Purpose The purpose of this assignment is to identify nursing care models utilized in today's various health care settings and enhance your knowledge of how models impact the management of care and may influence delegation. You will assess the effectiveness of models and determine how you would collaborate with a nurse leader to identify opportunities for improvement to ensure quality, safety and staff satisfaction. Course Outcomes Completion of this assignment enables the student to meet the following course outcomes. CO1: Apply leadership concepts, skills, and decision making in the provision of high quality nursing care, healthcare team management, and the oversight and accountability for care delivery in a variety of settings. (PO2) CO2: Implement patient safety and quality improvement initiatives within the context of the interprofessional team through communication and relationship building. (PO3) CO3: Participate in the development and implementation of imaginative and creative strategies to enable systems to change. (PO7)  CO4: Apply concepts of leadership and team coordination to promote the achievement of safe and quality outcomes of care for diverse populations. (PO4) CO6: Develop a personal awareness of complex organizational systems and integrate values and beliefs with organizational mission. (PO7) CO7: Apply leadership concepts in the development and initiation of effective plans for the microsystems and/or system-wide practice improvements that will improve the quality of healthcare delivery. (PO2, and 3) CO8: Apply concepts of quality and safety using structure, process, and outcome measures to identify clinical questions as the beginning process of changing current practice. (PO8) Read your text, Finkelman (2016), pp- 111-116. You are required to complete the assignment using the template. Observe staff in delivery of nursing care provided. Practice settings may vary depending on availability.  Identify the model of nursing care that you observed. Be specific about what you observed, who was doing what, when, how and what led you to identify the particular model Review and summarize one scholarly resource (not your textbook) related to the nursing care model you observed in the practice setting. Review and summarize one scholarly resource (not including your text) related to a nursing care model that is different from the one you observed in the practice setting. Discuss the nursing care model from step #6, and how it could be implemented to improve quality of nursing care, safety and staff satisfaction. Be specific. Summarize this experience/assignment and what you learned about the two nursing care models. Submit your completed worksheet no later than 11:59 p.m. MT on Sunday by the end of Week 5. References and important information: Week5  leader Examplar Audio Transcript After working a number of years in home health, I made the decision to return to the acute care setting and accepted a ...

1. Purpose
The purpose of this assignment is to identify nursing care
models utilized in today's various health care settings and
enhance your knowledge of how models impact the management
of care and may influence delegation. You will assess the
effectiveness of models and determine how you would
collaborate with a nurse leader to identify opportunities for
improvement to ensure quality, safety and staff satisfaction.
Course Outcomes
Completion of this assignment enables the student to meet the
following course outcomes.
CO1: Apply leadership concepts, skills, and decision making in
the provision of high quality nursing care, healthcare team
management, and the oversight and accountability for care
delivery in a variety of settings. (PO2)
CO2: Implement patient safety and quality improvement
initiatives within the context of the interprofessional team
through communication and relationship building. (PO3)
CO3: Participate in the development and implementation of
imaginative and creative strategies to enable systems to change.
(PO7)
CO4: Apply concepts of leadership and team coordination to
promote the achievement of safe and quality outcomes of care
for diverse populations. (PO4)
CO6: Develop a personal awareness of complex organizational
systems and integrate values and beliefs with organizational

2. mission. (PO7)
CO7: Apply leadership concepts in the development and
initiation of effective plans for the microsystems and/or system-
wide practice improvements that will improve the quality of
healthcare delivery. (PO2, and 3)
CO8: Apply concepts of quality and safety using structure,
process, and outcome measures to identify clinical questions as
the beginning process of changing current practice. (PO8)
Read your text, Finkelman (2016), pp- 111-116.
You are required to complete the assignment using the template.
Observe
staff in delivery of nursing care provided. Practice settings may
vary depending on availability.
Identify
the model of nursing care that you observed. Be specific about
what you observed, who was doing what, when, how and what
led you to identify the particular model
Review
and summarize one scholarly resource (not your textbook)
related to the nursing care model you observed in the practice
setting.
Review
and summarize one scholarly resource (not including your text)
related to a nursing care model that is
different
from the one you observed in the practice setting.

