We often share stories about what we do with patients while they’re at Ranken Jordan, but one of the most important parts of our job is actually getting patients home.

However, there can be barriers to discharge and the biggest issue we’re facing right now is a lack of private duty nursing (PDN).

Because of a nationwide shortage of PDN, there are typically 10-15 (17-25%) patients hospitalized at Ranken Jordan over the course of a year who would likely succeed at home if the family had access to sufficient PDN coverage, which is needed to safely care for their medically complex child.

We recently led a discovery model to look at how we could help with this shortage. We thought, “What if our own nurses could cover any gaps in care so our patients can get home faster?”

Getting kids home is a critical piece of our Care Beyond the Bedside model, which focuses on getting kids out of their hospital beds and using play as healing. Kids thrive when they’re with their families in a familiar environment, so getting them out of the hospital and back home with loved ones is a crucial part of the healing process.

We also want to get kids home as fast as we can because having a child in the hospital can be costly for caregivers, both financially and emotionally.

Hospital stays that are longer than expected can also lead to safety concerns. Patients sometimes remain in the hospital for as long as 200 “avoidable” days, causing families to become annoyed with the system and decide to care for their child at home on their own. This can lead to an increase in readmission or additional issues because families lack the training required to care for medically complex children, particularly those with tracheostomies that are ventilator dependent.

While we do want our patients to go home, safety is of utmost importance. It is part of our job to ensure enough care is lined up so the patient has the required level of support and the transition home is smooth.

To address this barrier to discharge, our leadership team selected our Director of Nursing, Amanda Boeckstiegel, to lead an initiative to look at increasing PDN support for patients ready to go home.

Amanda’s first job was to look at whether a partnership methodology would be best or if we should consider developing our own service line, meaning we would create a program for Ranken Jordan nurses to serve as PDNs to our patients going home.

For the first year of the project (2024), Amanda led a small working group to conduct research to determine the best route forward. Following the research stage, Amanda and her team advised the best route would be to launch a partnership with a local PDN agency, Team Select Home Care.

Together with the PDN agency, the team followed a “one patient at a time” approach, so the goal was to focus on just one patient getting home with sufficient PDN support. To do that, Ranken Jordan nurses would step in as PDNs to fill any gaps in care.

While planning for the discovery model was kicking off, patient Mikayla, an 18-year-old with polymicrogyria, Cerebral Palsy, epilepsy, scoliosis, and recurrent aspiration pneumonia, was admitted to Ranken Jordan in February 2024 for titration of ventilator support, titration of neurologic medications and establishment of good home routine.

Mikayla was determined to be medically ready for discharge on March 19, 2024, but required 16 hours of daily PDN staffing to go home.

Two attempts to discharge Mikayla fell through because of a lack of PDN staffing, keeping Mikayla hospitalized for an additional 197 days.

Amanda and her team decided to launch the discovery model with Mikayla as the first patient to be discharged. They set the goal of lining up PDN support by October 2024 so Mikayla could go home to her family.

Thanks to Amanda’s leadership, our PDN discovery model launched on time and Mikayla was discharged in October 2024 with sufficient PDN care.

Since then, Mikayla has thrived at home and has not been readmitted to Ranken Jordan or any other hospital since being discharged, a major success for a patient like her. Patients with complex medical issues are often at risk for readmission because of the level of care needed. Mikayla’s family built a great rapport and felt confident in the skills of Ranken Jordan nurses to care for their child within their home.

Exceeding expectations, we also launched a second PDN patient, 2-year-old Amelia. With a blend of agency and Ranken Jordan nurses serving in the PDN role, Amelia was able to safely go home to be with her parents and sister.

I am incredibly proud of Amanda and our nursing team for their work on the discovery model.

Everyone stepped up to meet this unmet patient need, and the model they worked on has the potential to be used in the future to help even more kids get discharged sooner. We are currently looking at how we can utilize learnings from our discovery model and how they could be implemented in our community and potentially at other hospitals across Missouri.

Finding ways for patients to get home sooner allows families to be together and it frees up hospital beds for children who need them, shortening the delay in care for many on a waiting list.

Amanda has also been recognized by the state of Missouri for her efforts. She has been announced as the winner of the 2025 Nurse Innovator Award–given by the Center for Missouri Nurses–which will be presented at the 2025 Missouri Nurses Association Fall Conference in November. Congratulations, Amanda!

If you would like to support innovative work like our PDN discovery model, I encourage you to give to the Ranken Jordan Foundation.

Our ultimate vision at Ranken Jordan is a world where children with complex medical needs can live their best lives. While we do what we can to make their time at Ranken Jordan as positive and impactful as possible, we know nothing can replace being at home.