Color coding of nurses' uniforms and expansion of duties led to reduction in overtime hours and job satisfaction

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Former Director, Kumamoto Regional Medical Center, Physician
Nagasaki International University Faculty of Health Management Department of Health and Nutrition Professor

Masahiko Hirota

Graduated from Kumamoto University School of Medicine in 1983. In the same year, he entered Kumamoto University Second Surgery. After a residency and graduate school, studied abroad at the University of Nebraska Epley Cancer Institute. 2005 Associate Professor of Gastroenterological Surgery, Kumamoto University. 2007 Associate Professor. 2011 Director of Kumamoto Regional Medical Center. Since 2022, he has been a professor at the Department of Health and Nutrition, Faculty of Health Management, Nagasaki International University. Up to now.

Color-coding of nurse uniforms and expansion of duties

Reduced overtime hours and made work more rewarding

The Kumamoto Regional Medical Center has reduced overtime hours and turnover rates for nurses by introducing a system that allows nurses to work in multiple departments, with uniform colors that change between day and night shifts. We will ask Dr. Masahiko Hirota, a former hospital director and surgeon who devised a two-color uniform system and supported work style reforms for nurses, about promoting work reforms.

Color-coding of nurses' uniforms and expansion of duties led to reduction in overtime hours and job satisfaction

Color-coded uniforms for day shift and night shift
For a work style that is conscious of time

It wasn't until 2013, when I was appointed as hospital director, that I implemented a two-color uniform system for nurses. In my work as a surgeon, I have always thought that it would be easier to give instructions if I could distinguish at a glance which nurses were on duty and who had finished their duty. I just happened to have the opportunity to change the nurses' uniforms, and I suggested that the day shift and night shift be color-coded. With the approval of the nursing manager and negotiations with the administrative department, the two-color system began in the form of leasing uniforms.

At the same time, we advertised this system on the bulletin board in the hospital. For example, when a nurse who has already finished her work does not pick up the phone, the patient may think that she is slacking off, so it was necessary to let patients and people outside know about this system.

For day shifts and night shifts, we changed to working 20 minutes before the shift time, and later introduced a long-day shift system. This gave me enough time to take over. The handover is the time when the two colors of uniforms are mixed, and you can tell at a glance that it is before the shift change.

In addition, we decided to play the school song on the hospital broadcast one hour before the end of the day every day. Our clinic has a school song just like the school song. By playing it, the staff will be aware of the end of working hours and will be a signal to finish the remaining work, and the patient will also know that the shift shift time is approaching.

There were various reactions to the two-color uniform system for nurses. The nurses said, ``I can now find a good balance in my work,'' ``I can easily see if my co-workers are within working hours or if they are overtime,'' and ``It has become easier to find people to talk to.'' It has become easier to take over and transfer work.” As an individual, I have learned to manage my time so that I can finish my work on time, and to adjust my work and examine the backlog of work.

On the other hand, for doctors, it seems that it was good that it became easier to find the person in charge and the person in charge on the day shift and night shift. It has become clear who to ask about the patient's nighttime situation, and it is no longer necessary to give instructions to the nurse after the night shift. Nurses who stay late are encouraged to go home.

Able to work for multiple departments
Develop and utilize nurses

However, simply changing the color of the uniform does not mean that work will be reduced, and it is necessary to prepare for a sudden increase in work, such as a sudden absence of a nurse, a sudden change in a patient's condition, or an emergency hospitalization. Therefore, training and utilization of "Polyvalent Nurses" who can handle multiple tasks, which was just progressing in parallel, was useful. “Polyvalent” means “doing many things” in English. Before the 2018 FIFA World Cup in Russia, I learned about this word from Akira Nishino, the manager of the Japanese men's team. For example, there are ward nurses who can handle outpatient work, operating room nurses who can assist with drain replacement in the fluoroscopy room, ward nurses who can assist with endoscopy, and outpatient nurses who can assist with cardiac catheterization. To that end, we have standardized the storage areas for chemicals and equipment, and reviewed the conventions of each department.

And from a few years ago, a shuffle of nurses' duties began. In each department, it is possible to view the status of patients and the progress of nurses' work on a whiteboard, etc. increase. You can also submit a support request. This type of shuffling of nurses' work had already been implemented at Iizuka Hospital in Fukuoka Prefecture, so I learned about the local approach and modified it to put it into practice.
　
Through these efforts, the work of the nursing department has become more efficient, overtime hours have decreased, and this has led to a lower turnover rate. For each and every nurse, work is no longer a rut, and it has led to motivation and growth.
Our hospital is a small hospital with 15 clinical departments and 287 beds. Therefore, it is easy for new initiatives to permeate. In large hospitals, it may be necessary to devise measures such as introducing it from some organizations.

Now that I have reached retirement age, I am working as a “libero doctor” who employs post-retirement doctors on a regular or part-time basis. "Libero" is Italian for "freedom", and in sports it refers to a player who moves around without a fixed role or a defensive specialty. For example, since surgeons spend most of their time in the operating room, they inevitably delay in giving rehabilitation instructions and prescribing drugs to patients who have returned to the ward. If there is a post-retirement surgeon in the ward who knows the movements and duties of surgeons in the hospital, I think it will be useful to support these duties and nurses' specific behavior training.

Former Director, Kumamoto Regional Medical Center, Physician Masahiko Hirota, Professor, Department of Health and Nutrition, Faculty of Health Management, Nagasaki International University

Former Director, Kumamoto Regional Medical Center, Physician
Nagasaki International University Faculty of Health Management Department of Health and Nutrition Professor

Masahiko Hirota

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