Nursing on an ACU: science and art
1Unit has been working extensively with a number of Canadian hospitals to implement the Accountable Care Unit (ACU) care model. I’m always interested to hear the stories from frontline staff of how the ACU can impact their daily work.
On a recent visit, I spoke with the nurse manager (the wonderful Ms. Marlee Cossette) of the first Canadian Medical Surveillance Unit (MSU) to implement the ACU. The Unit itself is a medical step-down Unit that has seen some incredible changes in clinical and cost outcomes. I’ll discuss some of those outcomes with you another time.
But, the Unit leaders have also had some wonderful experiences with the patients and staff. While discussing these less tangible benefits of the ACU care model, we chatted about the many, often hidden, stories that occur weekly on the Unit. The type of stories that uplift staff and remind them why they still come to work for a 12 hour shift. We also discussed the staff experiences of nursing on an ACU.
A few weeks later, I received an email Marlee with the content below to reinforce some of what we had chatted about. Too good to be hidden away in an email, I wanted to share this with you.
Thank you again Marlee for sharing on behalf of the whole MSU team.
After caring for a patient and his wife on MSU we were quickly reminded why we adopted the ACU. This patient’s story touched us all not only because they appreciated the team of professionals themselves, but also because they were so grateful for the manner in which communication and care was delivered. This particular patient had been admitted to the hospital for 16 days prior to being admitted to the MSU. He described his condition as being ‘incapacitated by nausea and vomiting’. Despite numerous tests, the cause continued to remain undetermined. He was transferred to MSU because of his continued deterioration.
On MSU, a diagnosis was achieved and treatment was provided. He was discharged direct to home 11 days after admission to the MSU: the patient had been suffering with his condition at home in his community for months. His wife described their experience on the MSU: “I can’t say that his care wasn’t good on the other ward, but there really is no comparison. They [the MSU staff] went through his history from [hospital] admittance to [transfer to] the MSU, right to that particular day. So there was no room for error. The ball never got dropped. The staff showed us positivity, patience, understanding and compassion. Our whole family was always included in discussions about his condition and care. This consistency saved his life.”
Intangible Benefits of the ACU
Impacts like these are the missed opportunities that become reality through the structure the ACU affords us. I believe it isn’t because we are any better at our jobs or have any greater desire to provide high quality care to patients. I believe it is because we are organized in a way that allows us to do so. Implementing the ACU on our unit was not easy, because it requires organizational change at many levels. It has allowed us to meet and exceed patient and family expectations consistently through teamwork and routines.
Frontline Nursing Perspectives
One nurse on the unit describes her experience: “Initially, you are nervous because this model is so different that you don’t know what to expect and how it will impact your work life. But, it’s been amazing. The physicians are not only skillful and knowledgeable, they deal with people so beautifully it makes my job easier. It’s the best working environment in my 23 years of nursing.” Another nurse on the unit recently compared the ACU care model to the art of nursing. She described ‘the medicine as ‘the science of nursing’ but the art is the area in which we have influence, on ‘how we practice and treat one another is the art’.
My Perspective as Nurse Manager
As a manager and nurse, I believe this model resonates with teams because of those exact reasons. It allows care providers to share their knowledge and expertise in a way they always hoped and believed they would. In the end, it is these stories that uplift teams and inspire us. They remind us that not only who we are but how we practice can have lasting impacts for the patients we serve.
These nurses have clearly found a solution that works for them and has renewed their passion for nursing. Congraulations to all of the MSU staff for their dedication to their patients.
Contact us to learn about ACU implementation
Liam Chadwick Ph.D.
“ACUs just appeal to my engineering sensibilities.”