulbrook 2, Frances Kinnear 3
1 The Prince Charles Hospital/Australian Catholic University, Rode Rd, Brisbane, Queensland, 4032; Melanie.Jessup@health.qld.gov.au
2 The Prince Charles Hospital/Australian Catholic University, Rode Rd, Brisbane, Queensland, Australia, 4032; Paul.Fulbrook@health.qld.gov.au
3 The Prince Charles Hospital, Rode Rd, Brisbane, Queensland, Australia 4032,:Frances.Kinnear@health.qld.gov.au
Aim: To evaluate the implementation of an emergency department (ED) Nurse Navigator role via staff feedback.
Background: It is well-documented that prolonged ED stays have an impact on patients, staff and quality of care. The challenge is to find innovative strategies to facilitate patient flow. Nurse Navigators have been suggested. However, their role in supporting staff in care delivery to facilitate efficient, timely movement of patients through ED has lacked rigourous evaluation.
As part of a mixed method, controlled observation study, a supernumerary ED Nurse Navigator was implemented on a week-off-week-on basis for a 20-week period. The Navigator’s role was to monitor patient timelines, highlighting those approaching target times, identifying and troubleshooting crisis areas, and undertaking time-consuming tasks, such as co-ordinating bookings and patient transfers, updating patient information, and facilitating referrals and decision-making; thus assisting patients’ movement through ED and freeing team leaders to focus on overall flow. Primary patient data and focus group feedback were collected during the study.
A key component of the final evaluation of the Navigator role was an online staff survey, conducted following completion of the study.
Method: Online survey data were collected in the 5-month period following the implementation phase of the Navigator role. Sixty-six respondents were included in the analysis [Table 1]. The Navigator Role Evaluation scale demonstrated very good internal consistency, with a Cronbach’s alpha coefficient of .94.
Results: Sum scores for the 24 items were calculated and then expressed as a percentage to indicate overall evaluation, with higher scores indicating more positive views [Table 6]. In terms of professional group, doctors’, nurses’, and other staff’s overall evaluations scores were similar. However, some within group differences between nursing grades were noted, with grade 5 RNs scoring significantly higher than higher grade RNs.
As additional comments, respondents reported differing levels of interaction and satisfaction with the Navigator role. Staff commented on the manner in which the incumbents enacted the role, its value to the department – both in terms of financial and overall flow benefits, its impact on both their own clinical role and on the department. Suggestions on how to augment the role included criteria for selection and training of the Navigator, and clarification of role and responsibility assignment.
Conclusion: Staff input into the evaluation of the Navigator role has yielded invaluable insider feedback for ensuing modification and has rendered a sense of departmental ownership.
Table 1. Respondents’ characteristics
|Years worked in study ED||
|< 1||1-5||Ø 5|
|Medical staff (n = 22, 33.3%)||Senior Medical Officer||0||6||4||10 (15.2)|
|Junior doctor ACEM registered||2||7||2||11 (16.7)|
|Junior doctor non-ACEM registered||0||0||1||1 (1.5)|
|Nursing staff (n = 34, 51.5%)||Grade 6 or above RN||0||2||9||11 (16.7)|
|Grade 5 RN||2||16||5||23 (34.8)|
(n = 10, 15.2%)
|Allied Health staff/HITH nurses||0||2||1||3 (4.5)|
|Total||5 (7.6)||37 (56.0)||24 (36.4)||66 (100)|
Table 2. Overall role evaluation by professional group
Mean score (%)
|Medical staff (n = 22, 33.3%)||Senior Medical Officer (n = 10)||68.0||
|Junior doctor ACEM registered (n = 11)||64.6|
|Junior doctor non-ACEM registered (n = 1)||75.0|
|Nursing staff (n = 34, 51.5%)||Grade 6 or above RN (n = 11)||59.6||67.2|
|Grade 5 RN (n = 23)||70.8|
(n = 10, 15.2%)
|Administration staff (n = 6)||74.6||
|Wardsperson (n = 1)||55.0|
|Allied Health staff/HITH nurses (n = 3)||60.3|
Dr Melanie Jessup RN, BN (Hons1), PhD, facilitates clinical research and supervises visiting researchers/higher degree students. She collaborates with multidisciplinary teams researching cystic fibrosis care, and efficacy of emergency department processes, enjoying current collaborations with Queensland Ambulance Service and CSIRO’s Australian eHealth Research Centre. She is developing a research program around falls: causes, context, and potential solutions, including multi-disciplinary assessment of patients presenting to ED post fall to circumvent admission.