Running head: USE OF A NURSE COORDINATOR FOR ADMIT AND DISCHARGE 1

Use of a Nurse Coordinator for Admit and Discharge Process in a Hospital Unit: Does it Improve
Patient Care and Satisfaction?
Sara Young
Ferris State University

USE OF A NURSE COORDINATOR FOR ADMIT AND DISCHARGE 2
Abstract
Responsibilities of the floor nurse include not only direct patient care, but increasing volume of
admissions and discharges due to rapid patient turnover and shortened lengths of stay in the
hospital setting. The admission-discharge process is lengthy, creating fragmentation in patient
care. The utilization of an admission-discharge nurse/coordinator to the unit to facilitate the
admission-discharge process has been demonstrated in studies to improve patient satisfaction as
well as patient safety.
Keywords: patient safety, patient satisfaction, admission, discharge

USE OF A NURSE COORDINATOR FOR ADMIT AND DISCHARGE 3
Use of a Nurse Coordinator for Admit and Discharge Process in a Hospital Unit: Does it Improve
Patient Care and Satisfaction?
The daily roles and responsibilities of the registered nurse on the hospital unit continue to
increase. Nurses are expected to take increased patient loads in an effort to reduce hospital
expenditure. This can create stress on units that are already understaffed and caring for patients
needing additional care due to their higher acuity levels. While insurance companies tend to
dictate length of stay for patients, hospitals are realizing greater patient turnover which puts
nursing in the position of spending more time on admission and discharge assessments and less
time on direct patient care. Ultimately, the result may be lowered patient satisfaction scores and
less hospital reimbursement. The purpose of this paper aims to determine if the creation of an
admission and discharge nurse coordinator on a hospital unit would be beneficial to patient care
and satisfaction.
Does the addition of a nurse coordinator to the hospital unit to facilitate the admission or
discharge process improve patient care and satisfaction compared to current practice
without the use of a nurse coordinator?
Currently, in the midst of direct patient care, the floor nurse continues to be responsible
in the admission and discharge process. When a patient is admitted to the floor, the patient
profile must be accurately updated: current list of medicines, medical conditions and any status
changes are noted. A physical examination that includes vitals, wound and skin descriptions,
level of consciousness, swallow evaluation along with a general review of body systems are
charted. Discharge planning and needs also begin at this time: the need for potential home care
and services requires coordinating efforts with case management and possibly social work. This
process can take as long as 1.5 hours (Spiva & Johnson, 2012, p. 91).
USE OF A NURSE COORDINATOR FOR ADMIT AND DISCHARGE 4
Upon discharge, it is the nurse that must make sure coordination of care among referring
providers has been met, that discharge instructions are delivered accurately, medication changes
are understood by the patient along with follow up appointments to the appropriate providers
noted. Special needs such as medical home supplies, support services and prescriptions need
clear instruction to patient and families. These processes take time. However, they create a
reduction and fragmentation of nursing care delivered to other patients. The reverse can be stated
as well: the high acuity and needs of some patients may keep the nurse from providing adequate
discharge instructions and planning.
Cutting corners in any of these aspects of nursing can have safety and quality
consequences for patients and the hospital. Delays in admission process can delay problem
identification and implementation of treatment: utilization of a quality admission and discharge
process is essential for safe and comprehensive patient care (Lane, Jackson, Odom, Cannella,
and Hinshaw, 2009). It is therefore useful to examine if the utilization and creation of an
admission and discharge (AD) nurse coordinator will improve patient satisfaction.
Methodology
A search of the databases CINAHL, Pub Med, AHRQ and the Cochrane Review site was
conducted for previous and current research regarding use of nurse coordinators and/or
admission and discharge (AD) nurses. Very little research was discovered, indicating lack of
study, however an analysis of three current reviews provide research indicating that patient
satisfaction and safety is improved when an AD nurse/coordinator is utilized to facilitate these
processes in the hospital setting. Research that is specific to nursing is the science of refining and
validating current knowledge to generate new knowledge that potentially influences the delivery
of evidence-based practice (Nieswiadomy, 2012, p. 3).
