Nursing & Care


Lean Workcell Nursing Implementation Can Enhance the Educational Effects of QSEN and Time Spent with Patients in Comparison to Team Nursing

Yuka Moriyama RN, Jiro Tanaka, MD, PhD, Emiko Kurachi RN, Keiko Higuchi RN, Kumiko Sudo RN.

This project was designed to evaluate the effects of lean workcell nursing on educating newly hired registered nurses (RNs) on Quality and Safety Education for Nurses (QSEN) concepts and to investigate the effects of lean workcell nursing on time spent with patients in ward practices. Lean workcell nursing practices and QSEN concepts were introduced and infused over a one-year residency program for the newly hired RNs. This is a descriptive prospective/retrospective study examining lean workcell nursing practices and comparing them to traditional team nursing practices in a clinical training hospital in southern Japan. Clinical Evaluation (CE) scores (prospective) based on QSEN knowledge, skills, and attitudes (KSAs) in two cohorts of newly hired RNs working in lean workcells were assessed twice each year, in June and September (cohort 1 hired in April, 2015 and cohort 2 hired in April, 2016). The mean CE scores in June 2015 were 0.50 ± 0.19 (n=85) and in June 2016 were 1.69±0.49 (n=81) (p<0. 01). The mean CE scores in September 2015 were 1.72 ± 0.63 (n=84, one RN left her job) and in September 2016 were 2.62 ± 0.34 (n=81) (p<0.001). Lean workcell was defined as a care style in which nurses spent more than 80% of their time in the patient’s room or just outside the patient’s door in the hallway. Likert questionnaires were developed and administered (retrospective) to evaluate agreement with lean workcell nursing. The transition for newly hired RNs from team-based nursing to lean workcell nursing advanced over the year-long period, from a low of 19.2% to a high of 48.6% (p<0.023), with positive results as time progressed. RNs also ranked lean workcell nursing to be more patient-centered and more positively associated with understanding QSEN concepts than teambased nursing. Lean workcell nursing implementation can enhance QSEN education and increase the amount of time nurses spend with their patients in ward practices.