Professional Documents
Culture Documents
● Focus:
○ Neuro unit staff RNs and Emergency Department (ED) staff RNs
○ Impaired trust and communication of healthcare teams related to
incomplete assessments and lack of structured handover process.
Microsystem Model: Leadership
Neuro Unit Leadership
● Unit Manager and Charge Nurse
● Servant, Authentic, and Quantum leadership
● Helped nurses when overwhelmed and helped teach student nurses
● Inspired staff nurses and set an example to help their colleagues
manage their workload
● Empowered staff to play an active role in unit management and
improvement
(Johnson, 2001)
(Marquis & Huston, 2017)
Microsystem Model:
Organizational Culture and Support
Unit Management Interunit Relations
● Respect and consideration ● Differing expectations on
● Aim to complete tasks before the information exchange
oncoming shift takes over ● Distrust of nursing
● Huddle before every shift with assessments and reports
unit nurses ● Dissatisfaction with patient
● Daily scheduled discussions of condition on arrival to unit
discharge planning
○ Multidisciplinary team discussed
progression of care every day
(Johnson, 2001)
● Staff eager to help each other (Marquis & Huston, 2017)
Microsystem Model:
Patient/Staff Focus of Healthcare Delivery
Culture and Work Roles Listening and Caring
● Unit manager interviews ● Structured and thorough shift-
oncoming staff, along with peer change reports
interviews ● Staffing measures to improve
● One year of training in the new patient understanding and
grad residency program comfort
● Staff ratio 3:1 on IO and 5:1 on ● Staff RNs are active
floor participants in educating
● Cactus stickers recognize good students on the unit
patient care with emphasized
recognition during huddles (Johnson, 2001)
Microsystem Model:
Interdependence of Care Team
● Collaboration within the team
● Trust between doctors and nurses
● Patient care huddle between the charge nurse, unit manager,
case manager, dietician, and OT/PT
● Staff encouraged to ask for help
● PCTs were professional and worked diligently
● Consistent team members within the unit
● Rapid response performed daily check-ins
(Johnson, 2001)
Microsystem Model: Use of Information
and Healthcare Technology
● Epic EMR
● Voceras available for nurses
● Computers in every room and around the unit
● Pyxis located in the hallway
● Bed alarms, Hi-Lo beds, and fall mats
● Telemetry available for IO patients
● Monitors at nurses’ station with IO patient vitals
● Tube system for sending labs and receiving medications
(Johnson, 2001)
Specific Aspect Targeted for Improvement:
Organizational Culture
Specific Aspect: Organizational Culture
● Impaired trust and communication of
Present healthcare teams related to incomplete
Vital signs assessments and lack of structured
Intake and output handover process
(Kreitzer, 2015)
Project Timeline
Test: Improvement:
-Neuro and ED RNs oriented -Analyze staff surveys
-Testing of P-VITAL -Identify further
handover tool improvements
References
Johnson, J. K. (2001). Clinical microsystem assessment. Retrieved from
http://clinicalmicrosystem.org/uploads/documents/microsystem_
assessment.pdf
Kreitzer, M. J. (2015). Integrative nursing: Application of principles across clinical
settings. Rambam Maimonides Medical Journal, 6(2). doi: 10.5041/RMMJ.10200
Marquis, B. L., & Huston, C. J. (2017). Leadership roles and management functions in
nursing: Theory and application (9th ed). Philadelphia: Wolters Kluwer Health.
Wilson, R. (2011). Improving clinical handover in emergency departments. Emergency
Nurse, 19(1), 22–26. doi: 10.7748/en2011.04.19.1.22.c8446