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Background: After a pilot phase in 2017, nursing visits (PV) were implemented in an intensive care unit (ICU) at a university hospital. So far, published findings on the impact of PV on the primary nursing organisation system (process-responsible nursing [PP]) could not be identified., Aim: Primary aim was to investigate the effects of PV on PP from the nurses perspective. Secondary aims included comparison with the results of the pilot phase (t 0 ) to determine further effects, general conditions of the PP and the overall evaluation., Methods: A quantitative evaluation study using a standardised questionnaire was used., Results: The survey was conducted in September to October 2023 (t 1 ) with a response rate of 74.6% (n = 47). On a scale of 1-6 (strongly agree; strongly disagree), 100.0% of the process-responsible nurses (PP; n = 8) and 77.0% of the nurses without process responsibility (P; n = 30) rated the PV at levels 1-3 (p = 0.328) as contributing to the evaluation of care planning for patients with process responsibility. PV provided support for the implementation of PP (PP: 100.0%, n = 8; P: 79.5%, n = 31; p = 0.318) and had a statistically significant effect (r = 0.97, p = 0.035) on improving the quality of care and care planning for patients with procedural responsibility. The nurses indicated with levels 1-3 that the patients were more consciously brought into the focus of nursing care through the PV (t 1 : 74.4%, n = 35; t0: 86.4%, n = 38; p = 0.953). The PV should take place weekly and was rated with a median of 2 (IQR t 1 : 1-3; t 0 :1-2)., Conclusion: PV support the implementation of PP and patient-centred care in the ICU., (© 2024. The Author(s).)

Development and implementation of primary nursing in the intensive care unit: evaluation in mixed-methods design. Abstract: Background: In a university hospital, the development and implementation of Primary Nursing (Prozessverantwortliche Pflege, PP) in a pilot intensive care unit was initiated. To develop the roles of nurses with and without process responsibility a working group PP was founded while taking into account the skill-grade mix. Aim: The working group aimed to develop the roles of process-responsible nurses (PP) and nurses (P), as well as to plan and implement the implementation process. Methods: Development and piloting steps were taken based on the recommendations of the Medical Research Council. At three measurement points, the instrument for recording nursing systems (IzEP©) was used quantitatively and a focus group interview, as well as a ward process analysis, were used qualitatively in t 0 (as-is analysis before development and piloting), t 1 (6 months after implementation) and t 2 (12 months after implementation). Results: PP mainly take over the care process's design and control. The IzEP© analysis showed that room care was practiced in t 0 with 50.0%. The values increased towards PP from 74.0% in t 1 to 83.5% in t 2 . Qualitatively obtained data supported these results and showed further optimization potential for practice. Conclusions: The results prove the successful implementation of PP in practice. For the development and implementation of new nursing roles, the involvement of the affected nurses is mandatory.

Objective: To define, measure, and characterize key competencies of managing labor and delivery units in the United States and assess the associations between unit management and maternal outcomes., Methods: We developed and administered a management measurement instrument using structured telephone interviews with both the primary nurse and physician managers at 53 diverse hospitals across the United States. A trained interviewer scored the managers' interview responses based on management practices that ranged from most reactive (lowest scores) to most proactive (highest scores). We established instrument validity by conducting site visits among a subsample of 11 hospitals and established reliability using interrater comparison. Using a factor analysis, we identified three themes of management competencies: management of unit culture, patient flow, and nursing. We constructed patient-level regressions to assess the independent association between these management themes and maternal outcomes., Results: Proactive management of unit culture and nursing was associated with a significantly higher risk of primary cesarean delivery in low-risk patients (relative risk [RR] 1.30, 95% CI 1.02-1.66 and RR 1.47, 95% CI 1.13-1.92, respectively). Proactive management of unit culture was also associated with a significantly higher risk of prolonged length of stay (RR 4.13, 95% CI 1.98-8.64), postpartum hemorrhage (RR 2.57, 95% CI 1.58-4.18), and blood transfusion (RR 1.87, 95% CI 1.12-3.13). Proactive management of patient flow and nursing was associated with a significantly lower risk of prolonged length of stay (RR 0.23, 95% CI 0.12-0.46 and RR 0.27, 95% CI 0.11-0.62, respectively)., Conclusion: Labor and delivery unit management varies dramatically across and within hospitals in the United States. Some proactive management practices may be associated with increased risk of primary cesarean delivery and maternal morbidity. Other proactive management practices may be associated with decreased risk of prolonged length of stay, indicating a potential opportunity to safely improve labor and delivery unit efficiency.

