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 and experience. 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-biased 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 (Felgen, 2004, p.2). 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 (Felgen, 2004, P.3).

Relationship –based care is suppose to transform 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 (Felgen, 2004, P.3). The fundamental definition of care given by nursing is the connection between the nurse and the patient (Felgen, 2004, P.3).  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- biased 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 (Felgen, 2004, P.3).

This requires a commitment of the leadership team to develop all team members to their full potential (Felgen, 2004, P.3).Leadership is devoted to creating a healthy work environment were daily work practices are aligned with a values decided by the entire team (Felgen, 2004, P.3).In a healthy work environment, the value of every person’s contribution to the organization is recognized as important (Felgen, 2004, P.3). 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 (Felgen, 2004, P.3).

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 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 has taken place.

McEwen, M., & Wills, E. (2011). Theoretical basis for nursing (3rd ed.). Philadelphia, Baltimore, New York, London, Buenos Aires, Hong kong, Sydney, Tokyo: Wolters Kluwer Lippincott Williams and Wilkins.

 

Koloroutis, M. (2004). Relationship -base care a model for
  
     transforming practice. Minneapolis, MN; Creative health care
  
     management.