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The Future of Nursing: Leading Change, Advancing Health
sist of three registered nurses, or two registered nurses and a licensed practical nurse, or one registered nurse and two other types of providers. This allows for flexible and productive staffing. Self-organization allows the team to determine how to best provide care for the patient cohort depending on patient needs and team capabilities.
The traditional care plan report has been eliminated in favor of a daily team planning conference to discuss patient care. The team enters data into an electronic record and between meetings, any team member can access the record to view or add current information about the patient.
This model has improved unit productivity and provided staffing flexibility without compromising patient care. Unit productivity improved from 10.2 hours per patient day to 7.5 hours per patient day. The hospital has adopted the philosophy of “doing less with less” as a sustainable model. The outcome is a high-quality product with the least amount of waste.
While the Agile Care Team model is an improvement within the current state of acute care, we need to consider a future that embraces technology and extends beyond the walls of the current hospital system. Imagine the manual care delivery system transformed into one that is managed virtually. An interdisciplinary care team is located in a control center with capability to plan, monitor and administer treatment to patients in hospitals or homes. The control center is connected to the patient at the care scene through multiple electronic data transfer interfaces. Treatment is administered through technology including robotics or by unlicensed staff directed to complete tasks through devices such as web cams, bluetooths, bar code medication verification scanners, and other information transfer devices. Complex tasks once only executed by a highly trained provider can now be completed through robotic and information systems. Errors in care are eliminated as providers in the control center focus on the treatment plan instead of distractions at the care scene such as completing tasks (including medication administration), looking for supplies, completing paperwork, managing interruptions, and moving patients. Nurse-to-patient ratios, increasing nursing time in direct care, nursing stations, and bedside change-of-shift reports between registered nurses are now obsolete. Now the professional nurse in the control center is a provider of care integration, expert surveillance, and management of imminent clinical needs such as pain management and emergency intervention.
Imagine this. The hospital of the future is not “a place” but rather a collection of inpatient and outpatient facilities as well as patient homes interconnected through a shared information technology infrastructure. Care will no longer be defined by episodic events such as a hospital stay but rather by the episode of care required across settings and providers to fully recover from an illness or manage an exacerbation of a chronic disease. Patients and their families will ac-