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Statement of the Problem: The implementation of healthcare reform requires new innovative nursing care models. Smaller work
teams have been shown to increase teamwork in nursing. Smaller work teams provide for increased communication and accountability,
closer supervision, better support for new staff, and increased knowledge of the patient condition. This study examines the effect of
an innovative care team model using smaller, geographic work teams on patient outcomes, continuity of care and teamwork.
Methods & Theoretical Orientation: This study was conducted in three hospital units in an academic medical center. Nurses in these
units were divided into equal teams with equal bed counts. Nurses were assigned to one team and one geographic area only. Success
of the model was assessed after one year including clinical outcomes, patient satisfaction, nurse continuity and nurse teamwork.
Results: Nurse continuity improved in all units as evidenced by the average number of new RN encounters (including day and
night shifts) decreased from 4.49 per patient to 3.94 per patient. The percent of team intactness was 87.4% indicating the model was
successfully followed. Patient length of stay (LOS) in the hospital decreased across units by 14% therefore reducing overall costs.
Patient satisfaction scores were variable across units. Satisfaction with nursing teamwork and nursing trust mean scores improved
significantly (p=.04) across units.
Conclusion & Significance: Developing smaller, more cohesive teams yields benefits of improved continuity of care for patients and
improved patient outcomes. Improved continuity of care for patients may lead to safer care and improved engagement for nurses.
Defining smaller work teams in a distinct geographic area is a model that shows promising results in developing teamwork among
nurses and improving patient care.
Cathy Rodgers Ward is an experienced Nurse Executive and Researcher and is most recently the Chief Nursing Officer for the past 18 years at the UCLA Medical Center in Los Angeles, California, designated three times as a Magnet facility. She also holds an appointment as Clinical Faculty in the UCLA School of Nursing. Her research has focused on the effects of nursing leadership on patient outcomes in hospitalized patients. Under her direction, UCLA achieved high patient satisfaction with overall quality of care ranking above the 90th percentile nationally and nurse satisfaction ranked above the 95th percentile. She has received many awards including the 2017 UCLA Leadership Award, 2015 Distinguished Alumni Award from the University of Alabama in Birmingham, the 2015 Transformational Leadership Award at UCLA, and the United States 2011 Nurse week National Management Nurse of the Year.
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