Adopting a common nursing practice model across a recently merged multi-site hospital

Principal Investigator: Dr. Michael S. Kerr
Team Members: Dr. Ginette Lemire Rodger, Dr. Heather Laschinger, Dr. Gail Hepburn, Ms. Martine Mayrand Leclerc, Ms. Julie Gilbert, Ms. Gale Murray, Dr. Linda-Lee O’Brien-Pa llas

Full report (266 KB)

Key implications for decision-makers

A new model of nursing care practice that emphasizes continuity of care for patients as well as the provision of clinical experts for nursing staff was developed by a multidisciplinary staff team at The Ottawa Hospital. The introduction of the model was extensively evaluated at the three largest campuses over a three-year period using a mixture of approaches and methods, including quality of care surveys from 1,672 patients as well as ratings of work and heath indicators from 731 nurses.

It is important to monitor the process of implementation as well as the main evaluation outcomes and to ensure that staff members have a strong buy-in for the changes being introduced in order to encourage active and ongoing participation throughout the process. Work reorganizations on this scale can take several years to complete and require extensive effort to maintain momentum and involvement.

Key Findings

  • Patient ratings (from multi-item surveys) of nursing quality of care are consistently very high and thus are not very sensitive to detecting changes created by the introduction of a new model of nursing care. Patients from all three hospital sites consistently rated the overall quality of their nursing care as excellent or very good about 90% of the time. There were no significant changes noted over time in either the combined patient rating summary scales or the scores for the scale’s individual questions designed to address several specific components of nursing care.
  • Nursing staff survey data indicate that the intervention had a number of positive outcomes on the quality of nurse work life, well-being and their perceptions of the organizational climate although the improvements seen one year after the introduction of the new model were often tempered over time, suggesting the need for ongoing monitoring and adjustments of quality of work-life indicators.
  • Major organizational change, such as introducing a new model of clinical nursing practice, can be done without negatively affecting work stress or nurse well-being. Markers of nurse health and well-being were not strongly affected by the introduction of the new model. Nurse burnout and family-work conflict were slightly improved one year after the new model was introduced while nurse ratings of their overall physical health showed a slight drop over time. No differences were seen over time for nurse ratings of their pain (back and neck/shoulder) or mental health.
  • Nurse practice environment and organizational climate indicators were positively influenced by the introduction of the new model, as nurse-physician relations, nurse control over practice, nurse autonomy, nurse empowerment as well as organizational support, the patient safety climate and organizational justice were all rated by nurses as being better one year after the model had been introduced.
  • Although the introduction of the new model appears to have had some benefit for nurses, this did not directly translate into improved patient care when assessed via the patients themselves or from nurse ratings. Thus, more work needs to be done to identify potential markers sensitive to the type of changes such interventions invoke.

SKerr Table 1