A Model of Nursing Care Microsystems for a Large Neonatal Intensive Care Unit

Abstract

Nationally the number and size of neonatal intensive care units (NICUs) continues to grow. Today, NICUs with >40 beds, often referred to as "megaunits," are not uncommon. Staff in large units find it challenging to maintain teamwork, communication, and continuity of nursing care for patients. Families find large units overwhelming. In large NICUs, nurse leaders struggle to achieve a balance between parent satisfaction with care provided and nursing job satisfaction. This article describes the development of a new model of nursing practice, a nursing team microsystem. This innovative model has the unique effect of creating smaller units within the larger one, using highly skilled nursing teams, that are geographically grouped to provide care for infants and their families. The model supports teamwork, communication, continuity of care, and has shown a positive impact on both family and nurses' job satisfaction.

How can we help staff transition to a new NICU design?

“…Authors discuss similar challenges post move: increased workload, distances walked, limiting communication with peers and reduced education opportunities (Shahheidari and Homer, 2012). Although it may take up to two years for staff to work effectively in the new environment there is only limited literature documenting research that has reviewed the impact on staff after two years (Goldschmidt and Gordin, 2006).…”

“…While changing NICU design to improve neonatal outcomes is the priority, studies have highlighted that staff will take two years or more to adjust to the change of design and subsequent model of care (Goldschmidt and Gordin, 2006). Nursing staff must not only familiarise themselves with new environment but also adjust to its impact on nursing practice and workflow.…”

“…As a consequence many Neonatal Intensive Care Units (NICUs) are in the process of changing their design from open plan (OP) to a single or small room design (SRD) catering for one to six neonates per room (Goldschmidt and Gordin, 2006). Research has shown SRD reduces infection rates, reduces length of hospital stay and facilitates an individualised approach in the care of neonates that improves the family's NICU experience (White, 2003).…”

Introduction of microsystems in a level 3 neonatal intensive care unit—an interprofessional approach

“…Advancement in neonatal care along with enhancement of life-saving technologies has resulted in the growth of neonatal intensive care units (NICU) in number and size [1, 2]. Development of large neonatal intensive units with over 40 beds, referred to as mega-units, has raised questions regarding their ability to maintain continuity and quality of care of these fragile patients [3, 4]. Increased rate of adverse events, provider burnout, strained infrastructure and impaired health system’s operation are among the potential risks associated with development of large NICUs.…”

“…In spite of increasing awareness of potential benefits of a microsystem model of care, there is no evidence regarding the safety and efficiency of this organizational change in NICUs [3, 5]. The NICU at McMaster Children’s Hospital (MCH) was scheduled for a change from the standard model of care to the microsystem model on the 1st of January 2014.…”