The CNL functions within the microsystem as an agent of change, involved in the quality improvement processes, which are designed to improve the delivery of patient care and outcomes. As defined by the American Association of Colleges of Nursing (2013), the CNL “assumes accountability for patient-care outcomes through the assimilation and application of evidence-based information to design, implement, and evaluate patient-care processes and models of care delivery” (2013, p. 4).
Statement of the Problem
The sub-acute unit at Rosewood Care Center is a 27-bed that specializes in traumatic brain injury, post cardiac arrest, and chronic and acute respiratory care. The staff composed of the registered nurses, vocational nurses, patient care assistants, unit manager, nursing supervisor, and registered respiratory therapists. At least 40% of the nurses are newly licensed and hired, as the unit reported a high nursing turnover for the last 8 months. In order for the patients to be admitted in the unit, they must meet the criteria for admission. The majority of ...
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...retention in the unit.
A comprehensive microsystem assessment was conducted in the sub-acute unit, which revealed many communication gaps that can affect the delivery of patient care. During informal staff interviews, many newly hired and even senior nurses expressed their frustrations in the way shift handoffs are conducted in the unit. According to the nurses, the report that they receive from the outgoing nurses often do not match the patients’ conditions. Nurses reported that they may sometimes find a dislodged Foley catheter, I.V line, and G-tube, wrong feeding formula infusing, disconnected oxygen, or a patient in distress, which are often discovered only after the shift handoffs are completed, and the outgoing nurses are no longer present in the unit. Unexpected events like these put a lot of pressure on the incoming nurse, as the nurse is required
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