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This procedure led to creation of the patient care technician role (a clinical role) and the patient care service associate role (a guest services role).

The patient care technician role includes specified nursing tasks that can be delegated by an RN to the technician, such as setting up of equipment, assisting patients with their activities of daily living , taking vital signs, and serving as another set of eyes for the nurses by noting changes in patient status.

The Cleveland Clinic Foundation Experience: An Overview At CCF we agree with the many experts who state that redesign efforts are essential to succeed in a world that now demands healthcare be delivered faster, cheaper, better, closer, and in a way that is more friendly than its competition.

Downsizing is defined as a reduction in personnel to do the same work with fewer people (Hammer & Champy, 1994).

Copies of state regulations served as a guideline and resource in the review process.

We are witnessing consolidation of hospitals into integrated delivery systems, hospital closings, staff layoffs, and care being provided in new ways and in new settings. The purpose of this paper is to describe the Cleveland Clinic Foundation's (CCF) response to these changes, namely, a redesign initiative.

This move resulted in better use of nurses' professional skills and abilities.

This role change provided the opportunity for RNs to look beyond the acute care episode to the full continuum of care.

The RN's role was redefined to be that of a care manager who directed the processes of care for the patient during the acute care episode and beyond.

The RNs moved from focusing considerable time on activities not utilizing their professional skills to functioning at their upper limit of professional education and licensure.