Driving Hospital Improvements by Empowering Front-line Nursing Staff

A Progress Report

Dates of Project: September 2009–April 2013

Front-line nurses at 48 hospitals—two-thirds of New Jersey’s acute-care facilities—plus two non-acute-care providers implemented innovative practices to improve the hospital work environment and patient care. This was a state-specific pilot of a national model, Transforming Care at the Bedside (TCAB).

Description: The quality of hospital nursing care has a direct impact on the quality and safety of patient care. Too often, inefficient workplace policies and practices prevent hospital nurses from focusing fully on the needs of their patients. Both patient care and nurse job satisfaction suffer as a result. Transforming Care at the Bedside (TCAB) was an effort to empower nurses to make changes.

Researchers from the RAND Corporation and the University of California, Los Angeles, evaluated the program and in April 2013 reported that overall the findings “suggest that TCAB provided a set of activities of high value to nursing units.”

  • The hospitals’ pilot TCAB units showed statistically significant improvement in prevalence of pressure ulcers and two measures of patient satisfaction. Changes in four other outcomes tracked by the evaluators were not statistically significant.
  • Survey responses of TCAB pilot unit managers “suggest that large proportions of the participating nursing units implemented the key TCAB processes.”

Almost all the unit managers indicated that “if they had to do it over, they would participate in TCAB again.”

  • Staff responses to a survey on teamwork “suggest the nursing work environment significantly improved in the TCAB units over the course of the program.”

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