12/6/2015

The

delivery of patient care for this facility is in

the style of total patient care. This means that
one nurse provides all the care needed for each
individual patient they are responsible for.
Total Patient Care:
o Charge nurse Nursing Staff Patient
o Autonomy and Simple
o Poor training and possible unsafe care

December 9th, 2015

(Marquis & Huston, 2015a)

At

our facility, leadership plays a crucial role in

providing care. The unit is currently missing a
nurse manager, which leaves a gap between the
charge nurse and the CNO.
The importance of leadership:
o Under staffed
o Poor communication / disruption in chain of
command
o Unsatisfactory outcomes

(Ovretveit, 2005)

The positive culture of the microsystem has led to the

building of a better delivery system where care is focus
on the patient. Though there is a positive culture, the
facility has not been adequately supportive in the
provision of resources for the unit.
Examples
o Positive culture (shared values, attitudes, and beliefs
reflecting the clinical mission, and the support of a
trusting environment)
o The provision of nurse manager (for the unit floor)
o Disconnection between facility and the unit
(Nelson et al., 2002)

Each nurse is assigned to 3-4 couplets, for which

they provide all care for both the mother and baby.
The interdisciplinary care team works together with
underlying trust, consideration, and appreciation of
each members role in a patients care.
Examples
o Pediatricians are readily available
o Social workers frequently seen on the unit
o Lactation consultants are frequently assisting
mothers

The care delivered by the unit is driven by the patient,

thus patient-centered. In addition, the staff perspective
and perception are not adequately integrated into the
unit.
Examples
o Patient-Centered Care: Patient needs take
precedence over staff needs
o Staff needs: staff input are not adequately regarded
due to gap in management
o Patient to Nurse ratio: 3:1 couplets
(Marquis & Huston, 2015a)

(The Institute for Patient-and-Family-Centered Care, 2010)

12/6/2015

The information and resources required for staff to

provide excellent patient care is usually available.
Patients are also provided with necessary
information upon admission and discharge.
Examples
o Patients have access to standard patient
information
o Most information is readily available for staff to
perform their duties
o No electronic scanning of medications

The process of improving staff knowledge is key to

improving patient care health. This is accomplished
by incorporating the nine success characteristics
which fall into four groups: Leading Organizations,
People, Information, and Performance and
Improvement.
Performance and Improvement
o Atmosphere
o Interdisciplinary huddles
o Computer based training/ mandatory training

(Nelson et al., 2002)

(Nelson et al., 2002)

Staff

performance is evaluated in many different

ways: by peers, management and patients.
Evaluation of staff ensures that employees are
meeting set standards of performance.

Staff

Focus: Increased workload of staff hinders

professional growth and training of new hires.

Workload

o All nurses taking a 4 couplet patient load

Evaluation

Methods
o At the end of orientation
o Yearly evaluations
o Patient care survey

o Charge nurses not anticipating patients

coming up from Labor & Delivery for census

counts
o Too many nurses being sent home; nurses
being called in half-way through day

(Marquis & Huston, 2015b)

10

Decrease

Focus training on charge nurses who are making

patient assignments and calling off nurses for the
oncoming shift

Positive

Successful Improvement
o Use data of number of nurses called off on each
shift vs. number called in during the shift they
were originally supposed to work
o Staff satisfaction
o Oncoming charge nurse double checking
assignments from outgoing charge nurse

nurse to patient ratio at beginning of

shift to 3:1 or 2:1 to anticipate admitting patients
based on the census from Labor & Delivery.
Impact
o Nurses less stressed with workload / less callins
o Nurses able to focus on professional
development and training of other staff
o Increased patient satisfaction / adequate care
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12/6/2015

Marquis, B. L. & Huston, C. J. (2015a). Organizing Patient Care.

Leadership roles and management functions in nursing: Theory
and application. 8th ed. Philadelphia, PA: Wolters Kluwer
Health/Lippincott Williams & Wilkins, pp. 311-332.
Marquis, B. L. & Huston, C. J. (2015b). Quality Control. Leadership
roles and management functions in nursing: Theory and
application. 8th ed. Philadelphia, PA: Wolters Kluwer
Health/Lippincott Williams & Wilkins, pp. 565-566.
Nelson et al. (2002) Microsystems in Healthcare: Part 1. Learning
from high performing frontline clinical units. Joint Commission
Journal on Quality Improvement, 28 (9). 472 493. Retrieved
from
http://lsatqdm.qdmnet.com/qdm/microsystems/JQIPart1.pdf
Ovretveit, J.,(2005). Leading improvement, Journal of Health
Organization and Management, 19 (6). 413-430.
Retrieved from http://dx.doi.org/10.1108/14777260510629661

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The Institute for Patient- and Family-Centered Care (2010). What is

patient- and family- centered care? Retrieved from
http://www.ipfcc.org/faq.html

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