USE OF A NURSE COORDINATOR FOR ADMIT AND DISCHARGE 5
Strength or level of evidence shall be considered when reviewing nursing research.
According to Melnyk & Fineout-Overholt (2011), there are seven levels of evidence taken into
consideration for review of literature. Level 1 is the highest level of evidence and includes
research that is a systematic review and meta-analysis of randomized controlled trials with
clinical guidelines. Level 2 is a study of only one or more randomized controlled trials; level 3 is
a controlled trial with no randomization; level 4 is a case-control or cohort study; level 5
involves a systematic review of descriptive and qualitative studies; level 6 is a single descriptive
or qualitative study; and level 7, which is the lowest level of evidence is composed of expert
opinion.
Review of Literature
Article One
The article by Spiva and Johnson (2012) takes a look at the clinical issue of whether or
not creation of an admission and discharge team would improve nurse and patient satisfaction
and quality. Spiva, who has a doctorate and is a personalized legal nurse consultant, and
Johnson, who is a baccalaureate trained nurse, conducted a survey of a convenience sample of
136 registered nurses at a 633 bed hospital in southeastern United States. A pre-post quantitative
design using an ordinal scale of 1 (strongly disagree) to 5 (strongly agree) was used to evaluate
nurse satisfaction with use of an admission-discharge (AD) nurse. Additionally, patient
satisfaction was measured by use of data obtained from the Press Ganey Survey and compared to
prior scores. Overall, nurse satisfaction increased from a mean satisfaction score of 36.24 (pre-
implementation) to 39.05 (post implementation of AD nurse) with free-text comments such as I
found that admission nurses have made a huge impact on the quality of care I can provide to my
patients (Spiva & Johnson, 2012). Patient satisfaction in the admitting process had a mean score
USE OF A NURSE COORDINATOR FOR ADMIT AND DISCHARGE 6
of 92.1 post-implementation as compared to 90.7 pre-implementation. It is also important to note
that a random sample of 50 charts post-implementation discovered documentation improvements
in all areas in terms of education, plan of care, pain assessments, vaccine screenings, and
medication reconciliation as compared to 50 charts pre-implementation (Spiva & Johnson, 2012,
p.92). Accuracy in documentation provides quality patient care.
This study is a level of evidence 5 according to the Melnyk & Fineout-Overholt scale.
Although limitations include a small sample size, the significance to nursing provides enough
evidence of patient satisfaction and improved quality standards to consider additional studies on
a larger scale. This study is significant to hospitals and nurses who value high quality patient
care and satisfaction scores.
Article Two
The goal of this 2009 study by Lane, who holds a doctorate (PhD) and registered nursing
(RN)degree, Jackson- a masters in nursing (MSN), Odom- doctorate in nursing science (DNS),
Cannella- PhD and clinical nurse specialist (board certified), and Hinshaw, RN, was to evaluate
the effect of a nurse admission, discharge and teaching position on nurse satisfaction and quality
of admission and discharge process. Quantitative data was obtained using a pre/post-test design
from 18 registered nurses on a 37 bed orthopedic unit in a southeast United States hospital.
Surveys conducted used a Likert-type scale to rate the satisfaction by nurses of the admission
and discharge process pre and post implementation of an AD nurse. Additionally, data was
gathered from job satisfaction scores from the National Database of Nursing Quality Indicators
(NDNQI) survey taken by the same 18 unit nurses. The NDNQI survey is used as part of the
Magnet application process by hospitals in which data can be used by hospitals to set goals,
develop interventions, and improve patient outcomes (Lane, et al., 2012). The mean nurse
USE OF A NURSE COORDINATOR FOR ADMIT AND DISCHARGE 7
satisfaction score pre-implementation of an AD nurse was 29.10; post-implementation was 44.7.
A retrospective medical chart audit indicated that the medication reconciliation rate increased
from 18% Pre-AD to 100% post-AD. The NDNQI survey indicated a 25% increase in job
satisfaction; the variable had enough time with patients increased by 38% (Lane, et al., 2009,
p. 150).
