Strategies to Evaluate New Models of Nursing Care to Meet Hospital Staffing and Patient Care Needs

Acute care hospitals continue to face challenges related to adequate nurse staffing to meet complex patient care needs. At an academic medical center in the Southeast, a nursing practice transformation initiative was designed based on an initial nursing retreat. Using design thinking and lean methodologies, prototypes of team-based nursing care models were developed for pilot-testing and evaluation on select hospital units. Additionally, discrete event simulation modeling techniques were used to evaluate varying staff-to-patient ratios for both licensed and unlicensed staff to inform staffing allocations on select units. One care model included an advising nurse role in which a nurse with at least 3 years of clinical experience supported novice nurses. Observational data on a pilot-test unit showed that advising nurses spent 62% of their time providing non-patient care support tasks and education to novice nurses, and an additional 19% of their time providing a combination of education and clinical task assistance. Concurrently with other care model initiatives, a pilot study was launched to evaluate a virtual nurse model facilitated by a telehealth application. This article reviews the ongoing work to develop and prospectively evaluate nursing models of care and provides important information for other health care systems currently faced with similar nurse staffing shortages and related concerns about patient care quality and safety.