Performance of nurses in the bed management service of a teaching hospital

descriptive, qualitative research inspired by Dubois theoretical model. 32 participants from the bed management unit and care units of a public hospital were interviewed from February to May 2018. Observations and data records from the Bed Management service complemented data collection. Theme/Category-Based Content Analysis was used.

Results:

the performance of nurses was described in three analysis matrices, represented by the categories: acquisition, implementation and maintenance of nursing resources; transformation of nursing resources into nursing service and results of the work of the nurse in Bed Management.

Final Considerations:

understanding the performance of nurses in bed management contributes to the scenario of new practices and different roles that favor visibility and strengthening of the nurse’s identity.

Descriptors:
Nurse’s Role; Bed Occupancy; Hospital Bed Capacity; Health Management; Teaching Hospital

AVAILABILITY OF NURSING STAFF, WORKING CONDITIONS AND MAINTENANCE OF THE NURSING TEAM		Total number of RUs / MU	% RUs / MU
MU1 Professionals required in Bed Management	Bed Management must be essentially composed of nursing professionals (14) (E). Other professionals were also mentioned, such as teams with nurses, doctors and social workers (12) (E).	26	8.7 %
MU2 Qualification and experience of the nurse in Bed Management	To work in Bed Management, nurses must have knowledge of both management and care (30). For this, they can use instruments such as the Fugulin Scale and Nursing Staffing, and must have a vision focused on the financial sustainability of the hospital. The professional must have experience in management (6) and experience in care (31). They must know how the flow and the units of the hospital work (23). The knowledge the nurse acquires during their training - in technical-scientific courses and on the health-illness process in nursing undergraduate courses - were considered sufficient to work in the service (6). Qualification, at the level of graduation, was not considered as a requirement to work in this service (4). However, the doctors and residents pointed out the need for training in management and care (2). The nurse must have competences (3) such as: leadership, decision making and teamwork. Flexibility (10) negotiation (7), proactivity (2), communication and agility (3), were also mentioned (E)	127	42.3 %
MU3 Profile of patients in the hospital	The Bed Management nurse assesses the patient profile as criteria for bed allocation, seeing, for example, if the patient is classified as elective, palliative, hospitalized for bone marrow transplantation, or critical (2) (D)	02	0.7 %
MU4 Physical, material and technological resources.	It was observed that nurses use computer, telephone and pager. These resources are considered essential for communication with other units and services. Regarding the structure, the space is shared with other services, includes a bathroom and a kitchen, and is accessible, illuminated and ventilated (1) (O)	01	0.3 %
MU5 Workload and organization of the service	Nurses in Bed Management work 12x36 hour shifts, with one professional per shift (1) (D). The service is organized by flow/itinerary, considering from entrance to the hospital to the other services involved (1) (D).	02	0.7 %
MU6 Difficulties	Communication between Bed Management nurses, care nurses and resident physicians is fragile, which is also related to their lack of knowledge about the transfer flow of patients in hospital beds (25) (E, O). Another difficulty was the material and physical resources of the institution, such as isolation beds and the great demand in contrast with the lack of beds in the hospital (25) (E, O). The clinical profile of the patients admitted, which is incompatible with the care characteristics of the care unit, was a weakness in the perspective of the care nurses (12) (E). The culture of the professionals in the institution with their peers was mentioned by the Bed Management nurses as a barrier to their performance in the service (4) (E). Aspects that lead to hospital discharge (5) (E), the work overload of nurses in the healthcare units (4) (E), fragile medical support (3) (E) and access to previous patient information (3) (E) were other fragilities that were pointed out (E).	81	27 %
MU7 Advantages	One advantage pointed out by the participants was the centralization of Bed Management in the hands of the Bed Management nurse, that is, only one service is responsible for this activity (22) (E). This makes allocation and/or transfer of patients quicker (10) (E, O), since nurses have an overview of hospital beds, while other professionals have a perspective limited to their unit/service (8) (E, O). The nurse can improve the work process by reducing the number of empty beds (2) (E). x	42	14 %
MU8 Aspects that lead to quality of life and work motivation from the perspective of nurses in Bed Management	Personal satisfaction when meeting the patient's need and recognition of their work were important motivations for nurses' work in Bed Management (8). Accidents, injuries and illnesses related to work in Bed Management were not mentioned by the nurses of this service (5). Support from bosses, colleagues and services involved was considered an aspect of quality of life, as it provides a fluid working environment (3). For them, quality of life is also related to psychological preparation, as there is communication with different professionals and conflict mediation is necessary (2). The availability of resources to do the work was also mentioned (1) (E).	19	6.3 %
Total		300	100%

