Date Available
8-7-2025
Year of Publication
2025
Document Type
DNP Project
Degree Name
Doctor of Nursing Practice
College
Nursing
Department/School/Program
Nursing
Faculty
Dr. Julie Marfell
Committee Member
Dr. Benjamin Hughes
Faculty
Dr. Debra Hampton
Abstract
Background: Registered Nurses (RNs) comprise one of the largest professions in healthcare, and they play a critical role in delivering patient-centered care. The nursing shortage exacerbates inadequate nurse staffing levels, leading to increased workloads, higher patient-to-nurse ratios, and a high-stress work environment.
Purpose: This project aimed to evaluate the implementation of a primary-nurse-led care delivery model with an all-RN staffing design and its effects on nurse-sensitive patient outcomes, patient length of stay, nurse-sensitive related outcomes, and associated financial implications in the Intensive Care Unit (ICU) setting. Nursing knowledge and opinions about the all-RN staffing model were also assessed.
Methods: Staffing in a 12-bed inpatient adult critical care unit ICU was restructured from the mixed-nurse staff model of seven RNs and two Nursing Care Technicians to an all-RN model of eight RNs. Outcomes were measured prior to changing the staffing model and after implementing the new primary care model. Nurse-sensitive patient harm events measured included Methicillin-Resistant Staphylococcus Aureus (MRSA), Hospital Acquired Pressure Injury (HAPI), Catheter-Associated Urinary Tract Infection (CAUTI), Central-Line Associated Bloodstream Infection (CLABSI), and Falls with and without injury.
Results: Opinions related to the all-RN staffing model improved following the implementation of the new model, except for the item related to adequate staffing. Statistically significant differences were noted for items focused on the value of the all-RN model, clinical responsibilities of the nurse, the promotion of positive patient outcomes, and satisfaction with the model but the differences for the other knowledge/opinion items were not statistically significant. Verbalized perceptions about the all-RN staffing model as obtained through the descriptive questions were positive. The HPPD weekly hours mean significantly increased from 107.9 to 116.2. Average length of stay decreased from 11.1 days to 8.7 days. The number of nurse-sensitive patient harm events decreased by 50%, from 6 events to 3 events, including the following hospital-acquired injuries: CAUTI, CLABSI, and Falls without injury.
Conclusion: Transitioning to an all-RN staffing model led to a significantly higher HPPD. Nurse sensitive harm events decreased but not at a significant level. An increase in direct nursing care hours leads to higher labor costs. However, these expenses can be offset by reductions in ICU patient length of stay and hospital-acquired patient harm events.
Recommended Citation
Sanders, Jeanette E., "Primary Nurse Framework: All-Registered Nurse Staffing Model in a Twelve Bed Critical Care Unit" (2025). DNP Projects. 505.
https://uknowledge.uky.edu/dnp_etds/505
