Quality Improvement

Project Health
Systems
Assessment: Staff
Focus
Sarah Franzen, Lauren Sparks, Rebekah
Miller, Tanya Garcia, & Taylor Hibbetts
 Overview of Patient Care Delivery
System
● Southern Arizona Veterans Affairs Hospital
● Intensive Care Unit
● Focus: Staff focus related to ICU nurses floating to
Step-down Unit and Emergency Department due to
inadequate qualification of Float Pool nurses
 Microsystem Model: Leadership
● Servant leaders, “put serving others, including
employees, customers, and the community as
number-one priority”
● Servant leaders promote collaboration and teamwork
● Overall supportive
● Nurse manager and charge nurse attend meetings
and make themselves readily available to unit staff
Marquis, B. L., & Huston, C. J. (2017). Leadership roles and management functions
in nursing: Theory and application (9th ed., p. 65). Philadelphia: Wolters Kluwer
Health/Lippincott Williams & Wilkins.
 Microsystem Mode: Organizational
Culture and Support
● Organizational culture “is the ways of thinking,
behaving, and believing that members of unit have in
common.”
● Bi-daily Interprofessional meetings
● Huddles every morning
● Rapid Response Team
Marquis, B. L., & Huston, C. J. (2017). Leadership roles and management functions
in nursing: Theory and application (9th ed., p. 306). Philadelphia: Wolters Kluwer
Health/Lippincott Williams & Wilkins.
 Microsystem Model: Patient Focus, Staff
Focus and Integrative Nursing Principle
Patient Focus
● Patient-centered and culturally-competent care
Staff Focus
● Comprehensive hiring and orientation process
● Wages and Benefits
Integrative Nursing Principle #6: Integrative nursing focuses
on the health and wellbeing of caregivers as well as those
they serve
Kreitzer, M. J. (2015). Integrative nursing: application of principles across clinical settings. Rambam Maimonides medical
 Microsystem Model: Interdependence of
Care Team
● “The use of multidisciplinary teams increases
the likelihood that care will be comprehensive
and holistic”
● Pharmacists and CC Team on unit
● Interdisciplinary daily rounding
● Issues with orders between nurses and
physicians
Marquis, B. L., & Huston, C. J. (2017). Leadership roles and management functions in nursing:
theory and application (9th ed., p. 329). Philadelphia: Wolters Kluwer Health/Lippincott Williams &
Wilkins.
 Microsystem Model: Information and
Healthcare Technology
● Charting systems: CPRS/PICIS & BCMA
● Links to reference manuals like Micromedex
● Tele strips available electronically
● Tubing system
● Telehealth Program
● Assigned phones on other units but not on ICU
○ Only Charge RN had a code phone
○ Phones outside patient rooms
Marquis, B. L., & Huston, C. J. (2017). Leadership roles and management functions in nursing: theory
and application (9th ed.). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.
 Microsystem Model: Process for
Healthcare Delivery Improvement
● Benchmarking and audits to implement standards of care
○ The VA uses benchmarking to compare their
standards of practice to other hospitals.
● Inservice and training sessions daily
○ Medical equipment, new beds, and chair alarms.
● Quality Improvement Fair
Marquis, B. L., & Huston, C. J. (2017). Leadership roles and management functions in
nursing: theory and application (9th ed.). Philadelphia: Wolters Kluwer Health/Lippincott
Williams & Wilkins.
 Microsystem Model: Staff Performance
Patterns
● Staff performance appraisals
● Team huddles at the beginning of the shift to quickly
discuss patient concerns, safety issues, and updates
on the unit.
● Charge RN audits for: ○ Infection rates
○ Orders for active foleys ○ Falls
○ Restraints orders ○ Missing
medications
Institute of Healthcare Improvement. (2018). Daily huddles. Retrieved from
http://www.ihi.org/resources/Pages/Tools/Huddles.aspx
 Specific Aspect Targeted for
Improvement and Integrative Modality
● VA float pool only trained for Med-Surg floors
○ ICU nurses serving as additional float pool
● Increased stress and turnover rates, poor job
satisfaction
○ IN #6
● Possible Interventions: Floor orientations, “floor
buddies”, expand float pool
Hoffman, A., & von Sadovszky, V. (2018). Staff nurses’ perspectives of resources needed during floating.
Journal of Nursing Administration, 48(11), 580–584. https://doi-
org.ezproxy2.library.arizona.edu/10.1097/NNA.0000000000000683
 Leading the Plan for Healthcare Delivery
Improvement
● Build float pool
● Implement training and orientation to float pool
staff
○ Increase RN competency for a variety of
units

Overman, K., Hauver, J., McKay, J., & Aucoin, J. (2014). Maintaining competency for float nursing
staff. Journal for Nurses in Professional Development, 30(4), 204-208.
doi:10.1097/NND.0000000000000083
 Timeline of Implementation

Unit Float Pool

Recruitment Spreadsheets Spreadsheet

1-3 months 3-6 months 6-9 months

Orientation Eliminate
Packet ICU Floating

9-12 months 12-18 months

Nursing Solutions Inc. (2018). 2018 national health care retention & RN staffing report. East Petersburg, PA: NSI. Retrieved from
http://www.nsinursingsolutions.com/files/assets/library/retention-institute/nationalhealthcarernretentionreport2018.pdf
Overman, K., Hauver, J., McKay, J., & Aucoin, J. (2014). Maintaining competency for float nursing staff. Journal for Nurses in Professional Development,
30(4), 204-208. doi:10.1097/NND.0000000000000083
Straw, C. N. (2018). Engagement and retention in float pools: Keeping the team above water. Nursing Management, , 31-36. doi:DOI-
 References
Hoffman, A., & Sadovszky, V. (2018). Staff nurses’ perspectives of
resources needed during floating. Journal of Nursing Administration,
48(11), 580–584. https://doi-
org.ezproxy2.library.arizona.edu/10.1097/NNA.0000000000000683

Institute of Healthcare Improvement. (2018). Daily huddles. Retrieved

from http://www.ihi.org/resources/Pages/Tools/Huddles.aspx
 References
Kreitzer, M. J. (2015). Integrative nursing: application of principles across
clinical settings. Rambam Maimonides medical journal, 6(2), e0016.
doi:10.5041/RMMJ.10200

Marquis, B. L., & Huston, C. J. (2017). Leadership roles and management

functions in nursing: theory and application (9th ed.). Philadelphia: Wolters
Kluwer Health/Lippincott Williams & Wilkins.

Nursing Solutions Inc. (2018). 2018 national health care retention & RN
staffing report. East Petersburg, PA: NSI. Retrieved from
http://www.nsinursingsolutions.com/files/assets/library/retention-
institute/nationalhealthcarernretentionreport2018.pdf
 References

Overman, K., Hauver, J., McKay, J., & Aucoin, J. (2014). Maintaining
competency for float nursing staff. Journal for Nurses in Professional
Development, 30(4), 204-208. doi:10.1097/NND.0000000000000083

Straw, C. N. (2018). Engagement and retention in float pools: Keeping

the team above water. Nursing Management, 31-36. doi:DOI-
10.1097/01.NUMA.0000546201.01962.0d