1. Huffman, Melinda H. RN, MSN, CCNS
  2. Cowan, Jennie Anderton RN, BSN


Explore how nurse leaders redesigned their facility's acute care and documentation procedures for evidence-based practice.




Achieve meaningful outcome measurement and enhanced performance improvement through redesigned acute care plans and documentation systems.


Senior nurse managers at Southern Tennessee Medical Center were concerned about the state of their nursing departments. Some units lacked adequate care continuity, outcomes measurement, and clearly defined clinical standards. Managers repeatedly observed staff nurses struggling with care planning, regardless of educational preparation or experience. Plans didn't reflect nursing standards for which they were developed. In fact, care plans were generalized and diagnosis-driven, based on the medical model. Perhaps most unsettling, these plans weren't located at the point of care, where staff members needed direction most.


Care plan evaluation proved basically meaningless to staff nurses, who had little time to review medical records, nursing files, or computerized data to locate existing plans. Continuity among unit caregivers was missing, as individual nurses implemented interventions independently of one another. Outcome measurement for individual patients and for all nursing units wasn't evident. Also, staff performance evaluations, even when criteria based, focused little on the type of nursing care expected at the facility.


Determined to change these inadequacies, we, as nurse leaders, developed a new care delivery system that served as the basis for performance improvement, one that:


[white diamond suit] incorporated care standards into bedside clinical nursing documentation


[white diamond suit] improved patient education efforts


[white diamond suit] reflected the nursing process and emphasized nurses' accountability


[white diamond suit] increased care continuity and staff communication


[white diamond suit] offered meaningful outcomes measurement and met accreditation standards


[white diamond suit] prompted multidisciplinary referrals and drove performance evaluations.



Serving as project coordinators, we opted to stop using diagnosis-driven care plans because staff feedback indicated that this terminology wasn't user-friendly or well understood at all nursing levels. We decided system linkages would create continuity of desired nurse behaviors and that nursing care standards would reside at the point of care. We allowed ourselves to create a new system, unencumbered by previously held notions of how the typical nursing care plan should look.