Evaluating the implementation of care models such as Primary Nursing requires assessment of both short-term and long-term outcomes. In a hospital in Piemonte, Italy, a mixedmethod time-series study was conducted to assess if and how the organizational culture of nurses changed in relation to the implementation of a new organizational model of care. Instruments used included the Condition of Work Effectiveness Questionnaire (CWEQ II) and an investigator-developed questionnaire to evaluate perceptions of dimensions consistent with Primary Nursing. Results showed a significant culture change over time related to the implementation of Primary Nursing, mainly in terms of nurses' understanding of their professional role specifications. In addition, the results supported a relationship between being involved in the project implementation and the procedural and cultural approach adopted.

Primary nursing is a model of care delivery that has been shown to improve the quality of care provided to patients and enhance the nurse-patient relationship. Although there is considerable attention in the literature on Primary Nursing concerning inpatient hospital units, there has been no discussion of Primary Nursing in short-stay units. Our hospital aimed to introduce Primary Nursing into all the units including short-stay. Staff were educated about the role of the primary nurse using Koloroutis's (2004) Relationship-Based Care model, comprising three crucial relationships: care provider's relationship with patients and families, with self, and with colleagues. The primary nurse develops the plan of care for individual patients based on their therapeutic relationship, which is sustained for the patient's length of stay in the unit.

Objective: To determine whether there is an association between the Primary Nursing Model and perceived quality of care., Method: An observational, descriptive, cross-sectional study in four hospital wards with Primary Nursing organization. Over a 12-month period, all the patients discharged from each ward were included in this study. The degree of development of Primary Nursing was measured by using the Personalization of Nursing Care Index and the perceived quality of care was measured with the LOPSS-12. Bivariate statistical analysis was carried out through ANOVA and Student's t-tests. Multivariate linear regression analysis was then applied to correlated variables (p < 0.05)., Results: 817 patients were included, 447 from two medical wards and 370 from two surgical wards. After a preliminary data analysis performed 6 months after the start of the study, four items were removed from the LOPSS-12 and each of the remaining items were analyzed separately. Scores for both patient satisfaction and the introduction of the Primary Nursing Model were higher in the surgical wards. Bivariate and multivariate regression analyses showed a statistically significant (p < 0.05) association between implantation of the model and all except one of the items included in the questionnaire., Conclusions: The introduction of the Primary Nursing Model in hospital wards allows the presence of a primary nurse for each patient and consequently improves the nurse-patient relationship, increasing perceived quality of care among patients., (Copyright © 2010 SESPAS. Published by Elsevier Espana. All rights reserved.)

At the Solothurn Hospitals (soH), 13 academically educated nurses are responsible for the development of nursing care with the goal to improve patient-oriented, effective, appropriate, and economic care. The strategy contains three priorities: a) expert care of single patients in demanding situations, b) sustained application of organisational methods such as primary nursing, nursing process, and skill/grade mix, and c) design and management of practice development projects related to specific patient groups. A first evaluation with qualitative and quantitative methods showed that the exemplary care of single patients by expert nurses was evaluated as positive for the patients as well as for the teams on two wards by nurses who were interviewed. After the introduction of primary nursing, the application rate was 81 to 90 % and the introduction of fall prevention methods in geriatric rehabilitation decreased the fall rate from 8.2 to 5.5 per 1000 patient days. A comparision with the literature shows that the expert nurses of soH perform both, working at the bedside and being responsible for practice development projects, as specialised Advanced Practice Nurses (APNs). APNs at the Solothurn Hospitals work also as generalists when organisational methods need to be consolidated. Their successes depend from their integration into the hierarchy and both, into the nursing as well as into the interprofessional teams. Competencies in Transformational Leadership also are essential at all management levels.

