Education and Training

of the Healthcare Team

BrookeLyn Black, Grace Cooper, Halle DeWitt, Acelya
Gastellum, Taylor Young
 Overview of Patient Care Delivery System

Banner University Medical Center - Tucson

● PCU MOSU Surg/Gyn Onc T1 9NS - Night Shift
○ 24 private beds
○ Adult and geriatric medical and surgical patients
○ Staff: 1 Charge, 7 RNs, 2 PCTs, 24/7 RT, Phlebotomy, on-call
Providers, remote Telemetry and Code Team
○ Goal: Post-op care for stable vented patients awaiting LTC
● Focus: Discrimination and implicit bias towards diverse
patient populations leading to low quality care and advocacy

Banner Health Workday. RN Surgical PCU. (2021). Retrieved from https://bannerhealth.wd5.myworkdayjobs.com/en-

2
US/Careers/job/BUMC-Tucson-1625-N-Campbell-Ave/RN--Surgical-PCU-_R45904.
Microsystem Model: Leadership

● Charge nurses lead in democratic style

○ “Democratic leadership promotes autonomy and growth in individual
workers”
○ Communication flows up and down
○ Charge offers constructive feedback when necessary
● Charge nurses
○ 5 rotating
○ Asked to be charge after a year of experience
○ Assigned 0-2 patients per shift
Johnson, J. K. (2001). Clinical microsystem assessment. Retrieved from
3
http://clinicalmicrosystem.org/uploads/documents/microsystem_assessment.pdf
Marquis, B. L., & Huston, C.J. (2021). Leadership roles and management functions in nursing: theory and application. Wolters Kluwer Health.
Microsystem Model:
Organizational Culture and Support
Workplace Culture Organizational Support
● Mandatory unit meetings ● Annual “Voice Survey”
● Diverse in culture, ethnicity, ○ Incentives for
language, age, and experience completion
● Lateral violence ● COVID:
● No night shift huddle ○ Free therapy
● Burnout Factors ○ Disaster charting
○ Understaffing ● Resources: 24/7 RT,
○ Exclusion of travelers and SWAT Nurse called prior
floats to Code Team 4
Johnson, J. K. (2001). Clinical microsystem assessment. Retrieved from
http://clinicalmicrosystem.org/uploads/documents/microsystem_assessment.pdf
Microsystem Model: Patient & Staff
Focus

Staff Focus Patient Focus

● Selective hiring ● Autonomy
● 3 month orientation ● Pain is gold standard
● Patient ratio 2-5:1 ● All patient needs met
● Cliques create social hour ● Difficult patients
● Float/Travel Nurses ● Homeless population
● Daisy award

5
Johnson, J. K. (2001). Clinical microsystem assessment. Retrieved from
http://clinicalmicrosystem.org/uploads/documents/microsystem_assessment.pdf
Microsystem Model:
Interdependence of Care Team
Providers and nursing staff had a fairly trusting
relationship

Areas for Potential Problems

● Nurses are not included in rounds
● Providers rounding at different times and
inconsistently
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Johnson, J. K. (2001). Clinical microsystem assessment. Retrieved from
http://clinicalmicrosystem.org/uploads/documents/microsystem_assessment.pdf
 Microsystem Model:
Use of Information and Healthcare
Technology
Patients Technology
● Remote telemetry monitoring
● Bedside monitoring, bed ● Cerner EMR (built in
alarms MAR)
● Call light intercoms ● 24/7 IT support
● COW shortage
Providers and Staff ● 1 Translator
● WorkDay
● Facility-wide phones
● 6 EKG and Pulse Ox monitors

7
Johnson, J. K. (2001). Clinical microsystem assessment. Retrieved from
http://clinicalmicrosystem.org/uploads/documents/microsystem_assessment.pdf
Microsystem Model:
Process for Healthcare Delivery Improvement
● Continue education
o Yearly renewal
o Extended orientation and preceptorship
● Skills training
o Wound care
o Calendar in breakroom of upcoming trainings
● Huddle
o Quality Measures-helps keep track of unit
performance and patient care.
o Monthly nurse meetings
● Debriefing
o After code/rapid response 8
o Monthly nurse meetings Johnson, J. K. (2001). Clinical microsystem assessment. Retrieved from
http://clinicalmicrosystem.org/uploads/documents/microsystem_assessment.pdf
Microsystem Model:
Staff Performance Patterns
Some of the main things staff were monitored on
included:
● Falls
● Pressure ulcers
● CAUTIs
● CLABSI
● VAP
Johnson, J. K. (2001). Clinical microsystem assessment. Retrieved from
http://clinicalmicrosystem.org/uploads/documents/microsystem_assessment.pdf
9
 Integrative Nursing Principle

Integrative Nursing Principle #4

● Integrative nursing is person-centered and
relationship-based
Integrative Modality
● Anticipate and support the needs and
preferences of each patient
● Authentic listening with both staff members
and patients
Kreitzer, M. J. (2015). Integrative nursing: Application of principles across clinical settings. Rambam Maimonides Medical Journal, 6 (2). 10
doi:10.5041/RMMJ.1020011
Specific Aspect Targeted for
Improvement
● Diversity and inclusion training
● Issue: Lower performance in care and advocacy toward diverse
patients and those who face health disparities due to lack of
training and awareness of implicit bias.
o Mandatory 2 day training for new hires
o Follow-up training every three to six months (2 hours)
o Post-staff survey
o Patient/family survey after discharge
Kerrigan, V., Lewis, N., Cass, A., Hefler, M., & Ralph, A. P. (2020, May 29). "how can I do more?" cultural awareness training for hospital-based healthcare
providers working with high aboriginal caseload. BMC Medical Education. Retrieved November 30, 2021, from https://doi.org/10.1186/s12909-020-02086-5. 11
Johnson, J. K. (2001). Clinical microsystem assessment. Retrieved from http://clinicalmicrosystem.org/uploads/documents/microsystem_assessment.pdf
Leading the Plan for Healthcare
Delivery Improvement - Timeline

Kerrigan, V., Lewis, N., Cass, A., Hefler, M., & Ralph, A. P. (2020, May 29). "how can I do more?" cultural awareness training for hospital-
12
based healthcare providers working with high aboriginal caseload. BMC Medical Education. Retrieved November 30, 2021, from
https://doi.org/10.1186/s12909-020-02086-5.
References

Banner Health Workday. RN Surgical PCU. (2021). Retrieved from https://bannerhealth.wd5.myworkdayjobs.com/en-

US/Careers/job/BUMC-Tucson-1625-N-Campbell-Ave/RN--Surgical-PCU-_R45904.

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.1020011

Marquis, B. L., & Huston, C.J. (2021). Leadership roles and management

functions in nursing: theory and application. Wolters Kluwer Health.

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