Jill Fuller, RN, PhD

Jill Fuller, RN, PhD has been the chief nursing officer of Prairie Lakes Healthcare System for seven years. Her special interests include the design of nursing work in the acute care environment to promote job satisfaction, patient safety, and increased productivity. She is currently serving a fourth term on the AONE Future Patient Care Delivery Task Force and she is a consultant for the AONE/TCAB project.

"Because the old model, which we referred to as 'fragmented total patient care,' did not promote teamwork or address work intensity. Nurses were attentive to their own patient assignment but did not focus on how to provide a more integrated approach to work on the unit. With the 'integration of labor,' work intensity was decreased and staff had more time for direct patient care. Prior to the change, bedside nurses were task oriented. This model helped nurses move from a task orientation into the professional role as they took full responsibility for decision making and accountability for patient care."

"The practice knowledge of the bedside team is emergent and enables them to redefine problems and manage complexity – leaders need to stand back and manage the boundaries. The intricate, messy world of practice cannot always be addressed through traditional problem solving that involves concrete, precisely defined 'best practices.' Transformation means finding alternatives to our over-reliance on structure and developing faith in the intuitive approach of the expert."