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The Need for Critical Care Nursing Skills in an Acuity-Adaptable Care Delivery System

Bonuel, Nena MSN, RN, CCRN, CNS, ACNS-BC; Cesario, Sandra PhD, RNC, FAAN; Cabading, Alma Degracia MSN, MBA, RN, CCRN

doi: 10.1097/CNQ.0b013e3181f649ef

With the relentless pursuit of patient care quality and patient safety, one has to explore every possible avenue to transform and redesign care delivery to remain solvent and meet the health care needs of patients in the future. Keeping patients undergoing renal transplantation in the same room from admission to discharge positively impacts clinical care outcomes on length of stay and cost. The success of this kind of care delivery lies on 1-week didactic structured training of the transplant nurses based on critical care concepts to manage fluctuations in patients’ condition. With an added 3 months clinical rotation in the critical care areas, the competent transplant nurses were able to care for the patients undergoing renal transplantation in the acuity-adaptable medical-surgical transplant floor with confidence. A hybrid nurse was created who possessed both critical care and medical-surgical skills. This can be a potential trend in the professional nurse model to address the health care challenges we face today in terms of nursing shortage, abbreviated plan of care, and facility operation efficiency. Thus, the need for critical care nursing skills is invaluable to the success of an acuity-adaptable care delivery system.

The Methodist Hospital, The Center for Professional Excellence (Ms Bonuel); Texas Woman's University (Dr Cesario); and Transplant IMU & Acute Care, The Methodist Hospital (Ms Cabading), Houston, Texas.

Correspondence: Nena Bonuel, MSN, RN, CCRN, CNS, ACNS-BC, The Methodist Hospital, The Center for Professional Excellence, 6565 Fannin St, Houston, TX 77030 (

The study was supported by The Methodist Hospital Research Institute CTSA Award, 2007, for Acuity-Adaptable Renal Transplant Pilot Study. The authors thanks Ann Scanlon McGinity, PhD, RN, Chief Nurse Executive, The Methodist Hospital, and Katherine Walsh, DrPh, RN, Vice President of Nursing Operation, The Methodist Hospital, for executive support.

© 2010 Lippincott Williams & Wilkins, Inc.