Date of Conferral



Doctor of Nursing Practice (DNP)




Cynthia Fletcher


The goal of the acute inpatient rehabilitation facility (IRF) is to rehabilitate patients and discharge them back into the community at their optimal level of functioning. The IRF patient is more acutely ill today than in the past, and due to a change in condition may be discharged back into the acute care hospital before achieving maximal level of function. An IRF was identified as discharging 14% of patients back into acute care, which indicated the IRF was not meeting its treatment goals. A chart review revealed a possible link between the nurse's role in patient care and the patient's discharge disposition. The purpose of this project was to design a nurse staffing care model that would support the registered nurse in providing care and treatment for the IRF patient. The missed nursing care model and Lewin's change theory were used to support the design of the new staffing model. Sources of evidence included a literature review of nurse staffing models and the nurse's role in patient outcomes. A project team of expert stakeholders participated in the development of the new model. The Appraisal of Guidelines for Research and Evaluation was used in formative and summative evaluations of the new model to systematically assess the quality of the new staffing model. Formative feedback was given by 3 project team members. Nine expert end users provided summative evaluations of the new model after revisions by the project team. All end users recommended implementation without modification. Positive social change with implementation of this model may lead to reduced acute care transfers, improved quality measures, and enhanced patient outcomes in the IRF.

Included in

Nursing Commons