This research would be considered level 5 based on the Melnyk & Fineout-Overholt
scale. While this article focused on nurse satisfaction and the sample size is small, it is important
to consider the indirect results of the improved satisfaction: patient satisfaction. If nurses express
satisfaction with their ability to provide high quality direct nursing care, patient satisfaction will
improve. Improvements were observed in charting as well, which is a quality and safety
measure for patients and hospitals.
Article Three
The purpose of the study by Longworth, BSN, Larraz, BSN, Ciaramella, RN and Murphy, BSN,
(2013), was to evaluate the position of a discharge nurse on a mother-baby unit. The goal of the
discharge nurse was to improve consistency with patient education and satisfaction and assist in
timely discharges. Method of evaluation was quantitative and obtained through use of a Hospital
Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey and Press Ganey
scores of patients post-discharge. Post-intervention scores were compared to scores pre-
intervention scores. The discharge nurse was trialed for three months. Post-intervention scores
validated an increase in patient satisfaction. The study further noted that nursing verbalized
increased satisfaction as they had more time to monitor, care for and teach patients with less
fragmentation (Longworth, Larraz, Ciaramella, & Murphy, 2013).
USE OF A NURSE COORDINATOR FOR ADMIT AND DISCHARGE 8
This study had obvious limitations: there was lack of actual numerical data such as
number of patients surveyed and how much satisfaction actually increased. This evidence is level
5 based on the Melnyk & Fineout-Overholt scale. While no actual numerical data was presented
in the study, it does produce similar results obtained in previous studies: improved patient
satisfaction with utilization of an admission-discharge nurse/coordinator. Further research a
larger scale study is warranted to validate this intervention as evidence based practice.
Significance to Nursing
As a profession, nurses have the obligation to deliver safe and quality care based on the
latest research and evidence based practice. Standard nine of the American Nurse Association
(ANA) Standards of Scope and Practice states that nurses shall integrate these findings into
practice and continue to always evaluate new evidence and research for practice changes (ANA,
2012, p.138). The clinical issue evaluated in this paper attempts to demonstrate that use of an
admission-discharge nurse/coordinator would be both beneficial to patient satisfaction and
patient safety. While there is not much research available in general or from a large scale study,
evidence shows improvements and positive outcomes as a result of the intervention. Patient
safety is priority.
Quality and Safety Education for Nurses (QSEN) goals include strategies and
competencies in pre-licensure and graduate programs to effectively develop nurses in the areas
of patient-centered care, teamwork and collaboration, evidence-based practice, quality
improvement, safety, and informatics (QSEN, 2014). These strategies will help prepare nurses to
deliver care that uses clinical judgment based on sound research. It encourages nurses to always
seek improvements in nursing care, keeping patient safety at the forefront.
USE OF A NURSE COORDINATOR FOR ADMIT AND DISCHARGE 9
It is recommended that hospitals consider the use of an admission-discharge
nurse/coordinator. Studies demonstrate that the utilization of such a position will not only
improve nurse and patient satisfaction, but also improve patient safety.

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References
American Nurses Association (ANA). (2012). The essential guide to nursing practice: Applying
ANAs scope and standards in practice and education. Silver Spring, MD: Author.
Lane, B.S., Jackson, J., Odom, S.E., Cannella, K.A., & Hinshaw, L. (2009). Nurse satisfaction
and creation of an admission, discharge, and teaching nurse position. Journal of Nursing
Care Quality, 24, 148-152.
Longworth, N., Larraz, L., Ciaramella, J., & Murphy, S. (2013). The implementation of the
discharge nurse on a mother-baby unit: A conduit to increased patient satisfaction.
Journal of Obstetric, Gynecologic and Neonatal Nursing, 42, s4-s5. doi: 10.1111/1552-
6909.12051
Nieswiadomy, R. M. (2012). Foundations of nursing research (6th ed.). Boston, MA: Pearson.
Spiva, L., & Johnson, D. (2012). Improving nursing satisfaction and quality through the creation
of admission and discharge nurse team. Journal of Nursing Care Quality, 27, 89-93. doi:
10.1097/NCQ.0b013e318227d645
QSEN Institute. (2014). Competencies. Retrieved from http://qsen.org/competencies/