Nurse Administrator Role in Nursing Care Delivery Models and Systems

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At the most recent senior leadership meeting, you as the chief nursing officer reported a trend toward nursing shortage on several units. The human resources director reported that even with open nursing positions, because of the shortage of nurses available within your recruitment area, there have been very few applying to fill them.The critical care units have experienced the greatest attrition recently and using the primary care nursing care delivery model is becoming difficult to do consistently. The decision is made to hire more nursing assistants to assist during this shortage.As the CNO, you must introduce a different nursing care delivery model that includes using nursing assistants in the units involved. Address the following related to this scenario:Discuss the model you will use and include your rationale for the choice.Describe the impact this new model will have on the organization.What challenges to the change will you face?What strategies will you use to facilitate the change?

 

Sample Solution

Addressing the Nursing Shortage: Implementing a Team Nursing Model

Model Choice and Rationale:

Given the staffing shortage and the increasing difficulty maintaining a primary care model, I propose implementing a team nursing model in the critical care units. Here’s why:

  • Teamwork and Efficiency: Team nursing distributes patient care tasks among a Registered Nurse (RN), Licensed Practical Nurses (LPNs), and Nursing Assistants (NAs) based on their skill sets. This allows the RN to focus on complex assessments, critical thinking, and patient education, while LPNs and NAs handle routine tasks like vital signs, basic hygiene, and medication administration under RN supervision.
  • Improved Patient Outcomes: By delegating appropriate tasks and maximizing RN expertise, team nursing can improve patient care efficiency and outcomes.
  • Scalability: This model scales well with staffing fluctuations. When RNs are scarce, LPNs and NAs can manage routine tasks, freeing up RN time for more complex needs.

Impact on the Organization:

  • Improved Staff Utilization: Team nursing can lead to better use of existing staff skills and a more balanced workload.
  • Potential Cost Savings: While hiring additional NAs may incur some cost, it can be offset by improved efficiency and reduced overtime for RNs.
  • Retention and Recruitment: This model can make the work environment more manageable for RNs, potentially improving retention and attracting new nurses in the long term.

Challenges to the Change:

  • Resistance from Staff: Some RNs may fear a loss of autonomy, while LPNs and NAs might need additional training or clarification of their roles.
  • Communication and Collaboration: Effective communication and collaboration are crucial between team members to avoid confusion and ensure patient safety.
  • Clear Delegation Policies: Clear guidelines are needed for task delegation based on patient acuity and staff competencies.

Strategies for Facilitating Change:

  • Communication and Transparency: Engage staff in open communication about the reasons for the change and its potential benefits.
  • Training and Development: Provide training for RNs on delegation and team leadership, and for LPNs and NAs on expanded roles and patient care protocols.
  • Change Management Plan: Develop a comprehensive change management plan outlining communication strategies, training programs, and support systems for staff during the transition.
  • Pilot Program: Consider a pilot program in a smaller unit before full implementation to identify and address any unforeseen challenges.

Additional Considerations:

  • Nurse Assistant Scope of Practice: Ensure compliance with state regulations regarding LPN and NA activities.
  • Evaluation and Feedback: Monitor the effectiveness of the new model and seek feedback from staff to continually improve.

By carefully planning, addressing staff concerns, and providing adequate training, implementing a team nursing model can help your organization navigate the nursing shortage while maintaining quality patient care.

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