Using Jean Watson’s Theory on Human Caring as a foundation for nursing practice, MetroWest reorganized the nurses in the initial pilot unit into four-member teams comprised of two RNs and two Certified Nursing Assistive personnel who have responsibility for 12 patients. Each RN and CNA had six primary patients, but worked as team to care for all patients. One RN is the team leader, with training in delegation and conflict resolution, problem solving and facilitating group decision-making. The team approach to patient care delivery creates higher levels of interdependence and provides consistency in communication, collaboration and partnering.
At the beginning of each shift, while RNs received reports on all of their patients, the nursing assistants visited each patient and introduced themselves and the care team. Each team was responsible for providing each patient with a white board listing the names of all team members that were responsible for the patient’s care as well as an explanation of the care team approach (i.e. the patient has a primary nurse but other team members may respond to call lights or assist their primary nurse). Linens were distributed, and the patient is positioned and provided any other necessary assistance.
New graduates were partnered with an experienced RN in the 12-bed unit, and had a clearly defined mentor. This partnering provided a depth of support for the new graduate nurse that did not exist in the prior model where there was no identified resource such as the team leader role. As a result of the new care model, new graduate turnover declined. The two RNs in the model can be either two experienced nurses who take turns performing in the team leader role or an experienced nurse and a new graduate RN.
In order to ensure patient safety and care coordination, MetroWest established two all-team meetings during each shift. At the beginning of the shift after the RNs have taken report, the team leader calls a huddle for all four team members. At this brief meeting, the RNs shared critical information learned from the report with the nursing assistants. In addition, goals for the day were established, and the time of the mid-shift conference was scheduled.
In this model, any team member could call a huddle at any time if they feltit was necessary to regroup or to get support. Staff are more comfortable taking their lunch break off of the unit, as several team members are familiar with their patients and aligned with them around patient needs. Physicians appreciate the availability of an RN knowledgeable about her/his patient when the patient’s primary nurse is unavailable.
In addition, the RN team leader organized a mid-shift conference with all four members of the team and discussed patients and any concerns during their shift. This meeting allowed team members to identify and manage patient problems and concerns; to update each other on changes in the care plan as a result of MD rounding or test results; and to discuss discharge planning. Other disciplines wereinvited to attend the mid-shift conference if they are available or wanted to discuss something with the team.
The RN-led team actively involved each patient in her or his care. RNs conducted an uninterrupted “Caring Moment” with each patient each shift, during which the primary RN sats with the patient and listed to his or herconcerns for at least five minutes. The RNs asked each patient about his or her expectations of their RN during that shift. The RNs engage patients using prescribed “caring behaviors” that allowed the RN to exhibit competence, to recognize the patient as an individual, to demonstrate respect and understanding of the uniqueness of each individual, and to use touch where appropriate.
