Reconstructing a Nursing Model of Care to Enhance the Patient Experience

Purpose:
To redesign the nursing assistant model of care therefore changing the work environment of a twenty-six bed inpatient surgical floor to better enhance the overall patient experience while also influencing positive change within the nursing staff.

Relevance/Significance:
The current healthcare environment demands that hospitals and therefore nursing to continually adapt and improve to the meet these ever changing expectations. Specifically identified on this unit was a nursing model of care that ineffectively met the needs, safety and satisfaction of the patients and nursing staff. In response, the nurse manager and the unit shared governance council collaborated to redesign the nursing assistant model of care to assist in addressing these issues.

Strategy and Implementation:
After reviewing the literature, the nurse manager and the unit shared governance council incorporated nursing assistant feedback into the redesign of the nursing assistant model of care. Components of this redesign included new shift start times for all nursing assistant staff, redesign of the report structure and format, and the implementation of walking rounds between shifts. These changes allowed for a more seamless and balanced patient care approach at change of shift and assisted the whole team in delivering safer and more patient centered care. To fill in the still identified gaps in care, a patient experience nursing assistant role was created within already existing FTE's. This role functions to enhance patient satisfaction by incorporating patient rounding, improve call bell response time and attend to the personal needs of the patients previously difficult to deliver upon.

Evaluation:
The changes have been successful. Call bells at shift change decreased from 149 week one to 29 by week four. The HCAHPS rank for communication and responsiveness respectively increased from 44 and 56 in 2014 to 97 and 86 post change. While the Press Ganey rank for nurses kept you informed and response to call bell went from 46 and 58 in 2014 to 99 and 99. In addition,patient falls have decreased.

Implications for Practice:
This practice redesign was efficient and cost neutral. Overall,it was instrumental in enhancing patient centered safe care while improving patient and staff satisfaction. It can be generalized for any hospital and assist in increased reimbursement based on patient satisfaction and safety measures.