Concept Application Project:

Healthcare Delivery with an Emphasis on

Education and Training

Ashley Alexander, Milena Carrera, Caitlin Cox, Kayla Meester, & Tarryn OMahoney

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Overview of Patient Care Delivery System

At St. Josephs hospital in Tucson, AZ travel nurses

populate a large portion of the ICUs. A large portion of
these travel nurses receive a two day orientation to the
unit and are expected to carry out a full patient load and
execute unit standards.
Focus: Education and training of travel nurses at St.
Josephs hospital in the medical ICU

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Microsystem Model: Leadership

Leaders maintain constancy of purpose, establish clear

goals and expectations, and foster a respective positive
culture. Leaders take time to build knowledge, review
and reflect, and take action about microsystem and the
larger organization.
Quantum Leadership
Decentralized decision making
Leadership on the unit was adequate
Marquis, B.L., & Huston, C.J. (2015). Leadership roles and management functions in nursing theory and application (8th ed., pp. 63,
273). Philadelphia, PA:Wolters Kluwer health/ Lippincott Williams & Wilkins.
3
 Microsystem Mode
Organizational Culture and Support

The larger organization isnt supportive in a way that

provides recognition, information, and resources to
enhance my work
Limited fiscal resources to create change in orientation
(C. Cox, personal communication, February 7th, 2017)
Unit tension due to lack of resources

Marquis, B.L., & Huston, C.J. (2015). Leadership roles and management functions in nursing theory and application (8th ed., pp.
260-286). Philadelphia, PA: Wolters Kluwer health/ Lippincott Williams & Wilkins. 4
Microsystem Model:
Patient Focus & Staff Focus
Staff focus: I feel like I am a valued member of the
microsystem, but I dont think the microsystem is doing
all that it could to support education and training of staff,
workload, and professional growth
oEducation is available but not emphasized
Patient focus: We are actively working to provide patient
centered care and we are making progress toward more
effectively and consistently learning about and meeting
patient needs.
oNurses provided patient-centered care
Marquis, B.L., & Huston, C.J. (2015). Leadership roles and management functions in nursing theory and application (8th ed., pp. 365 -366). 5
 Microsystem Model:
Interdependence of Care Team
The care approach is interdisciplinary, but we are not
always able to work together as an effective team.
Interdisciplinary rounds
Core nurse relationships
Travel nurse relationships

Nancarrow, S. A., Booth, A., Ariss, S., Smith, T., Enderby, P., & Roots, A. (2013). Ten principles of good interdisciplinary
team work. Human Resources for Health, 11, 19-4491-11-19. doi:10.1186/1478-4491-11-19
6
Microsystem Model:
Use of Information and Healthcare Technology
Patients have a variety of ways to get the information
they need and it can be customized to meet their
individual learning styles. We routinely ask patients for
feedback about how to improve the information we give
them.
Use of both electronic and paper charting makes
locating patient information difficult
The technology available to the nurses was an outdated
version and difficult to use
Institute for Healthcare Improvement.(2015). Clinical microsystem assessment tool. Retrieved from
http://www.ihi.org/resources/pages/tools/clinicalmicrosystemassessmenttool.aspx
Marquis, B.L., & Huston, C.J. (2015). Leadership roles and management functions in nursing theory and application (8th ed., pp. 452-456). 7
Microsystem Model:
Process for Healthcare Delivery Improvement
Some resources are available to support improvement
work, but we dont use them as often as we could.
Change ideas are implemented without much discipline
Auditing is a systematic and official examination of a
record, process, structure, environment, or account to
evaluate performance.
Benchmarking is the process of measuring products,
practices, and services against best-performing
organizations.
Marquis, B.L., & Huston, C.J. (2015). Leadership roles and management functions in nursing theory and application (8th ed., pp. 547-551). 8
Philadelphia, PA: Wolters Kluwer health/ Lippincott Williams & Wilkins.
Microsystem Model:
Staff Performance Patterns
We often collect data on the outcomes of the care we
provide and some processes of care
oEvaluations
Core vs. travel
oCollect data and compare outcomes with other units
oStaffing ratio to provide favorable patient outcomes is
safe due to travel nurses

Marquis, B.L., & Huston, C.J. (2015). Leadership roles and management functions in nursing theory and application (8th ed., pp. 575).
Philadelphia, PA: Wolters Kluwer health/ Lippincott Williams & Wilkins.
9
Specific Aspect Targeted for Improvement

Goal: Improve orientation for traveling nurses.

Focus on information specific to the unit, not just hospital
policies (i.e. location of supplies, introductions with
charge nurses/unit directors/nurse practitioners/doctors,
etc.)
Studies found that majority of travel nurses felt the
orientation was too short and not very relevant.

Tuttas, C. A. (2015). Job Integration Factors As Predictors of Travel Nurse Job Performance. Journal Of Nursing Care Quality, 30(1), 44-52.
doi:10.1097/NCQ.0000000000000070

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Leading the Plan for Healthcare Delivery Improvement

Intervention: Provide more unit-specific information

through more effective communication
Literature: Communication between facility and travel
nurse is not consistent causing confusion and the
information is not completely relevant and needed
Suggested timeline plan for hiring travel nurses
Preparation Orientation Preceptorship Evaluation

Gustafson, C. (2017, February 6). Traveling nurse orientation - what to expect. Retrieved from http://www.travelnursing.org/traveling-nurse-orientation-what-to-expect/
8 hr online Three 8 hr days 3 shifts (12 hr)
Tuttas, C. A. (2015). Job Integration Factors As Predictors of Travel Nurse Job Performance. Journal Of Nursing Care Quality, 30(1), 44-52. 6 weeks
doi:10.1097/NCQ.0000000000000070
11
 Timeline of Process Implementation
1st-2nd month
Root- 3rd-6th month
7th month
Cause Implement
analysis the plan in Observe 8th-11th month
& identify 12th month
and one unit Implement
construct areas for new plan Observe
a plan improvem in current changes
ent unit and across both
one other units
unit
References

Gustafson, C. (2017, February 6). Traveling nurse orientation - what to expect. Retrieved from

http://www.travelnursing.org/traveling-nurse-orientation-what-to-expect/

Institute for Healthcare Improvement.(2015). Clinical microsystem assessment tool. Retrieved from

http://www.ihi.org/resources/pages/tools/clinicalmicrosystemassessmenttool.aspx

Marquis, B.L., & Huston, C.J. (2015). Leadership roles and management functions in nursing theory and application

(8th ed., pp. 63, pp. 273, pp. 260-286, pp. 365-366, pp. 452-456, pp. 547-551, pp. 575). Philadelphia,

PA:Wolters Kluwer health/ Lippincott Williams & Wilkins.

Nancarrow, S. A., Booth, A., Ariss, S., Smith, T., Enderby, P., & Roots, A. (2013). Ten principles of good interdisciplinary

team work. Human Resources for Health, 11, 19-4491-11-19. doi:10.1186/1478-4491-11-19

13
Tuttas, C. A. (2015). Job Integration Factors As Predictors of Travel Nurse Job Performance. Journal Of Nursing Care

Quality, 30(1), 44-52. doi:10.1097/NCQ.0000000000000070