Redesign of the model of nursing practice in an acute care ward : nurses' experiences

Objective: To describe nurses' experiences of the change associated with redesign of the model of nursing practice in an acute care ward in the preparatory and implementation phases. Design: Descriptive case study. Setting: A surgical ward in an acute care hospital in Greater Western Sydney. Subjects: Fourteen registered and six enrolled nurses working on the surgical ward volunteered to be interviewed, eight in the preparatory phase and twelve six months into the implementation phase. Main outcome measure: Descriptions of nurses' experiences in the preparatory phase and six months into the implementation phase of the redesigned nursing practice model. Results: Many nurses felt apprehensive in the preparatory phase, however, six months into implementation phase their willingness to trial the model was evident. Negativity pervaded both phases, as did their concerns for the quality of care being given. In the preparatory phase nurses described the clinical activities coordinator (CAC) role as having potential to be beneficial and this was realised to some degree six months into implementation phase. A preference for registered nurses over enrolled nurses as a dominant component of the staff was evident in both phases. Conclusions: The struggle with the change that nurses experienced suggests redesign needs to be a more collaborative process involving strong communication and supportive education so nurses can empower themselves within the change.