Purpose/Objectives:
The objective of this study was to describe a clinical nurse specialist (CNS)-directed collaborative model in implementing higher acuity intermediate care beds on a general care surgical unit.
Significance:
Adjustable acuity beds on general care units have important implications for providing continuity of care with fluctuating patient care requirements.
Design/Background/Rationale:
The expansion of otorhinolaryngology (ear, nose, and throat [ENT]) procedures at an academic medical center with extensive microvascular and robotic surgeries has led to more intensive postsurgical monitoring and greater need for multidisciplinary, decision-based care coordination. In the first 48 hours after surgery, patients require frequent hemodynamic assessments, psychological interventions, and ongoing anticipation of discharge needs.
Methods/Description:
Interdisciplinary collaborative efforts led the creation of intermediate care beds on an ENT general care nursing unit. With the leadership from a unit-based CNS and involvement of our Shared Governance Unit Council, decisions were made to educate clinical nurses and to procure the necessary resources to support an increased level of care. The CNS conducted a 16-hour comprehensive educational program for clinical nurses and other health professionals and held a 4-hour skills demonstration to prepare staff to critically assess patients, interpret monitoring parameters, instruct patients and families, and coordinate discharge. Competency validations were performed, and clinical nurse champions were mentored to prepare for ongoing education to peers.
Findings/Outcomes:
A new program to facilitate safe and effective care for ENT patients through an intermediate care bed model reduced the need for critical care unit admissions and resulted in overall decreased length of stay for this complex surgical population. Fewer delays in discharge have occurred, and patients' perceptions of readiness have improved with better care coordination and the establishing of effective patient/family-nurse relationships. The clinical nurses have obtained extensive professional development, the RN retention rates have increased, and turnover rates decreased.
Conclusions:
A unit-based adaptable acuity model of care improves patient, system, and nurse outcomes.
Implications for Practice:
The unit-based CNS is instrumental in designing bed models of care and in providing expertise to support transitions from a higher to lower acuity of care.
Section Description
The 2009 NACNS National Conference will be held in St Louis, Missouri, on March 5 to 7. More than 350 clinical nurse specialists (CNSs), graduate faculty, nurse administrators, nurse researchers, and graduate students are registered. This year's theme, "Clinical Nurse Specialists: Vision, Value, Voice," demonstrates the essential leadership skills of the CNS as well as the CNS role in implementing evidence-based practice.
Seventy abstracts were selected for either podium or poster presentations. Again, this year, there is a CNS student poster session. The abstracts addressed CNS practice in 3 practice domains (spheres of influence), emphasizing patient safety and quality care outcomes, leadership, evidence-based practice, and new ways to shape CNS practice. Topics include CNS work activities incorporated into 3 spheres of influence-patients, nursing practice, organization/system-including the development of clinical inquiry skills among staff nurses, use of simulation technology, strategies to maintain clinical excellence, CNS practice in end-of-life care decisions, and many new and thoughtful ideas to support CNS education, practice, and research. Collectively, the abstracts represent the breadth, depth, and richness of the CNSs' contribution to the well-being of individuals, families, communities, as well as to the advancement of the nursing profession.
The conference abstracts were published here to facilitate sharing this emerging new knowledge with those who were unable to attend the conference. As you read each abstract, appreciate the intellectual talent and clinical scholarship of your CNS colleagues who are advancing the practice of nursing and contributing to the health of society through improved outcomes for patients and healthcare organizations. We encourage you to contact individual presenters to network, collaborate, consult, or share your thoughts and ideas on the conference topics. Watch out for next year's call for abstracts and consider submitting for presentation at NACNS' next annual conference in Portland, Oregon, on March 4 to 6, 2010.