Excellence and evidence in staffing: a data-driven model for excellence in staffing (2nd edition).

The Patient Protection and Affordable Care Act (PPACA, 2010) and the Institute of Medicine's (IOM, 2011) Future of Nursing report have prompted changes in the U.S. health care system. This has also stimulated a new direction of thinking for the profession of nursing. New payment and priority structures, where value is placed ahead of volume in care, will start to define our health system in new and unknown ways for years. One thing we all know for sure: we cannot afford the same inefficient models and systems of care of yesterday any longer. The Data-Driven Model for Excellence in Staffing was created as the organizing framework to lead the development of best practices for nurse staffing across the continuum through research and innovation. Regardless of the setting, nurses must integrate multiple concepts with the value of professional nursing to create new care and staffing models. Traditional models demonstrate that nurses are a commodity. If the profession is to make any significant changes in nurse staffing, it is through the articulation of the value of our professional practice within the overall health care environment. This position paper is organized around the concepts from the Data-Driven Model for Excellence in Staffing. The main concepts are: Core Concept 1: Users and Patients of Health Care, Core Concept 2: Providers of Health Care, Core Concept 3: Environment of Care, Core Concept 4: Delivery of Care, Core Concept 5: Quality, Safety, and Outcomes of Care. This position paper provides a comprehensive view of those concepts and components, why those concepts and components are important in this new era of nurse staffing, and a 3-year challenge that will push the nursing profession forward in all settings across the care continuum. There are decades of research supporting various changes to nurse staffing. Yet little has been done to move that research into practice and operations. While the primary goal of this position paper is to generate research and innovative thinking about nurse staffing across all health care settings, a second goal is to stimulate additional publications. This includes a goal of at least 20 articles in Nursing Economic$ on best practices in staffing and care models from across the continuum over the next 3 years.

Care redesign: a higher-quality, lower-cost model for acute care.

OBJECTIVE: The aims of this study were to design, pilot, and evaluate a care team model of shared accountability on medical-surgical units. BACKGROUND: American healthcare systems must optimize professional nursing services and support staff due to economic constraints, evolving Federal regulations and increased nurse capabilities. METHODS: A redesigned model of RN-led teams with shared accountability was piloted on 3 medical/surgical units in sample hospitals for 6 months. Nursing staff were trained for all functions within their scope of practice and provided education and support for implementation. RESULTS: Clinical outcomes and patient experience scores improved with the exception of falls. Nurse satisfaction demonstrated statistically significant improvement. Cost outcomes resulted in reduced total salary dollars per day, and case mix-adjusted length of stay decreased by 0.38. CONCLUSION: Innovative changes in nursing care delivery can maintain clinical quality and nurse and patient satisfaction while decreasing costs.

Inpatient fall prevention: use of in-room Webcams.

OBJECTIVES: Patient falls are a challenging safety and quality issue in acute care settings. This study compared inpatient falls on medical-surgical units with and without Webcams and assessed the Morse Risk Assessment (MRA) for effectiveness in identifying fall risk. METHODS: Ten hospitals in one health system that exceeded the benchmark for falls were chosen for a 6-month study. One medical-surgical unit in each of the 10 hospitals was randomly assigned to an intervention or control group. The intervention group used Webcams that viewed the bed with a central monitoring system. A "virtual bed rail" function was used for those patients with a Morse Risk Assessment (MRA) of greater than 25. RESULTS: Consent rate was 20.7% for the intervention group. A significant difference (P ≤ 0.05) between groups was found in fall rate per 1000 admissions, but no significant difference was found in fall rate per 1000 patient days. The Morse Risk Assessment was a significant predictor of risk. CONCLUSIONS: Webcams are one option to increase surveillance for high-risk patients. The use of the MRA with a 50+ score for high risk is recommended. More research is needed on patient acceptance of this form of intervention and effectiveness in preventing falls on various inpatient units or with specific age groups.

The American Organization of Nurse Executives System CNE task force: a work in progress.

Health care is a complex industry, consequently requiring a diverse group of health care executives leading initiatives for efficiency and effectiveness in patient care delivery. Value-based purchasing and pay for performance are at the top of the list for indicators of success, and many hospitals are merging into health care systems. The role of the system chief nurse executive is an evolving role to lead health care systems in clinical, operational, patient safety, and patient satisfaction processes and outcomes. The American Organization of Nurse Executives, being the voice for nursing leadership, convened a group of system chief nurse executives to address the role, function, and competencies needed for this significant and emerging role in health care. This article describes the role statement and system chief nurse executive competencies needed for success in the role. In addition, the next steps for addressing the needs of this group will be outlined in this article.

Psychosocial needs of the critically ill obstetric patient: the nurse's role.

A critically ill obstetric patient can present a challenging and rewarding experience for the nurse who is accustomed to caring for the typical intensive care unit patient. This patient population makes up a small percentage of the average daily census in adult critical care units across the country. The patient population accounts for less than 2% of admissions in the developed countries, and these patients experience a very low mortality rate. This article will describe those psychosocial needs and address the nurse's role in meeting the needs. A case study will be presented to provide specific points for focus.

Amniotic fluid embolism.

Amniotic fluid embolism (AFE) (also known as anaphylactoid syndrome of pregnancy)is a catastrophic condition that occurs during pregnancy or shortly after delivery. It is found throughout the world in developed and undeveloped countries and occurs at an incidence of between 1 in 80000 live births. In the United States, AFE occurs in 1 in 20000 to 80000 deliveries.

The use of beta-blockers in the treatment of chronic heart failure.

The use of beta-blockers in addition to digoxin, diuretics, and ACE inhibitors was shown to be beneficial for patients with chronic heart failure. Benefits include decreased hospitalizations, decreased need for heart transplant, and decreased mortality. The fact that beta-blockers may improve a sense of well-being, as well as quality of life, for patients with chronic heart failure, is perhaps the greatest advantage to including these drugs in HF therapy.