For Kate Schmidt,RN, relationship-based care became change she could believe in. Photo/courtesy SSM St. Joseph Hospital West

After 6 years as a registered nurse, Kate Schmidt was happy with her career and pleased with her position at SSM St. Joseph Hospital West in Lake St. Louis, MO. Yet, at the end of some days, she could not shake the feeling she had served more as a "pill pusher" than a caregiver.

That gnawing feeling really registered one day in a patient's room.

 "I was calling up to the nurses' station to confirm a procedure and referred to my patient as 'the lady in room such and such,'" recalled Schmidt. "My patient overheard me and asked, 'Am I just a number to you?' I was so busy, I never had time to learn my patient's name."

Despite the crazy, non-stop nature patient care takes, Schmidt believes nurses are leery of change, even if that change promises more time to make those interpersonal connections that she believes patient care is all about.

So when SSM Health Care-St. Louis introduced the Relationship-Based Care nursing model network-wide early this year, Schmidt was skeptical. But as days turn into weeks and months, she has grown accustomed to spending more time talking to patients and less time focusing on measures and standards.

According to Schmidt, the Relationship-Based Care difference is immediately evident upon a patient's hospital arrival. A Relationship-Based Care concept called the "admissions blitz" changes the way patients are admitted: no one nurse admits alone; two floor nurse team members admit a patient together.

According to Schmidt, the admission blitz helps patients to get settled faster, and the work of the nurses to get done more efficiently and thoroughly.

 "It's decidedly nicer to have that extra set of eyes to do the charting while you're preparing the IVs for a new patient or vice-versa," said Schmidt. "The admissions blitz gives you more time to introduce yourself, to get to know your patient and focus on the social aspect of nursing care, not just the medical."

An admissions blitz partner need not always be a floor nurse colleague. The Relationship-Based Care model provides for a new position called the clinical support nurse, which plays a critical role in the model's success. With a broad understanding of the resources available, the clinical support nurse supports, mentors, coaches -- or lends a hand -- to fellow team members.

 "Recently I had a patient suddenly admitted at 9 a.m., right in the middle of dispensing morning meds," Schmidt recalled. "It would have created havoc to get away. Fortunately, I could rely on my clinical support nurse to take my place."

Encouraging team members to solve problems together is a Relationship-Based Care trademark. When things get hectic, a short, focused "huddle" pulls staff together to determine what can be done to better support each other.

Likewise, a "stop light" system on the unit's dry erase assignment board is utilized by nurses to signal to co-workers their workload and need for extra support by placing a green, yellow or red dot next to their name.

Another helpful Relationship-Based Care tool is a daily agenda -- a schedule of tests and therapy printed for the patient. "Knowing the daily goals of your hospital care helps patients meet those goals," said Schmidt.

One recent Monday, the extra time Schmidt had to make therapeutic, interpersonal connections with her patients was evident.

 "We admitted a 24-year-old woman with a severe kidney infection who was in the midst of a cross-country move from North Carolina to Colorado," remembered Schmidt. "Her husband couldn't be with her. He had to stay with their 15-month-old son at the hotel.

 "My patient was lonely and scared, but before long we had the time to talk about a common interest, our young children. I was able to focus on my patient's emotional well-being and her physical care in a way I rarely had before."