Nursing shortages have created a need to reconsider how care gets delivered. New nursing care delivery models allow health systems to more effectively respond to changing dynamics and ensure patients receive high-quality, evidence-based care.
An aging workforce, patient demands, and nurse burnout have long weighed heavily on hospitals and health systems. Those challenges have prompted the need for new nursing care delivery models that ensure patients receive high-quality care and that attract, engage, and retain nurses.
For new models to succeed, health systems and their nurse leaders must shift away from engrained approaches to care delivery. The first step to such transformation is to embrace competency-based care delivery, which ensures nurses have the knowledge, skills, and behaviors needed to provide safe and evidence-based care.
One proven way to assess nurse competency is through the adoption of technology solutions that track competency tests, evaluate learning needs, and determine resources needed for any remediation.
Culture, too, is key to successfully implementing new care delivery models. A nursing culture that is engaged and open to testing new models, analyzing results, and adapting as needed can support quality improvement and high-value care.
Nurse leaders can foster an engaged nursing culture by giving nurses more control over their hours and conditions, encouraging shared governance, mentoring and training new nurses, and providing opportunities for career advancement and learning.
New nursing care delivery models will be critical to enabling health systems and hospitals to meet healthcare workforce challenges. In recognition of that need, several health systems are using tools and piloting forward-thinking models to achieve successful outcomes.
Ringing in change via team-based care
Previous models of care have involved registered nurses (RNs) overseeing the care delivered by licensed practical nurses (LPNs), and unlicensed assistive personnel (UAP).
A new model of team-based care delivery brings together a wide range of healthcare professionals to ensure a unified approach to patient care. Teams would include physicians, pharmacists, physical therapists, occupational therapists, respiratory therapists, social workers, and patient care technicians.
In one example, Allegheny Health Network increased use of LPNs to improve patient care in certain inpatient settings. Each team was led by an RN and included an LPN and a nursing assistant, each applying distinct skill sets to improve patient care. In assessing the outcomes of that model, the network found that units with blended nursing models achieved the best results.
Team-based care has been found to positively affect patient satisfaction and can even reduce rates of hospitalization and emergency department visits while also lowering burnout levels among care professionals. However, for team-based care to work, organizations and nurse leaders must consider applying several core principles such as:
- Establishing shared, clear goals
- Defining clear expectations about roles and responsibilities
- Building trust so team members can admit mistakes, ask questions, or try out new skills
- Prioritizing and refining communication skills and channels
- Committing to ongoing assessment of the team structure and team performance.
Shifting the burden to virtual nurses
Virtual nurses are gaining prominence as means to remove some of the burden bedside nurses bear. According to recent data, 74% of hospital leaders say virtual nursing will become integral to delivery models in acute inpatient care.
Several health systems are implementing virtual nurse programs to support patient care. One example is Jefferson Health in Pennsylvania, which in 2023 introduced a program that used virtual nurses for check-ins, for supporting admissions and discharges, for managing patient education, for conducting care consultations, and for overseeing electronic health record documentation.
It is early days, but some data from hospitals that have made use of virtual nurses has shown improvements in RN turnover rates, better consumer scores, cost savings, and reductions in lengths of hospital stays and readmissions.
Reimagining internal float pools
Although travel nursing has been used widely to address staff shortages, travel nursing has its own set of challenges, including high costs and lack of familiarity with local systems and cultures.
An alternative approach creates internal float pools to fill nursing gaps with staff familiar with the local hospital or system and processes. This nursing care delivery model enables health systems to place nurses where they are needed to ensure high-quality patient care is maintained. Internal float pools have several advantages, such as no need to onboard new staff, workforce flexibility, reductions in pressure on core staff, and offerings of new skills and flexible schedules to nurses who are seeking variety.
Nevertheless, the challenges inherent in internal float pools include (1) the need for cross-training to ensure that nurses adhere to standards while adjusting to local needs and (2) the unpredictability of moving from unit to unit.
Advancing new care models
Hospitals and health systems have to reimagine nursing care delivery models so as to respond successfully to current and future pressures. As the largest healthcare workforce, nurses will play a critical role in supporting and driving change. To help nurses adjust, hospitals and nurse leaders must invest in competency-based care delivery, must foster a culture of change, and must integrate advanced technologies into healthcare systems.
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