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AACN Model Creates Synergy in Indianapolis

Saturday May 1, 2004
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Why would nursing theorist and legend Virginia Henderson be proud of the American Association of Critical-Care Nurses' Synergy Model for Patient Care? Because the heart of the model goes back to Henderson's renowned definition of nursing, according to Ramón Lavandero, RN, MSN, MA, FAAN, director of development and strategic alliances at the AACN. As many nurses will recall, Henderson said, "The unique function of the nurse is to assist the individual, sick or well, in the performance of those activities contributing to health or its recovery [or to peaceful death] that he would perform unaided if he had the necessary strength, will, or knowledge."1
The AACN Synergy Model for Patient Care was developed in the mid-1990s as the framework for the CCRN certification program. A handful of hospitals independently adopted the model for individual units and facilities. Then three years ago, Indianapolis-based Clarian Health Partners and AACN teamed up in a visionary implementation project across Clarian's three main campuses, Methodist Hospital, Indiana University Hospital, and Riley Hospital for Children.
The Synergy Model matches patient characteristics with nurse competencies in a patient care model that puts the patient at the center of care (see the "AACN Synergy Model for Patient Care - Patient Characteristics and Nurse Competencies" sidebar). "It makes no difference where the nurse is - whether working in a clinic or in a trauma unit - this model looks at the patient's needs and matches them with the nurse who has the competencies to meet those needs," Lavandero says.1
Although it sounds like a new corporate buzzword, "synergy" is defined simply in the dictionary as the action of two or more organs or systems that achieves an effect of which neither is individually capable. And the positive effects of the Synergy Model are not limited to patient care at the Clarian hospitals because nurse turnover and vacancy rates are now well below national averages. Satisfaction among staff members has increased by 28% to 35%, and the use of agency nurses has virtually been eliminated, according to Marilyn Cox, RN, MSN, chief nursing officer at Riley.
Theory into Practice
Martha A.Q. Curley, RN, PhD, FAAN, coordinated the project as AACN's on-site consultant and helped introduce the model to the 6,000 RNs in the Clarian system. According to Cox, the nurses grasped it immediately. "There are nursing theorist underpinnings to the model, but this model really speaks to the bedside nurse," she says. "When you look at the nurse/patient relationship being driven by what the patient needs, it makes good sense to them."
Sherry Holden, RN, BSN, who cares for patients on a medical specialties unit at Indiana University Hospital, agrees. She was initially skeptical of the model but is now a self-described "synergy cheerleader."
"This is really quite a simple model," Holden says. "When we give report on our patients, we use the patient characteristics. If the patient is complex, vulnerable, and unpredictable, the patient is not going to be assigned to a new grad."
Family-focused care has been in place for a long time at Riley Hospital for Children, but the Synergy Model gives the staff a clearer definition of how to approach patients and their families, according to Shelley Suarez, RN, BSN, a family support nurse at Riley. Using the list of patient characteristics, patients and their families are matched with the nurses most competent to meet those needs. "We have always been focused on the needs of the pediatric patient's family," Suarez says. "Using the model, we can become even more family-centered."
When the patient's characteristics match with the nurse's competencies, there is synergy, says Tracy Davis, RN, BSN, CCRN, a nurse in Methodist Hospital's pediatric critical care unit. "Operationalizing this model means recognizing the degree of complexity of each patient and placing that patient with the nurse who has the competencies to take care of them," Davis explains. "Or instead, the patient is assigned to an experienced nurse who acts as the 'wingman' for a less experienced nurse who needs to become more competent."
Model for Professional Advancement
Implementing the AACN Synergy Model also involved developing a new professional advancement system at Clarian, called the Career Advancement Program. This is a differentiated practice framework and not a clinical ladder program, which has different measures of clinical excellence.
In Clarian's practice framework, which is closely tied to the Synergy Model, all staff nurses, regardless of education and experience, are designated as associate partner RNs. In order to be promoted to partner and then senior partner, staff nurses submit portfolios for review. Requirements for the portfolios include a letter of intent, which describes how the nurse has met each of the competencies of the Synergy Model; examples of ways the nurse has contributed to the unit, hospital, and system of care; evidence of educational and certification efforts; and recommendations from peers and managers.
