[Nursing development at the Solothurn hospitals. Towards clinically oriented nursing expertise and practice development].

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.