The Family Health and Birth Center (FHBC) is a family- and community-centered collaborative partnership designed to address the needs of women and families in the geographic area known as Ward 5 in Washington, DC. This community is predominantly low-income and African American; however, in recent years, a growing Latina and middle-income white population have sought out FHBC's services. Based on the midwifery model, FHBC provides prenatal care and midwifery-supported and -attended births in the freestanding birth center or at the nearby Washington Hospital Center. Through the collaborative partnership housed in a former supermarket and known as the Developing Families Center (DFC), FHBC works closely with the Healthy Babies Project and the United Planning Organization's Early Childhood Development Center. The aim of these partnerships is to provide midwifery-supported prenatal and birthing care within a framework of understanding the social context of health care. Together, the DFC/FHBC collaborative partnership provides a comprehensive system of health care for this predominantly underserved population. The purpose of this article is to highlight the FHBC--our perspective on the history of the founding of this center as a nurse-midwife-led model of care. Included in this issue is a comparative case study conducted by Palmer et al at the Urban Institute that systematically contrasts the care provided by three different models of maternity care serving low-income African American women in Washington, DC. Using qualitative methodology, the study analyzes the content and delivery of care, and the cost-effectiveness of FHBC as compared to a large city hospital and a federally qualified health care center. Study findings indicate that the combined elements of nurse-midwife-led maternal and child care with a focus on the social and educational context of pregnancy, birth, and infant/toddler better meet the needs of the population than do the comparison models.

Objective: To explore how a group of midwives achieved a work-life balance working within a caseload model of care with flexible work hours and on-call work., Design: in-depth interviews were conducted and the data were analysed using a data-driven thematic analysis technique., Setting: Children, Youth and Women's Health Service (CYWHS) (previously Women's and Children's Hospital), Adelaide, where a midwifery service known as Midwifery Group Practice (MGP) offers a caseload model of care to women within a midwife-managed unit., Participants: 17 midwives who were currently working, or had previously worked, in MGP., Findings: analysis of the midwives' individual experiences provided insight into how midwives managed the flexible hours and on-call work to achieve a sustainable work-life balance within a caseload model of care., Key Conclusions: it is important for midwives working in MGP to actively manage the flexibility of their role with time on call. Organisational, team and individual structure influenced how flexibility of hours was managed; however, a period of adjustment was required to achieve this balance., Implications: the study findings offer a description of effective, sustainable strategies to manage flexible hours and on-call work that may assist other midwives working in a similar role or considering this type of work setting., (Copyright 2008 Elsevier Ltd. All rights reserved.)

Agreement was reached with 12 acute medical and surgical wards/units at Sydney's Prince of Wales Hospital to participate in a trial of team nursing (TN). Six units employed action research principles to undertake a change to a team nursing model and six remained with the pre-existing individual patient allocation (IPA) model. Task-based teaming was widely discarded by the team nursing units in favour of allocating patients within the team and introducing more supportive and communicative processes aimed at fostering responsibility sharing. Localised team-based models of care arose in the change wards and were outlined, implemented and refined using social action research principles. A 12-month prospective experimental comparison of job satisfaction and staff retention between the TN and IPA groups indicated statistically significant job satisfaction benefits and practically important staff retention benefits associated with moving away from an IPA model of nursing care delivery towards a team-based model of care delivery. Perhaps not surprisingly, job satisfaction gains were most marked among new graduate nurses, who reported real benefits from a teaming inspired shift in model of care in the acute inpatient environment.