ENVIRONMENT AND NURSING WORK PROCESS		Total number of RUs / MU	% RUs / MU
MU1 Autonomy of the nurse in Bed Management	The nurse has a limited autonomy (21). However, this autonomy exists mainly in the decision-making regarding the allocation of the patient (14). This is sometimes seen as an authoritarian autonomy by some nurses of the care unit (6). This autonomy is supported by the leadership and by the established flows (4). (E, O)	45	31.2%
MU2 Support from colleagues and managers and integration between services and the network	All hospital services were understood as support for nurses in Bed Management (22). Some of the services mentioned were diagnostic support (imaging and laboratory exams), Hospital Infection Control Service, Discharge Management, operational support, hospital management, and the Care Units (11). Bed Management is more integrated with the hospital's internal services and not so much with the Health Network itself; this interface occurs only in sporadic and specific cases (7) (E, O).	40	27.9 %
MU3 Decision-making process of Bed Management nurses	Decision making is based on the clinical profile of patients, assessed by the Bed Management nurse (17). From the perspective of care nurses, these decisions are shared between them (6). The patient is allocated to an available bed (5), or allocated according to cases in which the patient is a priority, such as critical patients and older adults (3) or the criteria is the transfer flow of the institution (2). Discussion of cases within the management team (1) and scheduling of discharges (1) are also considered. Some care nurses are unaware of how this decision-making occurs (2) (E)	37	25.7 %
MU4 Performance of the nurse in Bed Management	The nurses apply the Kanban Methodology and elaborate and implement strategies for resolution when identifying extended length of hospital stay (8). They manage beds through inter-unit transfer requests when allocating patients (7). They work with bureaucratic issues, data collection for the hospital census and generation of indicators such as the occupancy rate of the hospital. They fill out spreadsheets and elaborate Standard Operating Procedure (7) (E, O)	22	15.2 %
Total		144	100%

RESULTS OF THE WORK OF THE NURSE IN BED MANAGEMENT		Total number of RUs / MU	% RUs / MU
MU1 Interface between teams	There is generally a good rapport between teams in terms of communication and relationship (33) (E, O). However, means of contact other than the telephone could be used for a more immediate communication (E, O).	33	43 %
MU2 Patients' Length of Stay	Participants reported improvement in the length of stay of hospitalized patients (11). The concern of the nurses to identify and take action in relation to the causes that kept patients hospitalized was recognized by the nurses of the care units (7) (E)	18	23.3%
MU3 Improvement in Occupancy Rate	Participants reported improvement in occupancy rate as a result of nurses' work (10). Occupancy rate had a 5.73% increase from 2015 to 2017, according to data from the service (1) (E, D)	11	14.2 %
MU4 Influence on culture change in the hospital.	The bed is seen by professionals as belonging to the hospital, and not intended for any medical specialty, a fact that leads to bed turnover (6). For them, the service became a reference within the institution (3) (E)	09	11.7 %
MU5 Optimization of hospital beds	From the perspective of the nurse of the care unit, empirically, there has been an increase in the number of hospital admissions that may lead to a reduction in patient waiting lines (5) (E) Up to two thousand transfer requests for beds in the hospital have been done so far (1) (O)	06	7.8%
Total		77	100%

Associação Brasileira de Enfermagem SGA Norte Quadra 603 Conj. "B" - Av. L2 Norte 70830-102 Brasília, DF, Brasil, Tel.: (55 61) 3226-0653, Fax: (55 61) 3225-4473 - Brasília - DF - Brazil
E-mail: reben@abennacional.org.br

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[1] Corresponding author: Fabieli Borges. E-mail: fabieliborges6@gmail.com