Nurse-initiated changes in patient care model improve care, increase patient and staff satisfaction

Oncology nurses play an essential role in evaluating their patient care delivery model and staffing to ensure the best possible care for their patients. Having the right staff mix and staffing ratios is essential to providing quality patient care, whereas adequate staffing results in a safer environment for patients.

However, on a 48-bed inpatient oncology unit at the William Beaumont Hospital in Royal Oak, Michigan, patient assignments were frequently being changed throughout the day and with the current staffing matrix, the unit had higher acuity patients, increased fall rates, and declining satisfaction scores, noted Jane Caplinger, RN, MSA, OCN, and colleagues. To remedy this situation, a project was initiated to evaluate the current staffing and patient care delivery model and make changes to improve patient care and increase patient and staff satisfaction.

The project comprised the following: a patient acuity audit; patient satisfaction scores; a comparative analysis of staffing ratios of local and national hospitals; unit admission, discharge, and transfer volume; and hospital benchmarking. As a result, changes were made in the patient care model. Schedules were changed for various positions, including nurse assistant, nurse technician, and unit secretary, and a proposal was presented to hospital administration for the addition of registered nurse staff, Caplinger told those attending the Oncology Nursing Society 36th Annual Congress. In addition, the nursing staff was educated on changes to the patient care model.

Implications for oncology nursing practice include nurses taking ownership for their practice. The new patient care model, scheduling changes, and proposal to increase RN staff were presented to the nursing leadership as an example of how staff can collaborate with nursing management to improve patient care outcomes, Caplinger noted. In addition, the initiative was shared throughout the corporation and may be used by other health care institutions to evaluate their own patient care models and staffing ratios.

Future plans include a nurse satisfaction survey following project implementation. Patient satisfaction could not be assessed during the model of care change because the hospital was transitioning to a different patient satisfaction survey tool. Fall rates will continue to be monitored.
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