Collegian
Volume 13, Issue 1 , Pages 31-36, 2006

Redesign of the model of nursing practice in an acute care ward: Nurses' experiences

  • Brenda Hayman, RN, DipAppSc(Nursing), Grad Cert (Gerontological Nursing), Grad Cert (Infection Control), Grad Cert (Research ([Health]) (APAI Master of Nursing – Student)

      Affiliations

    • University of Western Sydney
  • , Dr
  • Jane Cioffi, PhD., M.AppSc (Nsg), GradDipEd(Nsg), BAppSc(Nsg), RN (Senior Lecturer)

      Affiliations

    • University of Western Sydney, School of Nursing, Family and Community Health
  • , Professor
  • Lesley Wilkes, PhD, MHPEd, GradDipEd(Nurs), BSc Hons, Midwifery Certificate (CM), RN (Professor of Nursing)

      Affiliations

    • University of Western Sydney, Sydney West Area Health Service

Article Outline

Objective

to describe nurses' experiences of the change associated with redesign of the model of nursing practice in an acute care ward in the preparatory and implementation phases.

Design

descriptive case study

Setting

a surgical ward in an acute care hospital in Greater Western Sydney

Subjects

fourteen registered and six enrolled nurses working on the surgical ward volunteered to be interviewed, eight in the preparatory phase and twelve six months into the implementation phase

Main outcome measure

descriptions of nurses' experiences in the preparatory phase and six months into the implementation phase of the redesigned nursing practice model

Results

many nurses felt apprehensive in the preparatory phase, however, six months into implementation phase their willingness to trial the model was evident. Negativity pervaded both phases, as did their concerns for the quality of care being given. In the preparatory phase nurses described the clinical activities coordinator (CAC) role as having potential to be beneficial and this was realised to some degree six months into implementation phase. A preference for registered nurses over enrolled nurses as a dominant component of the staff was evident in both phases

Conclusions

the struggle with the change that nurses experienced suggests redesign needs to be a more collaborative process involving strong communication and supportive education so nurses can empower themselves within the change

Key words:  redesign , model of nursing practice , acute care ward , nurses' experiences , change