Background: The concept of autonomy is regarded as an essential element for gaining professional status. Yet, it remains poorly defined and understood. To date, there is little research that has focused on exploring how nurses in different specialty areas perceive autonomy., Objective: The purpose of this research was to explore oncology nurses' perceptions of autonomy and understand how they develop and exhibit autonomy in their everyday practice., Methods: Using Leininger's ethnonursing method, data were collected from 15 oncology nurses using semistructured interviews. Participant observation was also carried out through job shadowing to complement interview data., Results: Three themes emerged from the findings: autonomy is an unspoken opportunity in the workplace; autonomy is developed through professional and personal growth acquired over time; and demonstrating autonomous behaviors is a conscious choice., Conclusion: The findings provide insight into how oncology nurses perceive, develop, and exhibit autonomy in everyday practice and how autonomous and collaborative clinical decision making contributes to quality cancer care., Implications for Practice: Descriptions of the meaning of autonomy and its explication in a nursing specialty practice can add to nursing knowledge by clarifying nurse autonomy and its relevance to nurses' work life. Descriptive studies can identify nurse behaviors and attitudes related to autonomy that may be measurable and relevant to real life.

The National Health and Hospital Reform Commission Report (NHHRC) and the Draft National Primary Health Care Strategy offer a vision for a better coordinated, multidisciplinary primary health care system in Australia. Equitable access, improved care and care coordination in primary health care are core components of this vision. Integral to this is a workforce that can work in an interprofessional way to provide quality and timely care to patients. There is good evidence supporting nurses undertaking an expanded role in the primary health care team.

In many hospitals, addressing increasing financial and regulatory requirements has resulted in a decline in care managers' time spent communicating directly with patients, families, and healthcare providers. The authors discuss the redesign of a hospital care management model that increased the time care managers spend with patients, families, and other care professionals, while patient satisfaction increased, labor cost remained neutral, length of stay decreased, and the payment denial rate remained among the country's lowest.

This qualitative study describes the staff nurses' perspective of change in the care delivery model and skill mix in an intermediate care unit. Data were collected in interviews in focus groups with the registered nurses affected by the change. Two major themes emerged: (1) autonomy and control and (2) interdependence. The nurses emphasized an increased satisfaction (self and patient) with this model. This study confirmed that autonomy, control, connection with the patient, and peer and interdisciplinary support and respect are important for the staff nurse. These findings reinforced the value of involving the staff members in change and the importance of giving voice to their perspective through qualitative research.

Since its development in the 1960s, primary nursing has become the model of care delivery in many health care settings. Over time, myths have developed about primary nursing's relevance in environments with high acuity, varying skill mixes, diverse staffing patterns, and short lengths of stay. This article addresses those myths.

The aim of this paper is to critically review the different approaches used to manage mental health care. Underpinning this aim is a literature review carried out using systematic approaches that clarifies how various frameworks are used and experienced. Responding consciously to policy, politics, and economic change there are a number of approaches that coexist without an explicit view as to whether they are useful tools kit or a phenomena that are, in-fact, less positive. Nevertheless experience to date suggests that clear lessons can be learned before practices become more widely adopted across health communities.

Homeless adults have a higher rate of morbidity and mortality than their housed counterparts. Improving the health of homeless adults is a complex problem because of the overlay of individual risk factors, social issues and lack of economic resources. Due to the increased morbidity and mortality rate in homeless adults, it is imperative to develop interventions with demonstrated efficacy that result in improved health outcomes. The purpose of this pre-post pilot study was to compare pre- and post-test scores on specific health outcomes in a group of homeless adults receiving a nurse intervention when utilising a nurse-managed clinic located in the urban core of a Midwestern city in the USA. Between September of 2004 and January 2006, 43 homeless adults completed a health survey at baseline and 2 months later that included measures of health-related quality of life (HRQOL), substance use and health resource use. There was a significant improvement on the post-test scores including substance use, perceived quality and availability of health care, and on two domains of HRQOL: mental health and vitality. This study provides evidence that a nursing intervention can result in improved health outcomes for adult homeless persons.

