Transforming care at the bedside: A new approach to nursing

There are many, many people with stressful jobs, but it is difficult to compare a Corporate CEO's stress with that of a Registered Nurse. Yes, the stress is different, as one deals with money and the other deals with life and death. The real contrast? That CEO may need the assistance of the nurse to save his life at some point in the future, whereas the nurse will never have the same sort of need for the CEO. Yes, our nurses are vital to our well being. They hold our hands through procedures, they assist in the delivering of our babies, and they take over completely in lieu of a doctor's presence. Unfortunately for the CEO, and for many patients in hospitals right now, nurses are pulled in so many different directions that it has become impossible for them to keep up. Job stress, long hours, and unmanageable constraints on their time have resulted in a major nursing shortage and a high turnover rate. A complete restructuring of the nursing profession is long overdue. It is obvious that the RN career path must change, and Transforming Care at the Bedside is the solution.

Transforming Care at the Bedside (TCAB) is attempting to change the current state of nursing today. TCAB is a three-year training program that will be undertaken by nurses around the country. Through training and support, RNs will focus more time on their patients and work to maintain job satisfaction over a long period of time.

The nursing shortage has reached critical levels due to many factors. The aging population of nurses is larger than the influx of new recruits, as the inhibiting costs and high enrollment rates in schools outweighs the ability to take in students interested in earning their nursing degree. Once on the job, long hours and an overwhelming work load can take its toll. TCAB began as an initial brainstorming project in a medical-surgical unit. Funded by the Robert Wood Johnson Foundation, the goal was to find and implement different ways for nurses to do their jobs. The eventual hope was that the unit could increase job satisfaction to the point that there would not be such a high turn over rate. What began in 2003 as an initial one-unit project has expanded to over 200 units across the USA.

TCAB uses a multi-tiered approach to finding new and innovative solutions in health care. Taking ideas from nurses, educators, and administrators, TCAB's focus is on change. Rapid test cycles, discussions as to what works and what doesn't, and involving the entire staff is what creates a new work environment.

The Robert Wood Johnson Foundation grant of $732,000 funds the initial changes, and allows for the freedom of implementing new policies and procedures in hospitals. A massive retraining and overhaul would cost a great deal of money to each individual hospital, and the grant puts much-needed funds to good work. Nurses that are currently in residence are retrained and encouraged to voice their opinions. New recruits are then given tools and information to begin their career as a nurse, learning to do things the new way and not fall into old traps.

TCAB may be the key to turning the current nursing shortage around and providing all RNs with a better work environment. It is the hope that a patient focused approach will increase the satisfaction of both the nurse and the patient.

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