The working conditions of nurses are extremely stressful. They often deliver care within inefficient and disconnected systems; they manage a complex list of physician orders that require continuous reprioritizing; they perform the critical functions of surveillance and continuous monitoring of patients; and they do this work while “hunting and gathering” for equipment, supplies, and personnel, and experiencing frequent interruptions and distractions. They become what Chow called “masters of work-arounds” for systems that do not function well.
Over the next decade, Chow asserted, new practice models are needed “that focus on the real contributions of nurses, and we need to change the way we organize and deliver that care.” For example, the Gordon and Betty Moore Foundation has funded a project called Destination Bedside in two Kaiser facilities in Northern California. It is seeking to create more effective work environments that seamlessly support nurses and other clinicians in the delivery of patient care. In addition, a