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The Future of Nursing: Leading Change, Advancing Health
TRANSFORMATIONAL MODELS OFNURSING IN ACUTE CARE
Jill Fuller, R.N., Ph.D.
Prairie Lakes Healthcare System
Karen Drenkard, R.N., Ph.D.
American Nurses Credentialing Center
INTRODUCTION AND BACKGROUND
Acute care describes healthcare provided to treat a condition over a short period of time. The hospital has been the center for acute care delivery for more than a century. There are three major problems with this “brick and mortar” model of acute care:
Hospital care is the highest cost health care and demand is increasing.
Hospital care is associated with complications. Poorly designed systems result in errors that compromise patient care and safety.
Hospital care is inadequately integrated with prevention and post–acute care systems. Care transitions between providers and settings are fragmented.
The present acute care hospital is largely dependent on the over 50 percent of registered nurses in the United States who work in hospitals. The predominant hospital role of nurses is to care for human bodies and prepare patients and families to leave the hospital as soon as possible. This care delivery model is labor intensive and predicted to break down as workforce shortages escalate.
CARE TEAM OF THE FUTURE: AGILE TEAMS, PRAIRIE LAKESHEALTH CARE SYSTEM, WATERTOWN, SOUTH DAKOTA
A medical–surgical unit care delivery model referred to as “Agile Teams” replaced a “Total Patient Care” care delivery model. In the Total Patient Care model, a nurse is assigned a number of patients to care for over a shift. The nurse is often task-oriented with responsibility for medication administration, documentation, and other patient care procedures with some assistance from unlicensed personnel. Such models are often fragmented emphasizing the nurse’s plan of care for the patient during the shift instead of focusing on the interdisciplinary team’s plan to transition the patient to the next level or care.
In the Agile Team Model, a team of three bedside care providers is assigned to care for a cohort of 10–12 patients. Every team has at least one experienced professional nurse but team composition varies. For example, the team may con-