New Nursing Model Enhances Care, Reduces Stress

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Enter most metropolitan hospitals and you’re confronted with a cacophony of sounds: pagers beeping, doctors, nurses, assistants talking, PA announcements echoing through halls and rooms—it’s a nonstop, stressful environment. One where nurses and staff can feel overworked, and where patients feel like numbers on a bed chart. 
Enter the nursing unit at Virginia Mason Hospital & Medical Center in Seattle during “quiet hour” and you’ll encounter just the opposite: dimmed lights, silenced pagers and hushed voices among nurses and staff. The hospital is among many nationwide that have recently adopted the Swanson Theory of Caring, which is designed to give nurses and healthcare staff a stress-reducing breather.


Developed by Kristen Swanson, RN, PhD, FAAN, dean of the University of North Carolina at Chapel Hill School of Nursing, the hour of serenity allows nurses and staff to care for one another and to catch up with their many tasks in a reduced-stress environment. 
The Swanson technique includes tracking yardsticks on how nurses improve care, efficiency and satisfaction for patients and staff. "As much as managing safe, competent care is essential, so too is the capacity to navigate relationships during stressful times," said Swanson. "It’s not [only] relationships with patients but [also] with our peer professionals."
The goal is for revitalized nurses to support each other, eliminate overlap and act proactively instead of simply reacting to patient discomfort. This improves patient care and efficiency, which ultimately reduces costs. 
Among the Swanson techniques are "Who am I?" boards, which list staff members' favorite foods and vacation places and challenge colleagues to guess who the person is. This helps staff—who are often separated by 3-day, 12-hour shifts—to get to know each other. Equally helpful are caring message boards, which allow nurses to post thank-you notes for switching shifts or helping them with a patient. Patient care teams are also encouraged to walk through each others’ work areas to learn, first hand, what that patient faces during treatment. Swanson also believes in "caring concierge carts" stocked with everyday items that give patients and families access to many of the comforts of home. Finally, the staff get together for 7 a.m. and 7 p.m. “care team huddles,” where staffing and systems issues are addressed, and letters from patients are read. 


Charleen Tachibana, RN, MN, senior vice president, hospital administrator and chief nursing officer believes the Swanson Theory has many merits. "There are still people who think you can either be caring, or efficient, but you can’t be both," says Tachibana. "The tools of VMPS have helped us eliminate waste and non-nursing activities that took nurses away from direct patient care. Our nurses spend more than 90 percent of their time at the bedside, compared with a national average of less than 50 percent. The Swanson Theory of Caring gives us the right context at the bedside to deliver the best care possible."

Plans are in the works to apply the Swanson Theory to ambulatory settings, satellites and physician partners at Virginia Mason. As a hospital administrator, it might  be worth your while to consider adopting some or all of Kristen Swanson’s techniques for your staff. 

Image courtesy of imagerymajestic/



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  • Yelka J
    Yelka J
    I would love to work in the environment that you are describing, especially time for patient care and opportunities to de-stress with my co-workers!
  • David C
    David C
    I am totally with you on this.. it is both Lean Methodology congruent as well as Eden Alternative and Pioneer Network applicable... I intend to use and promote this where ever I can.
  • Patricia W
    Patricia W
    I welcome this Therory of Caring. As a patient and a nurse the serenity hour or quiet awareness restores balance to our inner and outer self concepts.   "Who am I?" boards allows the "I am" beliefs that are true about the individual.   I recall similar "caring concierge carts" form my younger years. As a patient or a nurse, it was a time of good anticipation and we looked forward to be able to obtain a magazine, candy bar, toothpaste, or other goodies !       
  • Alex Kecskes
    Alex Kecskes
    Thanks for your comments. MARI Q: nurses at Virginia Mason spend more than 90 percent of their time at the bedside, compared with a national average of less than 50 percent. Kosair Children’s Hospital practices Kristen Swanson’s Theory of Caring. More answers to come.
  • MARI Q
    MARI Q
    It's a great model and I agree that it works; however I'm curious as to how staffing was reconfigured and does this work in a akilled nursing setting.
  • Maryanne H
    Maryanne H
    I really enjoyed this read. I would love to see this implemented  at my place of employment. Thank You for the article.Maryanne H, RN
  • Suzanne P
    Suzanne P
    I've been an RN for 42 years and have worked in various roles in many different nursing environments and I'm glad to see that someone with credentials had seen the light. Nurses are pulled in so many different directions and constantly are trying to beat the clock while satisfying everyone elses needs and keeping their employers happy with no overtime. Talk about stress...The list of woes nurses suffer because of it are endless, yet we get up every morning and do it all over again. i hope more employers will jump on this bandwagon and help nurses by attending to their need so they can continue to care for everyone else's.
  • Ramiro J
    Ramiro J
  • Leslie R
    Leslie R
    I believe the model is ideal. I personally find that when I'm able to spend time with my patients they feel better and tend to worry less. It promotes better health
  • Nancy K
    Nancy K
    FINALLY.....someone is taking nursing back to what it was at one time & should be..

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