How & why health systems should implement agile care models to support nurses

Agile care models can support nurse workforce well-being and resilience, while also ensuring optimum quality care is delivered.

Becker's discussed care models and their relation to nurse well-being with Anne Dabrow Woods, DNP, RN, a practicing acute care and critical care nurse practitioner at Philadelphia-based Penn Medicine and the chief nurse of Philadelphia-based Wolters Kluwer's Health Learning, Research and Practice business. Dr. Woods is also the author of the e-book Transforming the Nursing Workforce in the New Paradigm of Care.

What is an agile care model?

An agile care model is based on patient acuity and severity of illness, not just the number of patients and staff members, Dr. Woods said. The model gives hospitals the capability to move their workforce when and where they need them, whether that be to care for patients on a specific unit or with a specific diagnosis, or to another unit entirely.  

The primary care model, which has been used for the last 20 to 25 years, has one nurse care for anywhere from two to 8 patients on critical or med-surg units. One nurse caring for that many patients doesn't work well when understaffed or in crisis situations, such as the pandemic. Agile care models can provide flexibility on an as-needed basis when hospitals are in crisis or experiencing a staffing shortage.  

Key tenets of an agile care model 

Cross-training: A crucial tenet of the agile care model is cross-training nurses so they have expertise in more than one adjacent specialty. Hospitals should provide this education for nurses so they can rapidly shift models during emergencies, and staff is competent and confident in delivering care. Systems will need to add education resources and built-in cross-training programs, with staff development educators and preceptors teaching nurses on-unit. Cross-training for new nurses should begin a year or so after they enter a system and are competent in providing care within their primary specialty. 

Team-based nursing: This agile care model is team-based, with one nurse dubbed the team leader. Considered an expert in a specific kind of care, the team leader organizes and oversees care with the assistance of other nurses and support personnel. This form includes help from unlicensed assistive personnel such as certified nursing assistants, and often licensed practical nurses. This team based model is used frequently in long-term care settings. The team model allows for flexibility in crisis, giving the capability to care for more patients and quickly move staff from one area to another, resulting in more efficient staffing.  

What are some steps leaders can take to shift their care model to one that supports nurse resilience? 

Systems can't just shift care models overnight, although for COVID-19, they somewhat did, Dr. Woods said. 

Nurses who have been actively practicing for 20 years or less and were never trained in the team model must receive education on this agile care model. Organizations also need to recruit nurses who already have experience with alternative care models. Down the line, these nurses will then be able to teach newer nurses. 

It's critical that all members of an organization understand when the agile care model is used. The primary care model is a good model for adequately staffed facilities or hospitals that aren't amid a crisis. The team model should be implemented when flexibility needs to be a priority. Health system leaders and staff alike must understand when both primary and agile care models should be utilized.

Furthermore, academia needs to teach new students what it means to work in a team model. Nurses must be practice ready, which in part should mean understanding how and when to shift from a primary model to a team-based model. Partnership between health systems and academia can educate and prepare nurses, while also improving recruitment and retention, Dr. Woods said.

How the agile care model supports nurses

Ultimately, implementing agile care models support nurses by providing flexibility and creating a more conducive environment for optimal patient care. These outcomes support nurse well-being and foster resilience. 

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