3. Discuss
the nursing care model from step #6, and how it could be
implemented to improve quality of nursing care, safety and staff
satisfaction. Be specific.
Summarize this experience/assignment and what you learned
about the two nursing care models.
Submit your completed worksheet no later than 11:59 p.m. MT
on Sunday by the end of Week 5.
References and important information:
Week5 leader Examplar Audio Transcript
After working a number of years in home health, I made the
decision to return to the acute care setting and accepted a full
time night position on a very busy and high acuity step down
unit. Upon learning of the unit that I would be working on,
many of my nurse friends and former colleagues began warning
me about the current supervisor on that unit and filling me with
self-doubt regarding my ability to perform up to this person’s
expectations.
On my first day, I was introduced to my supervisor and
preceptor who was none other than Sue, the very person that I
had been warned about. Hoping for the best but fearing the
worst, I decided to put all of the bad things that I had heard out
of my mind and see what happened.
In doing so, I quickly discovered that Sue would become the
best supervisor and preceptor that I had ever had. She
immediately took a vested interest in my success by sitting
down with me each week for coffee and discussing what was

4. going well and not going so well. Together, we worked to
establish both short-term and long-term goals for not only my
time with her in orientation but my future ones as a member of
the staff on the unit. Sue helped me to identify weaknesses
within myself by allowing me to reflect on situations rather than
immediately pointing them out to me. Likewise, she made it a
point to highlight my strengths and provided me with
opportunities to put them into use in the practice setting. She
provided support and encouragement when needed while at the
same time allowing me to grow in my independence and
autonomy.
I truly believe that I am the nurse, educator, and leader that I
am today because of the leadership, support, and guidance that
Sue provided me all those years ago.
Amy Sherer MSN, RN
Assistant Professor, RNBSN Option
Chamberlain College of Nursing
[End of Transcript]
Quality and Safety Initiatives
How do we promote quality? Some of these activities include:
problem solving to improve communica tion, integration of the
NAS quality and safety standards into everyday practice, and
dedication to the National Patient Safety Goals in healthcare as
implemented by The Joint Commission (2017). Provider
curricula were reviewed, and the performance of root cause
analysis of errors and near misses became part of strategies. The
result has been an improved work environment and increased
nursing leadership in these areas.

5. Nursing is a key collaborative discipline in addressing patient
quality and safety concerns. According to the study by Squires,
Tourangeau, Spence-Laschinger, and Doran (2010), nurse
leaders and managers create a positive safety climate through
quality relationships based on fairness and empathy. It seems
that the transformational leader, a leadership style introduced
earlier in this course, would be driving quality and safety
outcomes.
Inspiring Performance Improvement
PI (performance improvement), CQI (continuous quality
improvement), TQM (total quality management), QA (quality
assurance), QC (quality control), and QI (quality improvement)
are all acronyms for programs and initiatives that have been
used over the years to monitor the delivery of quality care. Are
we dizzy yet with all these acronyms? For the purposes of this
lesson, we will concentrate on QI, or quality improvement. And,
who should inspire others in these initiatives?
Inspiring quality improvement is a goal for all nurse leaders. It
is geared toward unlocking individual potential and assisting
staff to provide high quality, safe care at all times while
continuously looking for ways to improve that care, as well as
the environment where patients receive that care. QI is about
inspiring change, a topic discussed in a previous lesson.
Fostering an environment where change is encouraged and
improvements are expected must be linked to the mission,
vision, and values of the healthcare organization regardless of
size, care delivery model, or geographic setting.
Quality and Safety Education for Nurses (QSEN)
In addition to the core competencies designated by the NAS,
nursing education has placed an increasing emphasis on quality

6. and safety through the Quality and Safety Education for Nurses
(QSEN) initiative funded by the Robert Wood Johnson
Foundation (2015). These should sound familiar to you. QSEN
provides resources and strategies to facilitate learning as it
relates to the five competencies of NAS plus safety.
Patient-centered care
Teamwork and collaboration
Evidence-based practice
Quality improvement
Safety
Informatics
This initiative has provided nursing programs, as well as staff
development and continuing education professionals with many
tools to teach these six competencies. Visit
http://www.qsen.org (Links to an external site.)Links to an
external site.
to review the prelicensure KSAs (knowledge, skills, and
attributes or abilities) and graduate KSAs. While browsing the
site, investigate the teaching strategies section to glean ideas
about how to integrate QSEN competencies into your nursing
education and staff education endeavors.
The Nurse Leader Ponders
“We have utilized several of these initiatives here. Most staff
are involved but how do I need to get more of them involved? I
wonder if QSEN was discussed in their nursing education

