Nursing care delivery models significantly impact patient outcomes and nursing job satisfaction. On a medical-surgical unit, a highly engaged team posed a question to improve staffing ratios, patient safety, and educational development. With a nurse to patient ratio of 1:6 the growing number of high acuity patients in the hospital became hard to manage. A proposal for an All Registered Nurse (RN) Care Model was applied with an emergence to solve a problem while evaluating the matrix. This unit transitioned from a Functional Care Model consisting of registered nurses and unlicensed personnel or patient care assistants (PCAs), to an All RN Care Model, eliminating the use of PCAs.
Objectives:
Several specific objectives stood out when considering the progression for this proposal including: a reduction in nurse to patient ratios, fall rates, hospital acquired conditions, and sepsis bundle compliance. Other objectives included improvement of patient education, outcomes, responsiveness, and overall improvement in nurse job satisfaction.
Methods:
A review of historical data to include staffing models, patient average length of stay, quality metrics, and organizational readiness is analyzed. An acuity table is formulated to identify patient assignments to include oxygenation status, vascular support, wound care, postoperative complications, and vital sign frequency. The shared practice council, director, manager, educator, and senior leadership strategize a plan to transition to an all RN matrix. In April of 2017, the restructuring for the high acuity population occurs where there is a 1:3 or 1:4 all RN patient ratio and the unlicensed personnel are transitioned within the organization.
Discussion/Evaluation:
Each shift consists of total care provided with a dedicated RN and a RN care partner. Assignments are made based on acuity with a daily review of the acuity table. Patient education and responsiveness has shown an increase in survey results. An increase in early identification of sepsis and the sepsis treatment bundle compliance rates has been noted. Rates of hospital acquired conditions have shown a median score. To evaluate the effectiveness of transitioning to an All RN Care Model on patient outcomes, trends will be measured from quality indicator reports, HCAHPS scores, turnover rates, and nurse satisfaction surveys. A continual review for evaluation is acknowledged to further investigate.
Conclusion:
The All RN Care Model maximizes the potential for nursing assessment, implementation, autonomy, critical thinking, evaluation, and revision as the highest in quality care. A reduction in staffing ratios has integrated a preferred method of choice for patient interaction and education. Evidence shows that All RN Care Models of care result in improved patient outcomes as well as higher patient and nurse satisfaction.