Relationship-Based Patient Care Delivery ModelNurses at UVAHS provide high quality patient care using a Relationship-Based Patient Care Delivery Model. Nurses acknowledge that their purpose is to care for patients and families. Nurses recognize that consideration of patients and their families contributes to successful outcomes. Improved outcomes are achieved when patients feel safe within a trusting relationship with a specific registered nurse. The nurse-patient relationship is strengthened through a focus on continuity of care delivered within the context of interdisciplinary collaboration thereby improving patient and staff satisfaction. This framework is comprised of four key constructs.Construct 1 - Autonomy and the Nurse/Patient Relationship Nurses practice autonomously, consistent with Virginia’s regulations governing the Practice of Nursing, ANA Scope and Standards of Practice, and within the provisions of UVAHS. Nurses are responsible for assessing, planning, implementing, and evaluating nursing care for an identified group of patients. Nurses collaborate with all members of the interdisciplinary team. Nurses have the authority to make decisions within the scope of their practice and to advocate on behalf of their patients. They prioritize patient care needs and are accountable for nursing care outcomes. Nursing practice is guided by evidence based Standards of Care and Standards of Practice. These standards are identified and incorporated into practice through our Professional Nursing Staff Organization. The nurse develops therapeutic relationships with patients and families. This professional nurse-patient relationship exists whether it’s through a single interaction, a shift, or an entire length of stay on a unit, or throughout the Health System. Scheduling of personnel and time enhances the nurse-patient relationship. Construct 2 – Professional Nursing Care to meet the needs of the PatientsPatient assignments are determined collaboratively on each shift, and decisions are made based on patient needs, patient acuity, and RN level of competency and experience. Every effort is made to maximize continuity of care and caregiver in order to achieve an optimal therapeutic relationship. Nurse Managers assure adequate resources to meet patient needs based on unit census, patient acuity, and overall activity within the respective units. Nurse Managers are supported by Nurse Administrators and the Chief Clinical Officer/ Chief Nursing Officer. Nurses have the authority to delegate nursing activities to other members of the nursing staff, including unlicensed assistive personnel, to optimize a therapeutic relationship. The nurse retains ultimate accountability for the process and outcomes of care. Delegation by nurses is based on patient needs, complexity of care, competency of the individual accepting the delegation, and the timing of the care to be given. The care provider receiving a delegated assignment from a nurse accepts responsibility, authority and accountability of the work assigned. Construct 3 - Communication between the Nurse, Patient, and the Heath Care TeamCommunication between all members of the health care team is essential to the achievement of optimal patient outcomes. Nurses collaborate with the patient and significant others as well as other members of the healthcare team to identify specific patient needs. Acting as a patient advocate, the nurse communicates these needs directly and proactively to the interdisciplinary team. Integrating information and coordinating all aspects of patient care are the roles and responsibilities of the professional nurse. UVA’s academic setting promotes mutual respect between professional nurses and physicians. The teaching environment encourages open communication to craft the patient's plan of care and supports a culture of collaboration. Construct 4 - Managing the Healing Environment of CareThis Framework recognizes the leadership capacity of each nurse. Nurse management creates an environment in which all staff members take conscious ownership for their patient care while contributing to the mission of UVAHS. Nurses collaborate to create an environment which is safe for both nurses and patients. Nurses deliver patient care within a culture of customer service consistent with UVAHS core values of Respect, Integrity, Stewardship, and Excellence. Safety, outcomes and service provide the rubric for the delivery of patient care and services. Patients are encouraged to be actively involved in their plan of care within a healing environment. Nurse management promotes the nurse-patient relationship and the professional role of the nurse through facilitating an environment that fosters collaborative and participative roles for nurses. They foster a healthy environment and empower the staff to remove barriers to care.ReferencesLaws and Regulations Governing the Practice of Nursing and Health Professionals in General, Code of Virginia, Virginia Board of Nursing website: http://www.dhp.state.va.us/nursing/nursinglawsregs.htmKoloroutis, M. ed. (2004) Relationship-Based Care: A model for transforming practice. Creative Health Care Management, Minneapolis, MN. American Nurses Association Bill of Rights for Registered Nurses, (2001), ANA website: http://nursing world.org/Manthey, M (2003). Aka Primary Nursing, Journal of Nursing Administration, 33, 7/8, p 369-370. Nursing: Scope and Standards of Practice, (2004) American Nurses Association, Silver Spring, MD. O:\PNSO\Core Reference Documents\Relationship Based Care Model.docRelationship-Based Patient Care Delivery Model Page University of Virginia Health System Professional Nursing Staff OrganizationSkill 5-4.1 Page 113. University of Virginia Health System Adult Acute Care Procedure Manual