7. programs. Perhaps this is the frame of reference I should use to
get more buy in from the staff.”
Monitoring Organizational Performance
Just as a dashboard in a car tells you at a glance about its
performance, so can a dashboard of the organization help you
monitor its performance measures. Remember the Windshield
Survey from Community Health. A dashboard (electronic) holds
all the quality indicator outcomes in one picture.
Anyone working in an acute care environment has probably
heard of nurse-sensitive quality indicators. These have been
profiled over the past few years as payment restrictions were
instituted by the Centers for Medicare and Medicaid Services
(CMS) in October of 2009. Subsequently, insurance companies
have followed suit. According to the Managed Care First Report
(2011), the no-pay policy is an effort to reduce medical errors.
This brought attention to nursing because many of the no-pay
situations could be managed or controlled through nursing care.
Since then, staffing levels and staff mix have become a major
factor in measuring performance.
Lean Daily Management
Somewhat new to the quality scene is Lean Daily Management
(LDM). What is it? It is a much disciplined process that gives
staff the power to solve problems by providing them with the
leadership support and various resources to make improvements
in care. On a daily basis, staff make their concerns about
workflow problems known to the executive (top) leadership in
the organization. A hallmark of the management process is the
Safety Huddle. Many units/departments begin their day with a
safety huddle which allows for identification and allocation of
resources. Some of these resources can be staffing,
acknowledging patient safety issues and concerns from various

8. stakeholders. Prioritization of problems seems to be a hallmark
of the safety huddle. Interestingly enough, this is led by the
Chief Executive Officer. One cannot argue with a system that
involves executive team involvement on a daily basis with the
outcomes being directly related to patient safety and quality of
care.
Leader’s Role in Just Culture
One cannot complete a lesson on Performance
Improvement/Quality/Safety Initiatives without learning more
about the term Just Culture. In early 2010 the American Nurses
Association Board of Directors adopted its new position
statement proposed by the Congress on Nursing Practice and
Economics related to Just Culture (ANA, 2010). This updated
position statement emphasized the support by the ANA of the
Just Culture concept and how it is used in health care to
improve safety. The ANA continues to support collaboration of
the various boards of nursing, professional nursing
organizations, hospital associations and others in developing
Just Culture initiatives. The just culture model (from the
aviation industry) provides for an environment where one is
encouraged to report mistakes instead of ignoring or hiding
them. In this environment practitioners should not be
accountable for failures related to systems over which they have
no control. It operationalizes a non-blame principle where
process improvement is the outcome. Prevention of future errors
is a result.
The Nurse Leader’s role in promoting a Just Culture work
environment cannot be overestimated. Staff need to know that
patient safety is everyone’s responsibility, avoiding blame and
supporting a culture of safety for patients, their families and the
staff who provide the highest quality care for them.
“This has been a busy week but since my job is all about

9. improving quality in home care, I found the topics very
interesting. I still have much to learn and I may share some of
this with my Nurse Leader. I know I have one more Assignment
to complete but that is not until the end of next week. I have not
done a PowerPoint assignment….ever…so I need to use the
website that was recommended by my instructor and get started
on this.”
Summary
This week, we broached the subject of quality improvement, an
issue that faces nurses in all practice settings. This core
competency is important to all nurses, especially nurse leaders.
QSEN was introduced as an initiative providing resources for
nurse educators. And, Lean Daily Management and Just Culture
were introduced. Becoming more familiar with these topics is
important. The emphasis on safety in today’s healthcare
environment cannot be ignored. Our patients are counting on us.
References
American Nurses Association. (2010). Position statement: Just
culture. ANA. Retrieved from
http://nursingworld.org/psjustculture
Centers for Medicare & Medicaid Services (CMS). (2011). CMS
is the latest to deny payment for hospital-acquired conditions.
Managed Care First Report Daily News
. Retrieved from
http://www.mccfirstreport.com/show_story.php?newsid=6697
Finkelman, A. (2016).
Leadership and management for nurses: Core Competencies for
quality care
(3rd ed.). Boston, MA: Pearson.

10. National Safety Academy. (1999).
To err is human: Building a safer health system
. Retrieved from
http://nationalacademies.org/hmd/reports/1999/to-err-is-human-
building-a-safer-health-system.aspx
Quality and Safety Education for Nurses (QSEN). (2015).
Competencies. QSEN
. Retrieved from http://qsen.org/competencies/
Squires, M., Tourangeau, A., Spence Laschinger, H. K., &
Doran, D. (2010). The link between leadership and safety
outcomes in hospitals.
Journal
of Nursing Management, 18
(8), 914–925.
The Joint Commission. (2017).
National Patient Safety Goals
. TJC. Retrieved from
http://www.jointcommission.org/standards_information/npsgs.as
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