But the heart of the portfolio is the exemplars, which are narratives written by the nurse that demonstrate nursing expertise above and beyond the usual. "These are fabulous stories - they're about saving patients' lives," says Karlene Kerfoot, RN, PhD, FAAN, Clarian's chief nursing officer. "These are stories about having a peaceful death. These are stories of heroes and heroines who do heroic things every single day."
Davis knows all about the kind of stories that are required for promotion: She is one of only three senior partner RNs in the Clarian system. "Every day is a story. They're just what we do every day," she says. "But the stories don't always have happy endings. In fact, one of my exemplars was really about system breakdowns and how we ended up changing the system to make it better." She adds that the career advancement program Clarian adopted truly celebrates the efforts of the bedside nurse as he or she grows and matures at the bedside, on the unit, and in the system.
Clarian's use of the AACN Synergy Model allows experienced nurses to focus on the
new generation of nurses coming through, according to Holden, an associate partner RN. "The model helps us to mentor better and helps us realize that overwhelming, complex patients are too difficult for new nurses,"
she says.
Davis agrees. She has been asked to become part of the Board of Review, a group of staff nurses and managers who evaluate the
portfolios and consider the applicants for promotion to partner and senior partner RNs. Davis says both the model and the training for the Board of Review have helped her individual practice and has given her more insight about mentoring those who want to advance their nursing careers.
Kerfoot and Clarian's executive nursing team say implementing the AACN's Synergy Model puts the patient front and center, which is really a culture change for most institutions and for all of nursing. "The model provides both more information and more expectations of the nurse to move into a professional practice model, one where they are not just task-oriented, but are accountable for their practice," Kerfoot says. "We've always had models that meet the needs of the nurse using the concept that 'a nurse is a nurse is a nurse.' But the Synergy Model meets the needs of the patient first."
Opportunities and Choices
Suarez, one of only 109 partner RNs, emphasizes that she has not observed resentment by associate partners toward those who have achieved partner or senior partner designations. Instead, she has seen a great deal of excitement among her peers since the first couple of review periods. "There is definitely more support and interest out there and ample opportunities for all nurses to participate at the unit and system levels so that they can show evidence of their growth," she says.
Not everyone will choose to develop a portfolio to become promoted to partner or senior partner. The model is about making choices, both professionally and in bedside care, according to Holden, who has chosen to remain an associate partner RN. "I have chosen to be very involved in implementing the model, but it's not the right time for
me to make a commitment to becoming a partner yet."
Although Holden has chosen to remain an associate partner for now, the model allows recognition of her experience and expertise. She is still assigned to complex patients and mentors less-experienced nurses. "The model allows us to say, 'This is a patient population that I'm good at taking care of, and I like this area of practice.' And it also helps all nurses gain experience where we need it," she says.
Synergy Equals Energy
Cox says that although developing the AACN Synergy Model at Clarian has not been a fairy tale, it has transformed the nursing department and reenchanted nurses with nursing. "Since we've implemented it, there has been more excitement among the staff nurses about what it is they do and [there is] a true gratitude that we have given them a vehicle that highlights their practice and the value that nursing brings to patient care overall," she says. "And they are absolutely thrilled."
In addition to a more satisfied nursing staff, Clarian also expects to see improvement in patient outcomes, such as falls and complication rates directly linked to the model. Cox adds that in this time of nursing shortage, anything that makes them a more competitive and attractive professional workplace ultimately makes the organization better for patients.
"It's all about the patient," Holden agrees. "It's very rewarding because when I know my patient and I meet my patient's needs, the outcome is 'everybody wins.' The AACN Synergy Model gives us back that nurse/patient relationship."
EDITOR'S NOTE: Duquesne University in Pittsburgh is offering an online MSN in acute care based on the AACN Synergy Model for Patient Care. Visit www.nursing.duq.edu/
gradMsnAcute.html for additional information.