create an “ideal” nursing unit. Your facility is a brand new small critical access hospital that has 25 medical/surgical beds and a small rehabilitation unit with 6 beds. you will need to work together to research and discuss specific issues to create your nursing unit. For Part 1, write a three to five page paper that includes the following:
1.Would you prefer that your unit be part of a centralized or decentralized organization? Explain why you chose one over the other.
2.Will your unit have a shared governance model? What are the advantages and disadvantages of a shared governance model? What committees/councils will you create to help lead your unit? What will the committees focus on?
3.Research and describe at least three models of care delivery using evidence-based sources. One model needs to be an innovative/future models. Then choose one of these models to be used on your nursing unit. Justify your decision.
Course Project: Ideal Nursing Environment
Course Project: Ideal Nursing Environment
The idea of developing a medical-surgical 25-bed unit can be mayor challenge for leadership and staff. Huber, (2014) states that to be successful in the endeavor leaders, administrators, nursing, and other disciplinary members must have the same vision and commitment to the organization. The goals of safe and successful patient care delivery include high-quality and low-cost care with the achievement of patient and family outcomes and satisfaction levels (Huber, 2014). Therefore, the model of care delivery in which an organization possesses can determine their success. Leadership must be able to delegate effectively and have good decision-making skills. Thus at the time of development of a new unit we have to ask the question: is the nursing unit structure consistent with a centralized or decentralized model?
Centralized vs. Decentralized
A hospital’s guiding philosophy is the foundation for the organizational structure of centralized or decentralized nursing units. The organizations influence of hierarchy in the processes of decision-making will determine if a unit is a centralized or decentralized (Huber, 2014). A centralized organization decision-making is at the highest level of hierarchy such as chief officer executive or a chief financial officer (Huber, 2014). In comparison to a decentralized nursing organization requires all decision-making to include all levels of nursing knowledge input in the process of making the appropriate decision that will benefit patient, staff and organization (Huber, 2014).
The concept of a decentralized unit emboldens nurses to practice autonomy with confidence and make effective decisions to promote health and wholeness improving patient satisfaction (Huber, 2014). Studies demonstrate healthy work environments that include care teams and patient-family in decision-making will create a healthy supportive work setting of unity, collaboration, that will foster high quality and efficient delivery of patient care (Joseph, 2006).
Therefore, a decentralized unit is been chosen for the purpose of the development of a nursing Med-Surgical unit of 25 beds. The decentralized medical-surgical unit philosophy is to practice patient and family centered care (Nguyen, 2015). To promote safe, quality, compassionate, and innovative expert nursing care to achieve optimal wholeness level of care with evidence-based practice approach. Nursing is committed to actively include patient and family in the process of care.
The architectural design chosen for the medical-surgical 25 private bed unit would have semi-oval home base center. The units’ home base is for physicians, nurses, patients, families, and other interdisciplinary team members designated communication hub space. The unit will have perch/pod layout workstations that will facilitate nursing-patient interaction. Studies have demonstrate perch/pod workstations increase efficient delivery of care therefore creating more nursing care-time at bedside (Joseph, 2006). In addition, this type of workstation reduces interruptions that will also decrease related errors, hence will improve workflow, patient safety, and satisfaction (Joseph, 2006).
Shared Governance Model
In a study done by Vila, (2016) indicates that physicians positively perceive nurses to have an impressive amount of knowledge in decision-making. Physicians identified nurses as changing agents, and educators in organizations that practice shared governance (Vila, 2016). A shared governance (SG) model refers to involvement of nursing professional in the decision-making process into clinical practice. SG empowers nurses to practice autonomy and incite leadership awareness (Huber, 2014).
The development of a new unit can be a challenging endeavor. Therefore, the unit will adopt an SG model. The SG model would be composed of councils and committees. The SG council would include providers, nurses, managers, and other professionals. The councils would comprise of an advisory board, staff nursing, professional growth development, coordinating practice, education, and informatics council. The council would deliberate the accountabilities for the shared decision-making and disseminate the information via e-mail, meetings, and huddles to others periodically. Effective communication is crucial for SG to be able to support initiatives and decision-making (Giambra et al., 2018).
It is essential to have committees that will influence the structure of the SG. The medical surgical unit will have several committees. Some of the committees that nursing can participate include: unit-base, falls, standards and policies, quality improvement, safety, nursing peer review, peri-operative, nursing recruitment and retention, and ethics. The advantages of SG are: it encourages nursing decision-making at the frontline, it ensures all nursing voices to be heard, and nursing will have some control over the workflow, policy, practices, and technologies processes that would affect clinical practices.
Committees are important in nursing because they help build shared decision-making skills, communication skills, collaboration, and improve practices and leadership skills. In conclusion, SG supports a nursing decisions making knowledge that contributes to patient safe and quality health outcomes (Giambra et al., 2018). It also creates a healthy work environment in which all the people involved are accountable for promoting safe, respectful, and equity patient-centered care. Conversely Huber, (2014), mentions three disadvantages of group decision- making are the potential of premature decisions, individual domination, and disruptive behaviors and encounters in SG meetings.
