At MetroWest, the Nurse Caring Delivery Model was piloted on a 36-bed medical/surgical unit. The unit was divided into three, 12-bed sub-units, each of which was staffed by two RNs and two nursing assistants. MetroWest selected this unit based on the strength of the nurse leader and the staff’s willingness and interest in creating change. (This unit was recently selected for participation in the RWJF/AONE Transforming Care at the Bedside Dissemination Project.)

This initial pilot ran for ten months before the model was expanded to other medical/surgical units.

In the next phase, the Nurse Caring Delivery Model was implemented on a telemetry unit. Telemetry was divided into 10-bed subunits, each of which was staffed by two RNs and 1 nursing assistant.

In Phase 3, Leonard Morse Hospital, a unionized hospital, implemented the model on its acute care units.

In Phase 4, Outpatient clinics (at both MetroWest Hospitals) implemented the model in 2007. Outpatient clinics included radiology, rehab, ultrasound (that is, any place where tests or procedures are done). In the areas where direct care is delivered, MWMC provides training for all staff in “caring” moment encounters. MWMC encouraged the direct care staff to take a few minutes of uninterrupted time to sit with each patient and explain what is going to happen (e.g. how long procedures will take, how the patient will get their results, who to call with questions after discharge) using caring theory principles and behaviors.

MWMC has found that it takes staff on units implementing the model about three months to integrate new behaviors and routines in a consistent fashion. During this time, staff from the original unit are able to provide training and serve as resources for their colleagues. Communication and meetings to course correct, to vent and to get support are essential.

One challenge with new implementations is working with RNs on the "Caring" moment interactions, as some nurses are offended when they are told they have to take a class on how to conduct a "Caring" moment. But MWMC emphasizes that the classes will cover Watson’s theory and how certain behaviors can result in a patient-nurse encounter which Watson believes transforms both the patient and the nurse.

MWMC has found that the Nurse Caring Delivery Model has helped them recruit and hire new graduate nurses. New graduates are interested in theory-based practice and are very excited about the RN partnership model that allows for ongoing mentoring once they have completed their initial orientation.

At the time of model development and prior to the sale of MetroWest to its current owner, the former owner partnered with Drexel University in Philadelphia and its College of Nursing to develop a comprehensive core curriculum for educating managers and staff in the elements of professional practice. Modules were written for training and included Watson’s Theory; Delegation; Conflict Resolution; Decision Making; Communication; Collaboration; Meeting Management. Each RN receives 8 hours of training, and each unlicensed care delivery member receives 4 hours of training.

MWMC used a nursing education consultant to do the staff training on the model who had previously worked with Drexel faculty to build the education modules. She continues to work with MWMC to do the training for the model. The Nursing Educators at MWMC partner with the nurse consultant for all training, and they introduce the model at nursing orientation and provide ongoing support to the model units and to their staffs.

The Nurse Caring Delivery Model has now been replicated on all the acute care inpatient units at MWMC. In 2007, the MWMC CNO expanded her role and now acts as the Regional CNO for Vanguard Health Systems for their hospitals in Chicago and Massachusetts. She has introduced the model at MacNeal Hospital in Chicago where all of the acute care units have implemented the model.

The model is currently being implemented at Weiss Hospital in Chicago; as of 12/07, half of the acute care units have implemented the model. The nurse educator consultant used by MWMC has done all of the training at MacNeal and at Weiss.

The Nurse Caring Delivery Model is adaptable in both academic and non-academic hospital settings.