NAPs and Their Role in Safety by Kristy Fillmore | Episode 1 - Amplified RN News Show
ANA\California Member and media-trained nurse, Kristy Fillmore, MScN, RN, NPD-BC, CPHQ, discusses how nurses can potentially advance patient care through better use of nursing assistant personnel (NAPs).
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Jared Fesler 0:15
Welcome to the Amplified RN News Show where we're turning up the volume on nursing news in California. Today we're going to be diving in the topic of Advancing Patient Care: Nursing Assistant Personnel and their role in safety. We're joined today by Kristy Fillmore, an ANA\California member and media trained nurse. Thank you so much for joining us. Kristy, would you please introduce yourself and tell everyone a little bit why you're an expert on this topic?
Kristy Fillmore 0:40
Yes, thank you, Jared. So my name is Kristy Fillmore as Jared mentioned, and I'm a registered nurse. I've been a registered nurse for over 20 years - I can't believe that - Masters prepared. I am a board certified in nursing professional development and a certified professional health care quality. I also have been working in hospitals most of my career, right now I'm in Southern California working in a nursing professional development role, where I focus most of my project work through the lens of quality and patient safety. I'm also a PhD student and the topic that my research is interested in or focused on is nurse practice environments, specifically with nursing assistants in hospitals and their implications for patient safety.
Jared Fesler 1:19
Thank you so much, Kristy, for that background. It is such an interesting topic watching the pandemic, knowing nurses are being overwhelmed having duties on top of duties. So what is the problem? Now currently with using nursing assistant personnel? Can you tell us a little bit more about this topic?
Kristy Fillmore 1:39
Absolutely. So I wouldn't say there's an identified problem, per se, there's not a lot of research currently about nursing assistants in hospitals in general. However, in terms of patient safety, a concern specifically is the education training standards. So for example, on California, nursing assistants can go through a certified nursing assistant training program, I'm not specifically meant for long term care. So the state mandates training and education and supervised clinical practice for nursing assistants and long term care. But that's not the case in hospitals. And so in terms of our quality, and patient safety outcomes, we have a real opportunity to look at that, especially with the increased nursing shortages and burnout and turnover, and just overall workload and the nurses are facing. So that's basically what I'm interested in. There's not just there's just not a lot of empirical research out there. And so that's kind of the focus, I'd like to take my research anyway.
Jared Fesler 2:32
And you said there is some research, what is this research currently pointing to? Or? Or what were the results of that research? And why is this creating an issue for nurses at the bedside?
Kristy Fillmore 2:45
Yeah, so there's actually limited data on certified nursing assistants in California. However, there have been studies usually in the context of, of nurse staffing models or that type of thing. So what they have found, some studies have found that are actually worse patient outcomes when nursing assistants are used in a substitute role. So for example, they're providing nursing care, because for example, nurses are in short supply, or there are studies that show you know, adverse patient outcomes when nursing assistants are added into a model of care in which perhaps registered nurses were the only care providers at that time.
Jared Fesler 3:24
And you believe that because there's limited data that this might not be the full picture?
Kristy Fillmore 3:28
Absolutely. There's so much variation, especially because the role is not standardized. It creates a lot of uncertainty in terms of what what is the role? What is the scope, the expectations, that type of thing. There's no minimum requirement for nursing assistants, for example, on nursing unit, so you may have one you may have three in California. Luckily, the nurses have the RN to patient ratio. So for example, this could potentially be a problem when the units like progressive care medical surgical units, or the RN is taking care of four to five patients at a time and relying on nursing assistants to delegate care, for example. So not knowing who they're delegating to or what the competency or education and skill level is, of the people that they're working with, can create a real problem for nurses in and even their ability to feel safe delegating to assistive personnel.
Jared Fesler 4:19
So, hospital leadership is looking into new ways to reduce the burden on nurses given that many are leaving the profession looking to lead the profession, what next steps would be needed in order to for hospital leadership to latch on to this idea to start utilizing nursing assistant personnel more?
Kristy Fillmore 4:45
Absolutely. I'm sure there are lots of hospitals who currently have great programs and that's something to that we'd love to hear about or I would love to know, what are the best practices out there. Utilizing the nursing education department this clinical nurse specialists the nursing professional development team Looking at the onboarding and orientation processes, and also collaborating and connecting with community partners. So for example, there are a lot of community education programs who are offering certified nursing assistant training, for example, and a lot of opportunity to collaborate and work with them to develop different programs or tailored programs, such as an acute care nursing program that that really focus on the outcomes that the hospital is trying to achieve. So not only quality, patient safety, but Well, specifically quality and patient safety, especially when it comes to under sensitive indicators and hospital acquired conditions. A lot of our care is provided, obviously, at the bedside. And that's where these nurse sensitive indicators or hospital current conditions start.
Jared Fesler 5:42
Are you currently aware of any case studies ongoing right now that might be looking to bring about some of this data?
Kristy Fillmore 5:51
Great question. Currently, in my own work, we're trying to partner with a community organization to do just that. And we're having a lot of good discussions and really excited about the opportunity there. One survey we did internally with some nursing assistants was was a great kind of foundational work to get a sense of, of what people are really thinking. So for example, our nursing assistants want more education, they they want more training, they feel a little underprepared. So in terms of their orientation, it wasn't necessarily long enough, especially for those who didn't have a certified nursing assistant program, that that supported their foundational experience. But yeah, so that's where we're starting. And hopefully, we can get more and more as the days go on and people get on board.
Jared Fesler 6:38
We'll have to have you back, Kristy, to talk a little bit more about that partnership you're in the works with right now. For those that are tuning in and listening, what would be some action items that they can take to help advance this topic for?
Kristy Fillmore 6:53
So I would say initially, you know, look at your practices, see what's going on in your own places of work. What are the workflows? What are the what are the relationships like? So there's a lot of concern about teamwork, right? So nursing assistants and registered nurses or the or the team, the direct care level, and really just digging into the culture of your organization and see where we're at and then looking at your practices for onboarding and education. And if there's opportunity to standardize or look for best practices, I would encourage people to do that.
Jared Fesler 7:25
Well, thank you, Kristy Fillmore so much for joining us here on the Amplified RN News Show, such an incredible topic. Super important given the light of nursing workforce retention today. Looking forward to having you back on the show here soon to talk more about it. Thank you everyone for tuning in. And we'll see you on the next episode of the Amplified RN News Show. Thank you!