This paper examines how healthcare facilities facing financial pressure from declining Medicare/Medicaid reimbursements and rising uninsured patient volumes can reduce costs while maintaining care quality by reforming their nursing care delivery model. The proposed solution transitions medical-surgical units from a primary care model to a team-based approach, combining registered nurses (RNs), licensed practical nurses (LPNs), and nurse assistants in coordinated three-member care teams. Using Kurt Lewin's three-phase change theory as a framework, the paper outlines implementation strategies, expected outcomes, and broader implications for patient satisfaction, staff retention, and institutional financial sustainability.
Healthcare centers across the United States have been searching for cost-cutting techniques while simultaneously maintaining the superior quality of their patient care delivery. Given the current economic climate, cost reduction is vital for healthcare organizations' continued functioning. An estimated growth in the number of patients lacking the funds to pay for services, combined with declining Medicare and Medicaid reimbursements, has created a financially challenging period for the health sector. Facilities that fail to respond proactively to these shifting trends risk dramatic cuts that could severely limit small communities' access to healthcare. This situation compels healthcare organizations to develop creative financial solutions.
Adjusting a facility's nurse assistant, registered nurse (RN), and licensed nurse practitioner skills mix within a given nursing unit may facilitate the delivery of more effective patient care, thereby enhancing both provider and patient satisfaction (Gier, 2013). Without a sound, competent nursing workforce, healthcare organizations' care delivery expenses increase in numerous ways. Increased personnel resignations, for instance, mean greater expenditure on recruiting and training, and salary increases are typically required to attract new candidates (Berlin & Grote, 2013).
Healthcare facilities must work toward improving patient flows, decreasing the duration of patient hospitalizations, and employing more bedside tools and techniques. Planning and developing evidence-based practices requires a critical analysis of findings from prior studies, followed by integrating those findings with patient requirements and the clinical expertise of nursing staff. Another important factor is the healthcare facility's existing financial standing. Modern patients are more knowledgeable about medicines and treatment than their predecessors, meaning they naturally expect efficient, high-quality care. Nursing care theories provide the basis for planning and delivering patient care, and they reflect the philosophical foundation of current organizational culture and patient care delivery. Patient care is grounded in each consumer's unique and evolving needs and condition, and it requires better planning, interdisciplinary teamwork, and coordination. Ultimately, the care delivery model adopted affects staffing numbers, their flexible utilization, and, consequently, organizational spending (Mattila et al., 2014).
Traditionally, medical-surgical divisions have maintained a high proportion of RNs relative to other direct-care provider skill levels. RNs perform a large number of functions that nurse assistants are generally not assigned, yet several of those functions actually fall within nurse assistants' scope of practice and ought to be delegated for more effective patient care delivery. The move toward a team care delivery model enables three-member units — which could consist of two RNs and one nurse assistant, or one each of a nurse assistant, RN, and Licensed Practical Nurse (LPN) — to share responsibility for caring for a defined patient group.
This novel model of patient care delivery has the potential to ensure nursing staff deliver improved patient care. Nurse assistants can fulfill patients' fundamental needs more quickly and effectively, while LPNs and RNs gain more time to carry out the tasks most critical to their roles. The skills mix adjustment can also enhance patient care quality outcomes. Through the adoption of Purposeful Rounding, nurse assistants can proactively anticipate patient requirements, contribute to fall prevention, and reduce the occurrence of pressure ulcers. This in turn reduces hospitalization duration and overall organizational expenses (Fowler, Hardy, & Howarth, 2006). Cost savings realized through this approach may take the form of both direct cash savings and reductions in costs associated with healthcare institution-acquired complications.
Like other healthcare providers, nursing personnel will generally exhibit job dissatisfaction in the absence of meaningful involvement with their organization. Collective governance is among the strongest tools available for increasing nurse engagement, as it accords nurses greater autonomy, allows them to express their opinions and ideas regarding workplace conditions, and enables them to collaborate with colleagues across institutional areas or units. In essence, collective governance helps nursing personnel collectively voice their perspectives and contribute to their workplace environment, thereby reinforcing their capacity to bring about patient care improvements (Berlin & Grote, 2013).
"Unfreezing, Moving, Refreezing implementation framework"
"Cost savings, quality gains, and staff benefits"
"Long-term impact on reimbursement and retention"
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