Armstrong, who came to Texas Children’s from New York Presbyterian-Morgan Stanley
Children’s Hospital, brought with her 30 years of nursing experience and took action to
refocus the attention on the point of care – at the bedside.
Based on this objective, Armstrong and her team designed a transformational leadership
model backed by scientific research. The new model vastly changed nursing at Texas
Children’s Hospital.
At its core, the reinvention of the nursing model creates an environment where bedside
providers strive to deliver exemplary practice every time to every patient and every family.
The new model, implemented in September of 2013, called for a number of changes
including filling vacancy rates, increasing staffing, requiring higher levels of education,
redesigning nursing leaders’ roles and titles and providing training as nursing leaders
transition into those newly defined roles.
Having sufficient staff with higher levels of education leads to decreased mortality
rates and lower rates of infections, falls and pressure ulcers. A primary component of
the strategy was to make sure the hospital was appropriately staffed to care for the
complex patient population.
“The plan is to bring strength and focus to the bedside,” Armstrong said.
“To do that, we needed to bring in additional staff by creating new
positions where more nurses were needed and filling vacancies that
existed within several units.”
The recruiting methods were changed to make them more efficient and effective, and
the requirements of newly graduated nurses were elevated, including a rigorous review of
candidates’ grade point averages and personally-written mission statements.
Transforming roles
The newly implemented nursing model revolves around providing patients with nursing
leaders 24 hours a day, seven days a week. Leadership positions in the previous model
were viewed as administrative and lacked training and support. Not surprisingly, there
were often vacancies in these leadership roles. Armstrong redesigned the roles in
partnership with Human Resources to require higher-level, more complex, advanced
competencies that take the nurses’ focus away from the administrative side and redirect it
to the patients’ bedside. Titles were changed to reflect the new requirements. The charge
nurse and manager roles were combined and titled patient care manager. The assistant
director role was renamed assistant clinical director and was given responsibility for one
unit rather than the previous two units.
Gay Matthews, RN, MSN, now assistant clinical director of the cardiovascular intensive
care unit, said in her new role, her workload was cut from supervising 53 beds and a staff
of 200 to 21 beds and a staff of 100.
“I now have more interaction with staff nurses and a frontline view to
see things as they happen and provide real-time coaching and feedback,”
Matthews said. “This has allowed me to be a better leader for my staff.”
