Marymount Hospital Pilots a New Model of Nursing Care Delivery

Medical-surgical (med-surg) nursing has been hit particularly hard by the national post-pandemic nursing shortage. To address the issue, Cleveland Clinic Marymount Hospital convened a team of nursing managers and directors to design an innovative solution. After months of fact-finding (including learning the methods other hospitals employed to help overcome the shortage of clinical med-surg nurses) and determination, the working group has created a new model of care delivery designed to support med-surg nurses by leveraging the skills of high-quality patient care nursing assistants (PCNAs).

“We knew the nursing shortage wasn’t going away anytime soon, so we began with a question: How do we continue to provide world-class patient care while making sure our nurses have the help they need?” explains Mallory Sovacool, BSN, RN-BC, nurse manager for the three med-surg units at Marymount Hospital. “We needed to do something different — something nobody had tried before.”

Building a support system

After careful consideration, the working group developed a new model that pairs one PCNA with one nurse to provide care for seven patients. Previously, med-surg PCNAs worked with a higher number of patients, all of whom were assigned to multiple nurses. Now, care collaboration is streamlined, enabling PCNAs to perform more unlicensed patient-care tasks for a smaller group of patients and giving nurses the time they need to focus on the advanced skills and care roles for which they are trained.

“PCNAs are an invaluable part of the team; nurses simply could not do their jobs without them,” emphasizes Barbara Zinner, DNP, RN, NE-BC, CENP, Chief Nursing Officer for Marymount Hospital. “Once we began to evaluate the various med-surg roles, we realized that we weren’t taking full advantage of the support PCNAs could offer. That was a pivotal shift.”

Sovacool says the new model has provided an opportunity to enhance the PCNA role, which has expanded to include bedside reporting. Additionally, Zinner and her team have created two new nursing positions that cover the entire floor: a throughput nurse, who primarily handles admissions and discharges, and a lead nurse. These positions provide extra support to caregivers by freeing them to spend more time with their patients.

Med-surg staff were involved very early in the process to ensure the model’s implementation aligned with what caregivers found most helpful. Zinner says their feedback was crucial in developing the lead and throughput nurse roles.

“Our new approach gives us a way to better utilize the staff we have,” she explains. “This model is all about teamwork between the nurse and their PCNA partner for the shift. As simple as it sounds, there’s a lot of power in that relationship.”

Rave reviews

Cleveland Clinic Marymount Hospital launched the new model in September 2023, first with two units and then a third unit in November. Since then, all three medical-surgical units on one floor of the hospital have been operating enthusiastically under the new model.

“The model-of-care development team heard about the concept, accepted it and listened to their caregivers to make it the best possible model,” Zinner says. “Nurses are driving it now.”

To expand the program, the Marymount team developed a series of “boot camps” for nurse leaders in other Cleveland Clinic hospitals, which were designed to teach caregivers how to implement the model in their own med-surg units.

The Marymount nursing team will soon assess how the program is working in the newest locations. In the meantime, both nurses and PCNAs have already reported greater job satisfaction. “The reason this model is a success is because our caregivers are happier,” says Sovacool.

“They’re getting regular, much-needed breaks and feel better supported.” By building on proven care-delivery methods and incorporating innovative ways of enabling staff to perform most effectively, Marymount Hospital has created an environment where patients, PCNAs and nurses can all thrive, she adds.

“Caregivers have been instrumental in our program’s success,” Sovacool explains. “They dove in with a positive attitude and a willingness to give it a try, and they did the hard legwork needed to give this model the best chance for success.”