Transformation of the Role of the Bedside Nurse: A Model for Clinical Practice

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by Olga Vlad and Christine O. Newman, MS, RNC (in collaboration with Olga Detsyk, MD, and Sudhakar G. Ezhuthachan, MD, RS, DCH, FAAP)

Objectives: The neonatology partnership between Henry Ford Health System (HFHS) and L'viv Oblast Clinical Hospital (LOCH) sought to develop a Level III Intensive Care Nursery to care for sick infants. To achieve this objective, we expanded the responsibilities of the bedside nurse in the unit. A nontraditional head nurse role, similar to a unit educator role, was created to educate and support the bedside nurse.

Implementation: Prior to partnership activities, nurses in the neonatal unit provided basic care. Infants were fed, clothed, and monitored. A small group of nurses cared for premature infants, observing them closely, starting intravenous lines and administering medications. The nurse-patient ratio ranged from 1:8 to1:16. A proposal was presented to the Administrator of LOCH to create an additional "head nurse" role, similar to a nurse educator. The Unit would have two head nurses, one functioning in the traditional role and one whose responsibilities would include educating nursing staff, overseeing clinical changes, and establishing standards for the intensive care unit. The partnership workgroup developed a plan for training the nurse, including US-based training in neonatal intensive care nursing and the role of education. Upon her return to L'viv she began training bedside nurses. Over the two years, additional nurses worked side by side in the NICU in Detroit with nurse preceptors. Reinforcement of principles and increased training occurred in L'viv with each U.S. exchange. Policies and procedures for patient care were shared, and formal lectures addressing a variety of topics were presented to the nursing staff. As nursing responsibilities increased, a patient care flowchart was developed so nurses could document vital patient data. This facilitated collaboration and communication between nurses and physicians. Both head nurses are members of the unit's Collaborative Practice Committee. Nurses from the region and city hospitals now come to LOCH for training in nursing care for infants. The unit educator also has been trained as an instructor in the Neonatal Resuscitation Program (NRP). All nurses in the unit have been certified in NRP.

Evaluation: Nurses now assess infants' vital signs as well as oxygen saturation using intensive care monitoring equipment. They care for infants on ventilators, assessing breathing, managing the airway, endotracheal suctioning and troubleshooting. Bedside laboratory testing, including blood glucose, hematocrit, reticulocyte count, and blood gas analysis, is performed by the nursing staff. Nurses participate in daily patient rounds and are involved in problem- solving issues in the care of infants. The nurse patient ratio in intensive care is 1:3. A neonatal transport program established in the unit includes a nurse as a team member. The team transports sick infants from hospitals in the region.

Conclusions: Changes in nursing responsibilities can be made in the unit, despite the absence of a formal nursing structure, if the environment is supportive of the growth. A well-structured curriculum and an expanded nursing role in the clinical area can provide the necessary education and support to bedside nurses to successfully master the skills needed to care for sick newborns. Collaboration and support from physicians is crucial.

Implications: This model can be replicated in any patient care setting to increase the skills of nurses and advance nursing practice. Strategies can be put in place in clinical settings that will promote immediate improvements and increase the level of nursing care to patients. Changes in the role of nurses in patient care areas will provide an environment that will support the clinical experience of nursing students and provide necessary role models for the advancement of nurse practice in the NIS.

Olga Vlad is Head Nurse at L'viv Oblast Clinical Hospital,
L'viv, Ukraine
tel: 38 (0322) 75 50 21
fax: 38 (0322) 75 78 15

Christine O. Newman is a Neonatal Clinical Nurse Specialist with the Henry Ford Health System, Detroit, Michigan

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