Date of Paper/Work


Type of Paper/Work

Doctor of Nursing Practice Project

Degree Name

Doctor of Nursing Practice



First Advisor

Susan Hageness


Doctor of Nursing Practice


Health care and medical care are currently undergoing dramatic changes. Factors that are driving the changes include: an aging population, an increase in chronic conditions, corollaries of the Affordable Care Act (ACA) including mandatory healthcare insurance for the population and coverage for individuals with preexisting conditions, and changes in reimbursement through the Centers for Medicaid and Medicare Services (CMS). A significant challenge is the financial balance needed to provide affordable care that produces quality outcomes and patient satisfaction in acute care hospitals.

One of the quality outcomes sought is safety. One of the key provisions of the American Nurses Association Code of Ethics (2001) is the accountability of registered nurses (RNs) for providing a safe environment for their patients. The use of safety assistants is one way that nursing care is supplemented to create that safe environment. Safety assistants are individuals who are positioned at the bedside of those patients whom have been determined to be a safety risk.

The use and cost of safety assistants has steadily climbed over the last few years. A Safety Assistant Team was convened at the organization in which this System Change Project took place to determine ways to reduce the cost of the use of safety assistants. A team charter was established. The team membership included: Directors, Managers, Staff Nurses, Safety Assistants, and Clinical Nurse Specialists. The Safety Assistant Team members reviewed current literature for projects that lowered the cost of safety assistants. The team identified one project that could serve as a model. The model would use Clinical Nurse Specialists and Advance Practice Nurses to round on all non-psychiatric patients on medical surgical units who had been assigned a safety assistant.

Three theories undergirded the project: Dorthea Orem’s Self-Care Deficit Theory provided foundation for the assessment of patients who were unable to totally care for themselves and put them at a safety risk; John Kotter’s eight-step Change Management Theory provided a framework for successful and sustainable project outcomes: and Everett Rogers’ Theory on the diffusion of Innovations was used to evaluate the potential sustainability.

The project question was can the cost of using safety assistants be reduced by rounding by Clinical Nurse Specialists and Advanced Practice Nurses? An evaluation of the number of Safety Assistant hours used 6 months before the rounding occurred and 6 months after the initiation of the rounding identified a decrease of 7825 hours used that translated into a reduction of $131,065 in cost. The return on investment for rounding project was 2735%.

While the cost savings are impressive, cost cannot be the only consideration. Those provisions of care that result in quality outcomes and patient satisfaction are equally important. However, these elements were not measured in this system change project. Further research must be supported at the highest level of the organization to determine what specific outcomes are priority in the rounding process by the CNS or APN; are collaborative relationships essential to the success of the rounding process and how are those collaborative relationships built and sustained; what written recommendations for alternative interventions and complimentary modalities resulted in the most advantageous patient outcomes; and what are the elements of a successful safety plan? Another parameter to be studied is what is the thought process used by the CNS and is it transferable to other nurses?

The future holds many questions for the economic success of organizations involved in the healthcare of the populations they serve. The ability to deliver cost effective care is inherently linked to providing quality care. Health care professionals should be practicing collaboratively at the top of their education, licensing, and ability towards the common goals of any quality and safety program. This project identified that the CNS effectively delivered an economic outcome: however, with more consideration of the potential of the expertise and skill of those in the CNS role, further gains await the populations served.