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References 

  1. Aiken LH , Clarke SP , Cheung RB , Sloane DM , Silber JH . Educational levels of hospital nurses and surgical patient mortality . Journal of American Medical Association . 2003;290(12):1617–1623
  2. Aiken LH , Clarke SP , Sloane DM , Sochalski J , Silber JH . Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction . Journal of American Medical Association . 2003;288(16):1987–1993
  3. Baileff A . Integrated nursing teams in primary care . Nursing Standard . 2000;14(48):41–44
  4. Browne G , Lam LT , Giles H , McCaskill M , Exley B , Fasher B . The effects of a seamless model of management on quality of care for emergency department patients . Journal of Quality in Clinical Practice . 2000;20(4):120–126
  5. Carney M . The development of a model to manage change: reflection on a critical incident in a focus group setting. An innovative approach . Journal of Nursing Management . 2000;8:265–272
  6. Christensen P , Bender LH . Models of nursing care in a changing environment: Current challenges and future directions . Orthopaedic Nursing . 1994;13(2):64–70
  7. Creswell J . Qualitative Inquiry and research design. Choosing among five traditions . Thousand Oaks: Sage; 1998;
  8. Crotty G . Focus. Change in health care organisations: an overview . Tennessee Nurse . 1996;59:15–16
  9. Davidson JU , Davidson JC . Fundamentals of restructuring: How to accomplish transformational change via transformational leadership . Kansas Nurse . 2000;75:1–3
  10. Davis JM , Farrell M . Factors affecting the delegation of tasks by the registered nurse to patient care assistants in acute care settings – A selective review of the literature . Journal of Nursing Staff Development . 1995;11(6):301–360
  11. Ellis JR , Hartley CL . Nursing in today's world: Challenges, issues and trends . 4th edn.. New York: J.B. Lippincott Co.; 1992;
  12. Glaser BG , Strauss AL . The discovery of grounded theory: Strategies for qualitative research . Chicago: Aldine; 1967;
  13. Gray M . Introducing single case study research design: an overview . Nurse Researcher . 1998;5(4):15–24
  14. Herrington L . Nursing educators lead change . Texas Nursing . 1996;70:4–5
  15. Ingersoll G , Wagner L , Merck SE , Kirsch JC , Hepworth JT , Williams M . Patient-focused redesign and employee perception of work environment . Nursing Economics . 2002;20(4):163–187
  16. Ingersoll GL , Cook JA , Applegate M , Frank B . The effect of patient-focused redesign on midlevel nurse manager's role responsibilities and work environment . Journal of Nursing Administration . 1999;29(5):21–27
  17. Jones J , Cheek J . The scope of nursing in Australia: a snapshot of the challenges and skills needed . Journal of Nursing Management . 2003;11:121–129
  18. Keleher KC . Change is nothing new . Vermont Nurse Connection . 2000;3:1–3
  19. London J . Employees' perceptions of workplace change . Australian Health Review . 2001;24(4):128–134
  20. London F . Take the frustration out of patient education . Home Healthcare Nurse . 2001;19(3):158–164
  21. Lundgren SM , Segesten K . Nurses' altered conceptions of work in a ward with all- RN staffing . Journal of Clinical Nursing . 2002;11:197–204
  22. McCullough C . Collective bargaining empowerment and change . Nevada Rnformation . 1995;4:14–16
  23. Needleman J , Bureaus P , Mattke S , Stewart M , Zelevinsky K . Nurse-staffing levels and the quality of care in hospitals . The New England Journal of Medicine . 2002;346(22):1715–1722
  24. Palmier D . How can the bedside nurse take a leadership role to affect change for the future? . Conce RN . 1998;27:16–17
  25. Pearson A , Vaughan B , Fitzgerald M . Nursing models for practice . 2nd edn.. Oxford: Butterworth Heinemann; 1996;
  26. Rheaume A . The changing division of labour between nurses and nursing assistants in New Brunswick . Journal of Advanced Nursing . 2003;41(5):435–443
  27. Richards BS 1999 President's message. The challenge of change. ISNA Bulletin 25.
  28. Shoptaw L . Ar NA report of survey on structural/organisational changes in the workplace . Arkansas Nursing News . 1996;13:4–5
  29. Strandell BK . Self care in the world of change…part 1 in a series of 6 articles on workplace issues . Minnesota Nursing Accent . 1997;69(7):9
  30. Telles MV . How to manage change and make it work for you . Nursing News (New Hampshire) . 1996;46(1):8
  31. Thomas LH . Qualified nurse and nursing auxiliary perceptions of their work environment in primary, team and functional nursing wards . Journal of Advanced Nursing . 1992;17(4):373–383
  32. Thomas LH , Bond S . Towards defining the organisation of nursing care in hospital wards: an empirical study . Journal of Advanced Nursing . 1990;21(9):245–256
  33. Tingle A . Mental health nurses: changing practice? . Issues in the Quality of Care . 2002;11:657–663
  34. Van den Walt HM , Swartz L . Task orientated nursing in a tuberculosis control programme in South Africa: where does it come from and what keeps it going? . Social Science & Medicine . 2002;54:1001–1009
  35. Willmot M . The new ward manager: an evaluation of the changing role of the charge nurse . Journal of Advanced Nursing . 1998;28(2):419–427
  36. Winsor K , Blake S , Pyne L , Juers A . The innovative ward project: promoting innovation in health service delivery . Australian Health Review . 2000;23(4):151–159
  37. Wright PM . Test of the mediating role of goals in the incentive-performance relationship . Journal of Applied Psychology . 1989;74:699–705
  38. Yin RK . Case Study Research, Design and Methods . 2nd edn.. Newbury Park: Sage; 1994;

PII: S1322-7696(08)60514-4

doi:10.1016/S1322-7696(08)60514-4

Collegian
Volume 13, Issue 1 , Pages 31-36, 2006