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Ask a Researcher

What is the 80/20 professional development model? What does the research say about it? Is it feasible to implement?

Researcher:

Debra A. Bournes, RN, PhD,
Director of Nursing, New Knowledge and Innovation,
University Health Network, Toronto, Canada,
Debra.Bournes@uhn.on.ca

What is 80/20?

It is a professional development model in which nurses spend 80% of their salaried time in direct patient care and 20% of their salaried time on professional development. The professional development time focuses on learning about patient-centered practice guided by the nursing theory called humanbecoming. In their 20% time, nurses participate in a combination of structured and unstructured learning opportunities that include an initial 12-week seminar series about humanbecoming and patient centered care—followed by bi-weekly reflective practice sessions where they continue to learn about the theory in relation to change, leadership, research, and teaching-learning. They also engage in group projects and have in-depth discussions about the challenges and opportunities that they have in their day-to-day work and in their professional development.

What does research say about 80/20?

Implementation of 80-20 model has been evaluated on four nursing units (Bournes & Ferguson-Paré, 2007, 2009; Bournes, Ferguson-Paré, Plummer, Kyle, Larrivee, & LeMoal, 2008)—three at University Health Network in Ontario and one at Regina General Hospital in Saskatchewan (in collaboration with Regina Qu’Appelle Health Region and the Saskatchewan Union of Nurses). The studies examined the impact of this innovative academic employment model and demonstrated that it increased nurse satisfaction, nurse retention, patient satisfaction, and quality of patient care (Bournes & Ferguson-Paré, 2007, 2009; Bournes et al., 2008), while decreasing turnover, sick time, overtime, and variable direct labour expenses (Bournes & Ferguson-Paré, 2007, 2009; Bournes et al., 2008). In addition, findings from the qualitative descriptive evaluation interviews (conducted on 2 of the 4 units) with nurses, patients and families, and other health professionals supported the humanbecoming theory as an effective basis for learning and implementing patient-centered care that benefited both nurses and patients. Patients and families interviewed (Bournes & Ferguson-Paré, 2007; Bournes et al., 2008) reported that they appreciated the reverent consideration given to them by nurses who had learned about humanbecoming-guided patient-centered care. They also described being confident engaging in discussions with nurses who were understanding and attentive experts interested in who they were and what was important to them. Similarly, the nurse participants in all studies reported being more concerned with listening to patients and families, being with them, getting to know what is important to them, and respecting them as the experts about their quality of life after learning about humanbecoming-guided patient-centered care. Nurse participants in all four study units described the benefits of the program, not only in relation to how it changed their relationships with patients, but also in relation to how it changed their view of how to be with their colleagues in more meaningful ways. In fact, nurse participants consistently stated that the most valued part of being in the studies was their opportunity to engage in facilitated reflective practice sessions about nursing theory-guided practice with their peers. They also reported being more satisfied with their work—a theme noted by nurse leader and allied health participants who shared that, in the post-intervention period, nurses listened more and focused on patients’ perspectives (see for example, Bournes & Ferguson-Paré, 2007).

Finally, the 80-20 model is currently being used as the basis for a study to evaluate the impact of a humanbecoming mentoring program with experienced critical care nurses and new graduate nurses interested in a career in critical care (Bournes, Ferguson-Paré, Plummer, Hollett, & Sherman, 2010). Rather than coming from a single patient care unit, the nurse participants (11 critical care nurses and12 novice nurses) were recruited from multiple areas across a 3-site organization. Preliminary findings demonstrate a positive impact on nurse satisfaction, sick time, overtime, and retention. Nurse participants reported being more concerned with listening to patients and families and with getting to know what is important to them. They also described the benefits of the program in relation to how they learned from each other and how it increased their confidence. A final report of this study will be available in late 2010.

Is it feasible to implement?

The short answer is yes—if healthcare leaders believe in the capacity and the ability to lead that resides in every nurse and if they are willing to adopt an investment mindset. The research has demonstrated that the humanbecoming 80-20 model has the capacity to transform the work environment, the quality of patient care, and the ability of leaders to recruit and retain nurses. Employers of nurses must focus on recruitment and retention by addressing quality of work-life issues, and by promoting strategies that support professional development and leadership for all nurses. This is one way to do it—but it does require healthcare leaders and decision-makers to take a risk, make an investment, and trust that the benefits of the model (reductions in sick time, overtime, turnover; improvements in nurse and patient satisfaction, and others) will offset the costs.

References

Bournes, D. A., & Ferguson-Paré, M. (2007). Human becoming and 80/20: An innovative professional development model for nurses. Nursing Science Quarterly, 20, 237-253.

Bournes, D. A., Ferguson- Paré, M., Plummer, C., Kyle, C., Larrivee, D., & LeMoal, L. (2008). Innovations in nurse retention and patient centered care: The humanbecoming 80-20 study in Regina. Manuscript in progress.

Bournes, D. A., & Ferguson-Paré, M. (2009). Nurse retention and patient centered care: Continued evaluation of the humanbecoming-80/20 professional development model (general surgery and medical oncology units). Unpublished manuscript, University Health Network, Toronto, Canada.

Bournes, D. A., Ferguson-Paré, M., Plummer, C., Hollett, J., & Sherman, D. (2010). Critical care mentoring study: Testing a program to enhance retention and recruitment of nurses. University Health Network, Toronto, Canada. Unpublished raw data.