Satisfaction with a new model of professional practice in critical care.

Although only a moderately severe general nursing shortage exists at this time, the shortage of critical care nurses remains severe. Innovative administrators across the country are trying new professional practice models aimed at maximizing autonomy and freeing nurses from mundane tasks with the hopes of retaining experienced clinicians. We implemented a professional practice model in which unlicensed assistive personnel were trained to assist registered nurses in patient care. Monies saved by increasing nurse-patient ratios were distributed to staff nurses. Acuity-based staffing was maintained and professional practice encouraged through self-scheduling and elimination of hierarchical relationships. Satisfaction among nurses working in the program increased in terms of coworkers and supervision. Patient satisfaction with the quality of care provided did not change during the course of the program. Data from interviews demonstrated that staff were satisfied with the quality of care provided by the assistants, but the changes in the staffing ratios coupled with the increased responsibility for overseeing the assistants caused stress in the nurses. We conclude that a professional practice model in which critical care assistants are added to the work force is a viable option, but creative methods of addressing the stress of increased workload are needed.