Congress Abstracts 2004

66

INTEGRATING FLEXTIME WITH PRIMARY NURSING IN THE ONCOLOGY AMBULATORY SETTING: A NEW MODEL FOR PRACTICE. Elizabeth Schmidt, RN, BSN, OCN^®, Patricia Schaindlin, RN, MA, AOCN^®, Susan Dosil Loiacono, RN, MSN, OCN^®, and Barbara MacGregor Cortelli, RN, BSN, OCN^®, Memorial Sloan Kettering Cancer Center, New York, NY.

A collaborative practice model has been in place in our ambulatory department in this NCI-designated comprehensive cancer center for over a decade. Twenty physician/nurse practices share a patient case load that supported 15,770 patient visits in 2002, providing care to patients with hematologic malignancies receiving standard multimodality therapies, investigational drugs on clinical trials, and palliative/supportive care. This model promotes physician/nurse collaboration while optimizing continuity of care.

Limited space prompted the need to add hours to the usual office practice day to accommodate more patient visits. Personal responsibilities, educational commitments, and commuting times conflicted with the longer workdays, leading to nurse attrition. In response to the increased hours and the subsequent need to boost recruitment and job satisfaction, the five-day workweek was replaced by a flexible four-day work schedule (FFDWS). This shift led to a modification in the collaborative practice model.

To facilitate the change, nurses work in teams caring for the patients in their primary practice and the team member’s patients on the scheduled day off. Teams are determined by clinic schedules, practice volume, and equity of the workload. During office practice hours, nurses circulate through the clinical area to assess the flow of the patients and identify needs for additional nursing care. Electronic mail, telephone, and text paging are utilized to share, distribute, and delegate tasks and responsibilities. All team nurses sign out to each other before and after the scheduled day off. Communication and teamwork are essential for the success of the FFDWS.

Team nursing meets the increasing specialized needs of oncology patients while optimizing continuity of care. Nursing satisfaction, with the change in practice model, is evident in the commitment to the team approach, cooperative efforts in the clinic area, and shared responsibility for patient care.

Recruitment efforts have extended in scope to include novice nurses. Collaborating with experienced nurses provides the novice nurse with opportunities for interdependence while supporting continued professional development. The FFDWS supports nurses in this competitive job market, encouraging more nurses to consider office practice nursing as a career choice.