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units for admitted patients; facilitating patient discharges in the ED with ED nurses; ensuring clean bed availability to both triage walk-ins and ambulances.Practice Change ModelSeveral practice change models exist to provide a framework for individuals and institutions to implement change. Among them is the Iowa Model, as described by both Melnyk and Fineout-Overholt (2018) and Schaffer, Sandaw and Diedrick (2013). “The Iowa model…is a systematic method that explains how organizations change practice” (Melnyk & Fineout-Overholt, 2018, p. 431). “The model is represented as an algorithm with defined decision points and feedback loops” (Schaffer et al., 2013, p. 6). The first aspect of the Iowa model is whether the subject of change is an institutional priority (Melnyk & Fineout-Overholt, 2018, p. 431;
Translational Research 13Schaffer et al., 2013, p. 6). The second question is whether there is enough research evidence to support the proposed change (Melnyk & Fineout-Overholt, 2018, p. 431; Schaffer et al., 2013, p. 6). Lastly, after determining the efficacy of a piloted change, the Iowa model suggests the consideration of determining whether or not to continue the change of practice (Melnyk & Fineout-Overholt, 2018, p. 431; Schaffer et al., 2013, p. 6). The implementation of the NN role requires an individual role change (the addition of appropriately experienced nursing staff). This requires organizational support (buy-in from the institution’s administration and nursing management) with the standard work of the new role developed in collaboration by ED nursing staff and management. The Iowa model “considers input from the entire organizational system” (Schaffer et al., 2013, p. 7) making it a relevant choice for the suggested practice change.Melnyk and Fineout-Overholt (2018) provide a decision tree for implementation of the Iowa model1(p. 431). Within the context of developing the NN role the first step is determining what triggered the need for change and if it is a priority for the institution (p. 431). The need to establish new practices to improve ED throughput and overcrowding is clearly a priority for this Minnesota hospital, as it was clearly an institutional priority for the hospitals in all the articles reviewed for this paper. Based on this priority, the Iowa model suggests a team formation of key stakeholders to research existing literature to verify adequate current best practices related to the desired change (p. 431). Key stakeholders as mentioned earlier are ED nursing staff, ED management and hospital administrators. Labor divisions for data collection and analysis would be established. In collaboration, these stakeholders would critique the results of the analyzed data and then be ready to form an intervention. 1 Please see appendix to refer to the Iowa model decision tree for this section.
Translational Research 14At this stage, the Iowa model proposes that a pilot program of the practice change be implemented (p. 431). Implementation of the NN role in this hospital would involve the selection