Objectives: To describe (1) the extent to which acute and intensive care units use the elements of nursing models (team, functional, primary, total patient care, patient-focused care, case management) and (2) the deployment of non-unit-based personnel resources., Background: The lack of current data-based behavioral descriptions of the extent to which elements of nursing models are implemented makes it difficult to determine how work models may influence outcomes., Methods: Nurse managers of 56 intensive care units and 80 acute care adult units from 40 randomly selected US hospitals participated in a structured interview regarding (1) day-shift use of patient assignment behaviors associated with nursing models and (2) the availability and consistency of assignment of non-unit-based support personnel., Results: No model was implemented fully. Almost all intensive care units reported similar assignment behaviors except in the consistency of patient assignment. Non-intensive care units demonstrated wide variation in assignment patterns. Patterns differed intra-institutionally. There were large differences in the availability and deployment of non-unit-based supportive resources., Conclusions: Administrators must recognize the differences in work models within their institutions as a part of any quality improvement effort. Attempts to test new work models must be rigorous in the measurement of their implementation.

This paper describes an evaluation of a change in health visiting service delivery from GP caseload management to corporate caseload working, in one inner city health centre located in a deprived area of Glasgow. The aim of the study was to identify if moving to corporate caseload working provides the reported benefits cited in the limited literature available. A purposive sample consisting of ten health visitors, one GP, one manager and three clients volunteered to participate in this mixed methods evaluation study. Data were collected by means of a stress questionnaire, public health nursing diary, focus groups and semi-structured interviews. Findings show that immediate improvements were seen in team working, staff communication, sharing practice, enhanced clinical reflection and standards of documentation. However, corporate caseload working did not appear to reduce staff stress levels, increase public health nursing activity or improve quality of client service. Further research conducted over a longer time period with a full staffing complement is needed to validate these findings.

The purpose of this study was to examine the effect of a renal nursing professional practice model (PPM) on nurses'perceptions of empowerment, characteristics of practice environments and the impact on nursing care outcomes in a university-based teaching hospital in Canada. Quantitative and qualitative methodologies were used. This paper will focus on the qualitative results. Content analysis was the data analysis method used. The following themes emerged: 1) Attunement, familiarity/knowing the patient, going the distance, 2) Patient outcomes, consistency and continuity of care, autonomy/taking the initiative, 3) Nurse rewards: satisfaction and accountability, empowerment/input, and 4) Facilitating systems: communication, support and assignment. The quantitative results had a significant (p = .005) improvement post-PPM implementation in the nursing foundations for quality of care subscale of the Practice Environment Scale of the Nursing Work Index (NWI-PES) and organizational relationships (p =.016) measured by the Conditions of Work Effectiveness II (CWEQ-II) questionnaires. This study provides evidence for PPMs and primary nursing as effective frameworks to positively impact nursing and patient outcomes in a hemodialysis unit.

Aim: To examine the association between hospitals' organizational variables and patients' perceptions of individualized care., Background: There is lack of evidence related to the effects that the hospital environment has on patient perceptions of the individuality of care they receive., Methods: A cross-sectional design was used. The questionnaire survey data were obtained from 861 (response rate 82%) hospital patients and 35 (100%) nurse managers in Finland. Results An inverse relationship between the size of the hospital and ward and patients' perceptions of individualized care was found. Increased staffing or skill mix failed to predict a higher patient perception of individualized care, but primary nursing care delivery did., Conclusions: Instead of increasing the amount of nursing staff, there is a need to improve the quality of the nurse-patient interactions to facilitate individualized care. The generalizability of the study is limited by the regional nature of the setting.

Change of shift report is unique to the nursing profession. During report, nurses transfer critical information to promote patient safety and best practices. Nurse-to-nurse bedside report is described as a strategy that includes the patient in the reporting process and is an innovative alternative to traditional shift report.

