Staff rotate between two units
The first option for implementing blended nurse roles is to have frontline staff split their time between two units. Greenwich Hospital did so by creating a “transition” role across its Mother Baby and Labor and Delivery (L&D) units. These nurses work most of their shifts on Mother Baby, but they work up to three shifts a month on L&D caring for newborns immediately post-partum.
Although leaders originally piloted this role to assist L&D nurses after patient volumes spiked, the role is now permanent. Patient and staff satisfaction both improved, and more than 90% of Mother Baby nurses opt into the transition shifts. Young nurses are particularly eager to fill transition roles.
Staff rotate between two care sites
At Cincinnati Children’s, blended nurses split their time between an inpatient and outpatient care site. Leaders pair two nurses within the same service line—one works half the week in an inpatient setting and the other works the same schedule in an outpatient setting. For the second half of the week, they switch sites.
This practice can be applied across any service lines that have corresponding inpatient and outpatient care sites. Participating sites at Cincinnati Children’s include inpatient neurosurgery, nephrology with dialysis unit, pulmonary clinic with IP trach unit, cardiology step-down with cardiology clinic, NICU with high-risk infant follow-up clinic, and gastroenterology with hematology.
Key considerations for introducing blended nurse roles
- When staff rotate, they take on a predetermined set of responsibilities. Leaders should set aside sufficient time for nurses in blended roles to train on new required skills and to stay up to date on competencies in both rotation areas.
- Nurses rotating between care sites should rotate within a single service line so they are already familiar with the general characteristics of the patient population.
- Ensure that staff rotate regularly between units or care sites so they are consistently exposed to other parts of the organization.
- Managers from both units or care sites must be equipped to coordinate scheduling and performance reviews for nurses in blended roles.