Sunday, November 4, 2007

This presentation is part of : Strategies to Enhance the Workforce
Changing the Nursing Model of Care on an Acute Care Unit
Sheila A. Havey, BScN and Maureen A. Sly-Havey, RN, MSN. Renfrew Victoria Hospital, Renfrew, ON, Canada
Learning Objective #1: identify the process of involving front line staff in making a change in nursing model of care
Learning Objective #2: explore staffing options to enhance the scope of practice of all nurses

The nursing staff on the active care unit at Renfrew Victoria Hospital had always used a team model of care. The Registered Nurses would pass medications and perform treatments on patients, while the Registered Practical Nurses would complete the basic care. This model was unsatisfactory to patients and families, nursing staff, physicians, and administration.  

A small group of staff members, including RN’s and RPN’s, were recruited in the challenge to find a new model of nursing care. This group reviewed literature describing different models of nursing care; visited other hospitals where a change from the team nursing model had already taken place; and, decided on a total patient care nursing model. 

Before implementation, several barriers needed to be addressed. The RPN’s were not functioning at their full scope of practice, so therefore, they needed to upgrade their medication and physical assessment skills. Equipment needed to be ordered and processes in the day-to-day running of the unit needed to be changed.   The new model of care went “live” in January 2005. Since that time, changes have been made to the model and to processes on the unit. However, all parties are satisfied with the team model of nursing care.  

The benefits include an improved patient satisfaction as both patients and families know exactly who their nurse is, who to direct questions to, and don’t see a number of people in and out of their room. The Registered Nurses feel that they are able to better care for a smaller group of patients. The Registered Practical Nurses now feel that they are functioning at their scope of practice. A qualitative study showed an increase in nursing job satisfaction. The physicians and administrators are able to identify the nurse looking after each patient and can direct questions and concerns to that particular nurse.