Use of the ADKAR® and CLARC ® Change Models to Navigate Staffing Model Changes During the COVID-19 Pandemic

In early 2020, hospitals faced unprecedented patient volumes resulting from the COVID-19 outbreak. Nurse executives at a faith-based, not-for-profit health care system quickly responded to ensure safe staffing, conservation of personal protective equipment, and implementation of infection prevention strategies. A significant challenge was safe staffing for the expected patient surge. To address this, a team of nurse executives utilized the ADKAR change model to guide a transition from primary to team nursing. The processes varied between hospitals, but core principles and implementation strategies were the same. This article discusses the quick, but methodical, journey one health care system experienced.

Effect of Nursing Care Delivery Models on Registered Nurse Outcomes

The two key components of models of nursing care delivery are mode of nursing care delivery and skill mix. While mode of nursing care delivery refers to the independent or collaborative work of nurses to provide care to a group of patients, skill mix is defined as direct care nurse classifications. Previous research has typically focused on only one component at a time (mode or skill mix). There exists little research that investigates both components simultaneously. This study examined the effect of mode of nursing care delivery and skill mix on nurse emotional exhaustion and job satisfaction after controlling for nurse demographics, workload factors, and work environment factors. A secondary analysis was done with survey data from 416 British Columbia medical–surgical registered nurses. Data were analyzed using hierarchical multiple regression and moderated regression. Registered nurses in a skill mix with licensed practical nurses reported lower emotional exhaustion when caring for more acute patients compared with those in a skill mix without licensed practical nurses. While mode of nursing care delivery was not related to nurse outcomes, work environment factors were the strongest predictors of both nurse outcomes. Skill mix moderated the relationship between patient acuity and emotional exhaustion. Nurse managers should invest in nurses’ conditions of work environments.

Using trauma informed care as a nursing model of care in an acute inpatient mental health unit: A practice development process

Without agreeing on an explicit approach to care, mental health nurses may resort to problem focused, task oriented practice. Defining a model of care is important but there is also a need to consider the philosophical basis of any model. The use of Trauma Informed Care as a guiding philosophy provides a robust framework from which to review nursing practice. This paper describes a nursing workforce practice development process to implement Trauma Informed Care as an inpatient model of mental health nursing care. Trauma Informed Care is an evidence-based approach to care delivery that is applicable to mental health inpatient units; while there are differing strategies for implementation, there is scope for mental health nurses to take on Trauma Informed Care as a guiding philosophy, a model of care or a practice development project within all of their roles and settings in order to ensure that it has considered, relevant and meaningful implementation. The principles of Trauma Informed Care may also offer guidance for managing workforce stress and distress associated with practice change.