Concept Application

Project:
Staff Focus
Katie Chavez, Addi Gunther, Olivia Helle, Kelly Longaker, Morgan McMillan

1
 Overview of Patient Care Delivery System

 Northwest Oro Valley

 Medical Surgical Unit, 30 bed-unit
Staff RN, travel RN, charge nurse, house supervisor, nursing
technician, rounding physicians, additional therapies as
needed
 Focus
 Impaired staff focus related to lack of adequate core nursing
staff on the unit as evidenced by the charge nurse having five
patients in addition to charge nurse duties 2
Microsystem Model:
Leadership

 Leadership
 The charge RN leads in laissez-faire style.
Motivates the staff by support with little to no
control over their actions
Encouragement of group productivity
Small authority-power gap
Marquis, B. L., & Huston, C. J. (2017). Leadership roles and management functions
in nursing: theory and application (9th ed, pg. 76, 339). Philadelphia: Wolters
Kluwer Health. 3
 Microsystem Model
Organizational Culture and Support

Unit Management
Daily staffing meeting that worked to help improve nurse-
patient ratios on the unit.
Strong collaboration among nursing manager, additional
therapies, and staff on the unit.
Nursing manager acts through a democratic leadership style.
Open door policy with the nursing manager for suggestions.
High turnMarquis,
over rates
B. L., & Huston,due to Leadership
C. J. (2017). nurses roles constantly going
and management functions in nursing:over
theory andratio
4
application (9th ed, pg. 76, 339). Philadelphia: Wolters Kluwer Health.
Johnson, J. K. (2001). Clinical microsystem assessment. Retrieved from
https://clinicalmicrosystem.org/uploads/documents/microsystem_assessment.pdf
 Microsystem Model:
Patient Focus & Staff Focus

Culture and Work Roles

Nursing manager hires new graduates
One year new graduate program
Must work med/surg for one year upon hiring
Ratio with a tech is 1:5 and without a tech is 1:4
Commonly goes over ratio: 1:6

Listening and Caring

Detailed SBAR reports from off-going to oncoming nurse
Six medication rights prior to administration
Advocate for patient requests to all members of the healthcare team
Timely and organized care 5
Johnson, J. K. (2001). Clinical microsystem assessment. Retrieved from
https://clinicalmicrosystem.org/uploads/documents/microsystem_assessment.pdf
Microsystem Model:
Interdependence of Care Team

 Trust, Collaboration, and Shared Purpose

Unit focused on interdisciplinary teamwork
Nurses encouraged to delegate, collaborate, and
use effective time management skills
Providing the best possible patient care
Effective interdisciplinary communication among
staff RNs, physicians, and other member of the team
Johnson, J. K. (2001). Clinical microsystem assessment. Retrieved from
https://clinicalmicrosystem.org/uploads/documents/microsystem_assessment.pdf
6
Microsystem Model:
Use of Information and Healthcare
Technology

 Integration of Information
Cerner
Built in Micromedex, MAR, patient care plan,
interdisciplinary team notes, lab orders
Surplus of WOWs on the unit
Mobile phone for communication with staff and physicians,
numbers posted on the whiteboard at the nurses station
Each side of the unit has one Omnicell
Bed alarms, call lights
Johnson, J. K. (2001). Clinical microsystem assessment. Retrieved from 7
https://clinicalmicrosystem.org/uploads/documents/microsystem_assessment.pdf
Microsystem Model:
Process for Healthcare Delivery
Improvement

 Process Improvement
Requirement of continuing education
Training for new implementations among unit
Certifications required for advanced skills
i.e. PICC nurse needs to be vascular access boards certified
Lack of rotation charge nurse role

Johnson, J. K. (2001). Clinical microsystem assessment. Retrieved from

https://clinicalmicrosystem.org/uploads/documents/microsystem_assessment.pdf
8
Marquis, B. L., & Huston, C. J. (2017). Leadership roles and management functions in nursing: theory and application (9th ed,
pg. 76, 339). Philadelphia: Wolters Kluwer Health.
 Microsystem Model:
Staff Performance Patterns

Performance Evaluations
The nurse manager is continuously checking in and evaluating the
flow of the unit
Yearly performance reviews
Keep track of falls at the main nurses station with a whiteboard
with most recent fall date
Pain reassessment within Cerner after PRN medications were
administered
House supervisor requesting floor nurses to go over ratio
Johnson, J. K. (2001). Clinical microsystem assessment. Retrieved from 9
https://clinicalmicrosystem.org/uploads/documents/microsystem_assessment.pdf
Marquis, B. L., & Huston, C. J. (2017). Leadership roles and management functions in nursing: theory and application (9th ed, pg. 76, 339).
 Specific Aspect Targeted for
Improvement

 Nurse Patient Ratios

 Lack of sufficient staffing on the unit
 The charge nurse has five patients
 Extreme lack of core staff, surplus of travelers
 Suggested Improvement
 Hiring more core staff than travelers
 Having nurse of the month events, team building events,
unit appreciation days
10
Haider, M., Aamir, A., Abdul Hamid, A.B., & Hashim, M., 2015. A literature analysis on the importance of non-financial
rewards for employees’ job satisfaction. Abasyn Journal of Social Sciences, 8 (2), 341-354. Retrieved from
http://ajss.abasyn.edu.pk/admineditor/papers/V8I2-10.pdf
 Integrative Nursing Principle

 Integrative Principle #6
 “Integrative nursing focuses on the health and wellbeing
of caregivers as well as those they serve”
 Adequate staffing ratios will give the nurses breaks and
time for self care
Meditation, eating healthy snacks, exercise, spending
time outside
Kreitzer M. J. (2015). Integrative nursing: Application of principles across clinical
settings. Rambam Maimonides Medical Journal, 6, 1-8. doi: doi: 11
10.5041/RMMJ.10200.
 Leading the Plan for Healthcare Delivery
Improvement
• Planning and budgeting (Months 0-1)

• Staff Recruitment and Interview Process (Months 2-4)

• New hire appreciation event (Month 4)

• Onboarding to unit (Months 5-7)

• Full patient load (Months 8-12)

• Stress relief event (Months 8-12)

• Evaluation of Patient Nurse Ratio/Stress and burnout levels
(Month 12-Continuous).
Haider, M., Aamir, A., Abdul Hamid, A.B., & Hashim, M., 2015. A literature analysis on the importance of non-
financial rewards for employees’ job satisfaction. Abasyn Journal of Social Sciences, 8 (2), 341-354. Retrieved from 12
http://ajss.abasyn.edu.pk/admineditor/papers/V8I2-10.pdf
 References

Haider, M., Aamir, A., Abdul Hamid, A.B., & Hashim, M., 2015. A literature

analysis on the importance of non-financial rewards for employees’ job

satisfaction. Abasyn Journal of Social Sciences, 8 (2), 341-354. Retrieved from

http://ajss.abasyn.edu.pk/admineditor/papers/V8I2-10.pdf

Johnson, J. K. (2001). Clinical microsystem assessment. Retrieved from

https://clinicalmicrosystem.org/uploads/documents/microsystem_asses 13
References

Kreitzer M. J. (2015). Integrative nursing: Application of principles across

clinical settings. Rambam Maimonides Medical Journal, 6, 1-8. doi: doi:

10.5041/RMMJ.10200.

Marquis, B. L., & Huston, C. J. (2017). Leadership roles and management

functions in nursing: theory and application (9th ed, pg. 76, 339). Philadelphia:

14
Wolters Kluwer Health.