1. Section Editor(s): Rodts, Mary Faut DNP, CNP, ONC, FAAN
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What would it take to make your nursing unit a unit where nurses were put on a waiting list to work there? What would the place feel like, look like, be like? Close your eyes and think about all of the things that you would do to change the way you practice nursing; the way patients are taken care of; the way administration values your opinion; the way you feel each day when you leave your unit and head home for the day. What would it be like to work with other nurses who were equally as happy to be working on that unit as you are?

Mary Faut Rodts, Edi... - Click to enlarge in new window, DNP, CNP, ONC, FAAN

I venture to think that most of us would have a long list of dreams that would make the workplace a better place to be. Many of the listed items would be ways in which patient care could be improved and patients and families expectations were exceeded. I might even go so far as to edit an old saying to say, "if patient's ain't happy, then nobody's happy."


In 2003, the concept of Transforming Care at the Bedside (TCAB) was introduced by the Robert Wood Johnson Foundation and the Institute for Healthcare Improvement. The key idea of this project was to empower the "front-line nurses" to make the changes necessary to change healthcare. The four major aims of TCAB were to improve the quality and safety of healthcare, increase the vitality and teamwork among nurses, encourage patient-centered care and include patients and their families in designing that care, and improve the functioning of the entire healthcare team including the development of efficiencies in providing excellent patient care (Rutherford, Moen, & Taylor, 2009).


So how could adding more duties and responsibilities actually be helpful for the front-line nurse who was already overloaded? Rutherford et al. (2008) stated that at the beginning of this project "front-line staff was exhausted and dispirited by the increasing workloads, inefficient work processes, and negative work environment. Nurses were leaving not only the unit, but the nursing profession." This finding would not come as a shock to many of us as this is what we have also experienced. The reality of the early TCAB work done was that "within the first year of TCAB, it became clear that by giving front-line staff the skills and permission to innovate and make improvements in their work, new energy and passion were building on the unit. Staff felt empowered as they contributed directly to making their work and the lives of their patients better."


It is exciting just to read those words. Could it even be possible that environmental changes so sweeping could actually reverse the trend of the high volume of nurses leaving the profession? If so, I would think most of us would say, "sign me up and sign me up now." The concept of TCAB is one worth thinking about and possibly instituting on your orthopaedic unit. Take some time to review the manuscripts referenced here by Rutherford and colleagues. I guarantee they will spark your interest in defining a new tomorrow on your unit.




Rutherford P., Moen R., Taylor J. (2009). TCAB: The "How" and the "What." The American Journal of Nursing, 109(11), 5-17. [Context Link]


Rutherford P., Phillips J., Coughlan P., Lee B., Moen R., Peck C., et al. (2008). Transforming care at the bedside how-to guide: Engaging front-line staff in innovation and quality improvement. Cambridge, MA: Institute for Healthcare Improvement. Retrieved December 8, 2010,[Context Link]