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"Our vision is that Clarian will become a model of clinical excellence second to none," explains Karlene Kerfoot, RN, PhD, CNAA, Clarian’s chief nurse executive and Indiana University School of Nursing associate dean for clinical practice. "We were looking for a strategy to transform our nursing care delivery model to a professional practice model. The AACN Synergy Model for Patient Care speaks to our belief that our true work is to transform the lives of our patients and staff. The model really resonates with our vision for nursing. It explains nursing practice in a way that all of our stakeholders, not just the nurses, can understand."
The Synergy Model’s basic premise is that when the needs of the patient are matched with the characteristics and skills of the nurse, synergy occurs and patient outcomes are optimized. Clarian has applied this model to define its nurse program and address the need to reprofessionalize nursing within the organization.
The model identifies 8 patient characteristics that represent the needs of the patients and systems. Eight additional competencies defined the required characteristics of nurses and care systems. "This work has resulted in a comprehensive professional practice model," said Marilyn Cox, RN, MSN, senior vice president for nursing and patient care services at Clarian’s Riley Hospital for Children campus. Cox is responsible for executive sponsorship of the project.
"The project has established a foundation that is ‘synergizing’ and transforming our entire organization. We started with nursing, but this model is already influencing how we deliver patient care services in every area," she said.
According to Cox, to date more than 1500 nurses have begun to participate in the professional advancement initiative, but she predicts it will take until the end of 2005 to get a critical mass of partner and senior partner positions in place based on the needs of specific units and care programs.
Clarian’s professional advancement model has developed 3 differentiated roles. The number of roles available in a particular clinical area is driven by the needs of its patient population.
"This is very different from what we’ve done in the last 20 years," Cox said. "Traditional clinical ladder programs did not link professional advancement with patient and program needs. Those ladders focused more on what nurses did to advance professionally, like obtaining continuing education credit or speaking and publishing."
The differentiated roles are associate partner, partner, and senior partner. Associate partners are highly competent nurses whose primary responsibilities are defined by a direct care relationship with patients and families, along with participation in achieving patient outcomes, unit standards, and performance benchmarks.
Partners are highly proficient in the care that they provide to patients with more complex needs. Partners are accountable for direct patient care, but are also considered unit leaders. As leaders they may be mentors or "safe passage nurses" who ensure that the unit’s practice environment is the safest possible. Partners help design and implement clinical process improvements to enhance patient satisfaction, clinical outcomes, and financial performance. A partner has direct relationships with patients, other nurses, and the unit’s environment.
Senior partners practice at a highly expert level focusing on the most complex patients and crafting interventional plans to meet their needs. Senior partners are in 90% direct patient care. They are mentors and preceptors, especially to the partners who develop unit-level projects. Senior partners also work on the broader health system level, translating unit-based advances to influence the entire organization. For this reason, they also have direct relationships with the system.
"In allocating the 3 roles, a greater number of partner and senior partner nurses may be needed in critical care areas where patients have highly complex needs and a comparably high level of knowledge and skills to meet them," Cox said.
On the other hand, patients in a postprocedure recovery area come in well and, after sufficient recovery, will go home the same day back to their normal baseline. Associate partners or partners would meet their needs.
"This is a huge transformational change for an institution, not only for nurses in terms of how we view our practice," Cox said. "So we have redesigned the nursing department to support this change." Clarian has developed strong partnerships with human resource and financial administrators to determine what policies and services, such as a new compensation system, are needed to support the program. This has included work with Indiana University School of Nursing, Clarian’s academic partner.
The next step of development is the patient side of the model. This will include modifying the patient acuity measurement and documentation systems according to the Synergy Model’s patient characteristics. Supports to daily work processes, like shift-to-shift reports and patient assignment parameters that assist charge nurses to match patient need to nurse skill set, will also be developed. As nurses perfect their practices through the model, dialogue with patients and families will evolve through a collaborative family center approach to planning care.
Expected outcome measures include clinical excellence, people excellence, service excellence, and cost excellence. In clinical excellence, nurse-sensitive outcomes will be tracked in patients based on the patient population in that unit. The partner and senior partners are linked to Clarian’s care management system so they have a more active part in daily rounding and patient outcome benchmarks.
"In people excellence, because we believe that this professional environment is what nurses want, our turnover rates will drop because we will see increased nurse satisfaction," Cox said. "This ultimately translates to financial excellence by eliminating some of the high costs of contingency staffing. We will spend fewer dollars to support new nurse orientations required because of high vacancy and turnover rates. In terms of service excellence, we have nurses with exquisite skill sets based on the nurse characteristics, so patient and family satisfaction will be much higher."
For more information on the AACN Synergy Model for Patient Care, visit www.certcorp.org or write to synergy{at}aacn.org.
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