Models of Care Delivery
Models of care delivery are the operational mechanisms by which cares provided to patients and families (Huber, 2014). The three models of care delivery most appropriate for an ideal nursing environment in this 25-bed critical care access and rehab unit is the care delivery model, team nursing, and primary nursing. A care delivery model is defined as a method of organizing and delivering care to patients and families to achieve desired outcomes (Huber, 2014). Care delivery models address both direct and indirect patient care functions. Direct patient care is hands-on care and indirect is the behind the scenes management of providers and the environment.
Team nursing is a care model that uses a group of people led by a knowledgeable nurse (Huber, 2014). A nurse is considered the team leader. This nurse divides assignments according to the nurse’s level of expertise and experience. Each team member provides most of the care to his or her assigned clients, although some tasks (e.g., medications) are assigned separately (Huber, 2014).
Primary nursing is an approach in which a nurse has responsibility and accountability for the continuous guidance of specific clients from hospital admission through discharge (Huber, 2014). This nurse does not care for the patient 24/7 but an associate helps deliver care. This style of nursing helps with continuity of care and consistency.
A future model of care that is most appropriate and ideal in this unit would be the partnership delivery model. This model of care is patient and family-centered. The key components of this model include daily multidisciplinary rounds, partnerships with patients and families, education and support, and a systems approach to care delivery (Huber, 2014). Many disciplines are required to treat the patient’s environment, spiritual and mental healing, physiological healing, and nutritional care. The partnership care delivery model offers education and support from additional resources such as respiratory therapy, physical and occupational therapy, diabetic educators, therapists, dietary services, social services, pharmacy, lactation, pastoral care, and wound care specialists. All members of the interdisciplinary team are equally accountable for the patient’s outcome.
Professional Practice Model
Professional practice models refer to the conceptual framework and philosophy under which the method of delivery of nursing care is a component (Huber, 2014). One professional practice model used is the Relationship-Based Care model. This specific model focuses on the basics of the needs of the patient and the family in a caring and nurturing environment. Other professional practice models can be integrated with the care towards patients, but the Relationship-Based Care model will be specifically used for this unit.
The Relationship-Based Care model is specifically chosen with the intent on giving quality care to patients as well as their family members. Utilizing this care model helps promoting a healthy environment. The forms of promoting a healthy setting are: by accommodating the needs of our patients and families, through relationships and human connections, by giving respect and treating the patients and family members with dignity, by advocating for the patient and including the family, and by fully understanding each patient’s unique health concerns (Howell, 2018). Focusing on the patient and their family will improve patient care and will increase patient satisfaction with the care given in the hospital unit.
While other professional practice models can be utilized on the unit, the Relationship-Based Care model will be best suited for this unit. Hence, the specialized care given to each patient and family member will represent the unit’s philosophy. Nurses will be able to learn about their patients and create a focused care plan to help initiate proper healing and improve the patients outcomes.
Composition and Skill Mix of Staff
Managing a 25-bed med/surg/OB unit in addition to a 6 bed rehab unit can be quite challenging if staffing and skills requirements are not met. The synergy model is a great way of managing a unit, as it ensures that the needs of the unit correspond with the competencies of staff (Huber, 2014). A combination of licensed direct and indirect patient care staff is required. This includes RN’s, medical directors, medical assistants, and social workers. Each member has a separate set of skills which will contribute to the unit overall workflow and productivity.
As a decentralized organization, this requires most staff to be RNs with bedside nursing skills and can include novice and seasoned nurses. This also requires all RNs to be trained and competent in all specialties of the units. As with such a small unit, it is beneficial for nurses to be skilled in order to float and care for patients with different needs when necessary. This includes keeping up to date with skills such as BLS, ACLS, would care, medication management, IVs, and so forth. There will be at least a nurse manager and two charge nurses, coordinating patient flow, assigning duties, making schedules, and rotating around the units to ensure that staffing is adequate and as resources for patients and care needs.
There is also the need for nursing assistants with bedside nursing skills to assist with activities of daily living, vitals, and patient assistance. This will help lessen the load for RNs and provide assistance to ensure increased safety on the unit. Furthermore, the role of the social worker is important as a resource for not only patients but also for the staff. The role of the social worker includes care and guidance not only while in hospital but also ensuring that the patient will be well even after discharge
Reiterate your introduction and provide a final closing statement.
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Giambra, B., Kneflin, N., Morath, H., Lee, J., Lin, L., & Morris, E. (2018). Meaningful participation and effective communication in shared governance. Nurse Leader, 16(1), 48-53. doi:10.1016/j.mnl.2017.08.004
Howell, K. (2018). Relationship-Based Care and Primary Nursing. Retrieved July 19, 2018, from https://www.sjhsyr.org/relationship-based-care
Huber, D. (2014). Leadership and nursing care management, 5th Edition. [VitalSource Bookshelf Online]. Retrieved from
Joseph, A. (2006). The role of the physical and social environment in promoting health, safety, and effectiveness in the healthcare workplace. [ebook] Concord, CA. Available at: https://www.healthdesign.org/system/files/CHD_Issue_Paper3.pdf [Accessed 18 Jul. 2018].
Nguyen, C. (2015). Time for a unit culture makeover? Nursing Management (Springhouse), 46(10), 14-16. doi:10.1097/01.numa.0000471584.23938.26
Vila, L. L. (2016). Physician perceptions of magnet nurses and magnet designation. Journal of Nursing Care Quality, 31(4), 380-386. doi:10.1097/ncq.0000000000000195