Modernising Nursing Careers envisages nurses moving between primary care, secondary care and the charitable sector. The fourth article in this series looks at careers based on patient pathways and a patient-led NHS.

A transformational nursing professional practice model (PPM) was developed and implemented in the London Health Sciences Centre's renal program. The purpose of this study was to examine the impact of a renal nursing PPM on nurses'perceptions of empowerment, characteristics of practice environments, and nursing outcomes. Quantitative and qualitative methodologies were used in this study. This paper will focus primarily on the quantitative results. The qualitative results are presented in Part II (Harwood, Ridley, Lawrence-Murphy, White, Laschinger, Bevan, & O'Brien, in press). A "then-and-now" design was used. There was a significant (p = .005) improvement post-PPM implementation in the nursing foundations for quality of care subscale of the Nursing Worklife Index-Practice Environment Scale (NWI-PES) and organizational relationships (p = .016) measured by the Conditions of Work Effectiveness II (CWEQ-II) Questionnaires. This study provides evidence for PPMs and primary nursing as effective frameworks to positively impact nursing and patient outcomes in a hemodialysis unit.

Objectives: To discuss the role of the radiation oncology nurse as changes in technology and treatment impact care delivery., Data Sources: Published articles and texts, professional organizations, and the authors' experience., Conclusion: Patients receiving cancer treatment today face a myriad of treatment options that can be delivered over days, weeks, and months. As treatments become more complex and standard chemotherapy regimens are combined with new agents and targeted agents, radiation oncology nurses need to have the knowledge and skills to accurately assess and intervene. The radiation oncology nurse is the cornerstone of patient advocacy, care, and education., Implications for Nursing Practice: Changes in treatment and technology continue to drive cancer care. Radiation oncology nurses need to collaborate with colleagues and incorporate evidence into practice.

The 1990s brought new fiscal realities to healthcare, leading to nursing job loss estimates in tens of thousands following widespread hospital restructuring to manage costs and improve efficiency. This research aimed at examining (a) how multiple episodes of hospital restructuring leading to layoff of nurses affected nurses who remained employed and (b) whether and how nursing leadership mitigated or intensified the negative effects of hospital restructuring on nurses. This dissertation comprised 3 empirical studies leading to 5 publications. The first study was a systematic literature review; the second and third used structural equation modeling to develop and test theoretical models addressing nursing practice environments and effects of hospital restructuring on nurses. The combined findings in this dissertation illustrate that hospital restructuring had significant negative physical/emotional health effects on nurses who remained employed. Nurses who worked for resonant (emotionally intelligent) leadership reported positive health and well-being, and opportunities to provide quality patient care. Nurses who worked for dissonant leadership reported greater negative effects of hospital restructuring. These findings led to a beginning theory of relational energy--a mechanism of mitigation whereby resonant nursing leaders invest energy into collaborative relationships with nurses, thereby positively influencing health and well-being, and, ultimately, outcomes for patients.

City Hospitals Sunderland developed a 'pen portrait' initiative as part of their nursing strategy to ensure patients are the centre of services. This article outlines the development of pen portraits and evaluates the impact they have had on patient care.

Aim and Objectives: The aim of this paper is to present a study describing nurses' adherence to the VIPS model by evaluating the quality of nursing assessment, and the quantity of completed nursing care plans., Background: Numerous efforts have been made over the years to improve nursing documentation in Denmark. Hospitals have traditionally based nurses' charting on a rudimentary version of the nursing process and on Virginia Henderson's theory of human needs. In 2002-2004 the Copenhagen University Hospital, Rigshospitalet, introduced the Swedish VIPS model for nursing documentation. VIPS is an acronym for well being, integrity, prevention and safety, all of which are seen as major goals for nursing care. The model organizes nursing data according to a system of keywords, which facilitates storage and retrieval of data., Design and Methods: The design in this part of the study was retrospective, wherein 50 journals from each of the departments of cardiology, neurology, oncology and urology were audited annually for three years using the Cat-ch-Ing instrument (n=600). All nursing journals were randomly selected by including the first 50 journals at each site given a specific date., Results: The nursing documentation significantly improved during the course of the study. After the second year the participants used the keywords appropriately and correctly according to the VIPS model. Application of primary nursing increased during the study. Initial, ongoing and discharge patient status improved. The nurses' familiarity with nursing diagnoses, goals and interventions increased., Conclusions: The structured implementation programme significantly improved nursing documentation, and the simultaneous training of the entire nursing staff shows promise. The VIPS model has prepared the nurses for more complex computerized taxonomies and classification systems in the future by improving the nurses' analytical skills. Relevance to clinical practice. New strategies for improving nursing documentation have been demonstrated.

