Unique Collaboration between Inpatient Hematopoietic Stem Cell Transplant Unit and Outpatient Hematopoietic Stem Cell Transplant Clinic to Address Staffing Challenges

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Topic Significance & Study Purpose/Background/Rationale Fluctuating patient census often requires inpatient nurses to float to other units in the hospital. When nurses float to unfamiliar units, it increases stress, anxiety and frustration which can negatively impact quality of care and patient safety. Methods, Intervention, & Analysis Due to concerns voiced by nurses on the hematopoietic stem cell transplant (HSCT) inpatient unit at an academic medical center, a unique collaboration was initiated between the inpatient HSCT unit and the outpatient HSCT clinic. Nurses from the HSCT inpatient unit floated either to a unit in the hospital or to the outpatient HSCT clinic. Staffing assignments were reviewed from January to September of 2019 to identify the frequency of floating in the HSCT inpatient nurse. Surveys regarding floating were constructed and emailed to HSCT inpatient and outpatient nurses and collected for 2 weeks. Findings & Interpretation Inpatient HSCT nurses floated 89 times (65 times to outpatient HSCT clinic, 6 times to different units during day shift, and 18 times to different units during night shift) during the assessment period. Inpatient nurses preferred to float to the outpatient HSCT clinic due to familiar patient population and the feeling of competence and confidence in providing quality nursing care for these patients. Inpatient nurses also experienced less distress with floating to the HSCT outpatient clinic. The outpatient clinic nurses reported that benefits of having HSCT inpatient nurses include familiarity with the HSCT patient population and improved continuity of care. Outpatient nurses added that because inpatient HSCT nurses are familiar with the processes of HSCT, they tend to need less help which takes less time away from patient care. Discussion & Implications When nurses are floated to an environment where they feel competent, the nurses' perception of stress, anxiety and frustration are greatly decreased. Due to the frequency of floating to the outpatient HSCT clinic, the importance of a more structured orientation to the clinic was discussed with leadership. Next steps would include reviewing the safety data over the trial timeframe to explore the number of safety events and developing a more systematic orientation to increase inpatient HSCT nurse competence in the outpatient clinic.