What are
the roles of Advanced Practice Nurse's (APN) employed by health care
organizations in your community in quality improvement activities? Are APNs
leaders of quality improvement teams? What significant contributions have
occurred because of APN involvement on Quality Improvement teams? Do you know
of any Evidence Based Practice activities in your area that APNs have
spearheaded?
The nurse manager of my unit is an advanced practice nurse. We
are a small community- based, non- profit hospital. A great deal of the revenue
the hospital receives is from Medicaid and Medicare. The government recently
passed a law stating that reimbursement obtained from Medicaid and Medicare is
based on the customer’s response on surveys. At first glance, this seems like a
great way to improve patient care. A problem with the survey is the standards
are unattainable because everything must read excellent to receive reimbursement.
Without reimbursement for the care provided the hospital is in jeopardy of
closing. It is a forty- five minute drive to the next hospital. This could
greatly affect the health in our community. The hospital is also a source of
employment for many of the citizens of the community. If the facility closes,
it could greatly affect the economics of an already struggling economy.
The ANP believes one way to improve patients care, as well as
patient satisfaction scores, is through the implementation of a model of care
referred to as relationship-based care. Relationship-based care is
evidence-biased practice that improves customer services scores and nursing
retention rates of the hospitals that have implemented the model (Koloroutis,
2004). The APN is the leader of a quality improvement team responsible for the
implementation of the relationship-based care model throughout the hospital.
The ANP contributions to this project are invaluable to the hospital and health
of the community.
Relationship based care is grounded on the premises that the
quality of the care provided by nurses has decreased because nursing practice
has moved from a nursing model of care to a business model (Koloroutis, 2004). One
of the primary components of relationship-based care is primary nursing care (Koloroutis,
2004). Primary nursing care is a way for nursing professionals to address the
problem of fragmented care and lack of personal contact with the patients
(McEwen &Willis, 2011). The premises of primary nursing care is a team
approach where one experienced (primary) and one less experienced (associate) nurse would be
caring for the patients throughout the patients hospital stay (McEwen
&Willis, 2011). Primary nursing is not were the nurse provides all the care
to the patient but, rather coordinates the care (Koloroutis, 2004).
Relationship –based care transforms health care to be more
patient centered. Patient centered care creates a harmonious healing
environment. Without a connection between the nurse and the patient, a feeling
of isolation occurs and the spirit of the patient is damaged (Koloroutis,
2004). The fundamental definition of care given by nursing is the connection
between the nurse and the patient (Koloroutis, 2004). By moving the clinical
health care team back to this primary relationship with the patient and putting
patients and family’s at the heart of care, the delivery of care improves and
the patient perceptions of care increases.
The fundamental framework of the relationship-based care model
is the relationship between the health care team and patient. This requires
health care team members to have a good understanding of self and healthy
interpersonal relationship skills (Koloroutis, 2004). This also requires a
commitment of the leadership team to develop all team members to their full
potential (Koloroutis, 2004). Leadership is devoted to creating a healthy work
environment were daily work practices are aligned with a values decided by the
entire team (Koloroutis, 2004). In a
healthy work environment, the value of every person’s contribution to the
organization is recognized as important (Koloroutis, 2004). All discipline and
departments work together with the patient at the center of the care. All care
is grounded in theory, research and therapeutic patient relationships
(Koloroutis, 2004).
Relationship
biased care requires commitment of the leader to clearly communicate goals and
provide opportunities for staff development (McEwen &Willis, 2011). Through
the implementation of this model of care, the hospital in which I work is
currently undergoing a transformation. The nurses are taking more responsibility
for their practice. Almost every nurse holds a nursing certification. The
customer service scores have demonstrated continued improvement. Many nurses
state they have decreased stress levels because the model in- line with the
values, as to why they became nurses. There have been some challenges such as
the recruiting and paying for increased staff. The hospital has seen an
increase of revenue generated from decreased hospital days, patient
satisfaction and decreased staff turnover, since the models implementation.
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