The Patient Centered Care model elevates the direct care RN to patient care manager. With charge nurse and supervisor roles eliminated, each RN is the care manager for his/her patients, and coordinates the care of those patients with all other members of the healthcare team. Physicians seek out direct care RNs to collaborate on individual patient issues.
Each unit/shift has an RN Designee responsible for day-to-day, shift-to-shift staffing decisions. The RN Designee is an oversight role for staffing matters only: empowered to adjust staffing up or down as needed to meet patient needs, and responsible for bed management within and across patient care units. Physicians contact the RN Designee when their needs or their patients’ needs are not being met. On some nursing units, the RN Designee role rotates among qualified RNs or carries a light patient assignment and performs normal RN duties.
Patient care units have flexibility and autonomy in defining the role of the RN Designee with respect to rotation and/or direct patient assignment. With increasing patient acuity and limited bed capacity, the role needs to be dynamic. The community of RN Designees throughout the hospital works in a collegial fashion and learns from role variation across patient care units.
To address the increase in novice nurses (particularly on the evening shift), the Resource Nurse role was implemented to provide expertise and perspective regarding the “big picture” of patient care. The unit-based Resource Nurse has a minimum of ten years clinical experience and guides novice nurses by developing their assessment, care management, and critical thinking skills. Resource Nurses do not function in a supervisory role and do not take a patient assignment. Experienced clinical RNs are happy to function in this supportive role, a cross between an educator and a coach.
Patient Service Coordinators are Clinical Nurse Specialists or experienced RNs who serve as unit-based clinical experts, outcomes managers, mentors, intradepartmental liaisons, and consultants. The Patient Service Coordinators provide informal staff education and leadership in the areas of quality improvement, change management, new technology, and new patient care initiatives that often are multidisciplinary or span the continuum of care.
The role of Admitting Nurse was created to address the problem of emergency department overcrowding and the resource intensive process of admitting a new patient to the hospital. The Admitting Nurse completes all paperwork and initiates IV and medication orders, thereby reducing workload for direct care staff nurses and facilitating a faster admission and initiation of treatment.
When it was determined that many nursing supervisory positions primarily performed support functions, traditional supervisors were replaced with SOS techs who provide timely support transporting patients, performing EKGs, obtaining supplies, running to pharmacy, lab, medical records, as well as lending a hand with patient care tasks as needed. SOS techs are licensed nurse aids or LVNs, who are self-directed and familiar with the entire hospital. Serving as the “go-for” individual for all hospital patient care units, the SOS techs self-schedule (one per off shift seven days a week), carry a pager, and prioritize calls.
Licensed nurse aides serve as Patient Safety Specialists who work with direct care RNs in geographic teams. Because the responsibility for patient safety is integral to the role, Patient Safety Specialists round on patients hourly with an individualized patient safety checklist, in addition to performing assigned patient care tasks.
Computer terminals on wheels allow in-room documentation by RNs. The emergency department RN Designees led the selection and implementation process for a new patient management and charting system.
In addition, SVWC uses a simple color code hospital capacity pager system to notify all RN Designees, Chief Medical Officer, Administrator-on-call, and Patient Service Coordinators of bed status throughout the day. Noon conferences occur on an as-needed basis to problem solve when capacity is limited.