Healthcare professionals must find ways to accelerate the diffusion of knowledge within their organizations. Although nurses have extraordinary access to patient care data, they may underestimate their roles as data managers and innovators of change, and relinquish control of data to others. The authors discuss how nurses at an acute psychiatric hospital collect and report their own data to show the direct relationship between outcomes and excellence in nursing practice. Knowledge that is gained through practice is shared to inspire and sustain needed changes.

Background: Nurse job satisfaction was identified as an outcome measure for a project to develop and implement a patient care delivery model in an acute psychiatric setting., Method: Seventy registered nurses were surveyed during 3 years, utilizing the Index of Work Satisfaction., Results: Nurse job satisfaction has improved significantly (14%) since model development began. Analysis of variance showed significant (p < .05) increases in all component mean scores in the second and third surveys., Conclusion: The relationship-based nursing model empowers nurses who know the patient best to decide how to provide care. It affirms the values that are the foundation of nursing practice, creating an environment where nurses feel they make a difference.

In a resident-oriented care model applied in nursing homes, the residents are assigned to primary nurses. These primary nurses are responsible for the total care of the residents assigned to them. The purpose of the present study, using a pretest, post-test and control group quasi-experimental design, was to evaluate the effects of the implementation of resident-oriented care on the following aspects of quality of care: coordination of care, instrumental aspects, expressive aspects, resident wellbeing and satisfaction with care, and family satisfaction with care. The study was carried out on somatic and psycho-geriatric wards in three nursing homes in the Netherlands. Data were collected by questionnaires, interviews and observations. The results of the study showed that the intervention was partly successful in the experimental group. Some aspects of the resident-oriented care model were not clearly evident. Moreover, the effects on quality-of-care aspects were limited. The results revealed that the 'coordination of care' increased on half of the experimental wards. Furthermore, there was an indication that 'expressive aspects' changed in favour of the experimental wards. The implementation of resident-oriented care had no effect on resident wellbeing and satisfaction or on family satisfaction. Finally, the results are discussed in the light of some methodological limitations that often go together with intervention studies in the real world.

Background: A university hospital clinic changed from a mixed to only registered nurse staffing, to reduce the staff and to encourage a philosophy of patient centred care. The aim was to maintain the same level of service and quality of care at a lower cost., Aim: The main purpose of the study was to examine job satisfaction in relation to the change from mixed to only registered nurse staffing and reduction in number of staff., Methods: Data were collected by an established questionnaire measuring job satisfaction. Non-parametric statistics were used to analyse the data. The questionnaire was distributed to 22 nurses on the ward on three occasions, covering a period of 3 years., Result: The experience of having time to plan patient care changed during the investigation period, from 'sometimes' to 'most often having time'. Nurses with longer work experience gave more verbal information to patients and perceived less stress. Information about job performance was more important to newcomers on the ward and became less important with time. However, quite a few have had regrets over choice of work and had considered non-caring work, nevertheless the results show no significant changes in overall job satisfaction.

The potential to have a unit based on excellence is within every manager's reach. The ability to submit for the Beacon Award and Magnet hospital designation are two avenues to fulfill that potential. Successes from University of California Davis Medical Center are shared in this article in the hope of inspiring other managers and their staff.