Nurse Leaders: The Key to Safe and Effective Patient Care
Nurses are the linchpin of hospital care delivery and represent a critical and costly resource. Maximizing the efficiency and effectiveness of nurses is essential to the integrity of hospital function and the promotion of safe patient care. Many hospitals understand this and are embracing their nurses and appointing leaders. A simple search on Google, for example, will direct you to hospital sites with pages dedicated to nurse leaders in all areas of hospital operations. Bloomington Hospital in Bloomington, Indiana, and United Hospital in St. Paul, Minnesota, are but two examples. When hospitals embrace nurse leadership across departments and disciplines, they are better able to design safe and effective systems for the delivery of a care.
To foster nurse leadership, hospitals should remove internal silos, empower all front-line nursing staff to contribute ideas and thoughts to better care delivery, create a climate that embraces nurse leadership and involvement at all levels within the hospital, and empower nurses to become decision makers and innovators. To better understand why this is so important, let’s evaluate how nurse leaders can improve the care environment when involved in decisions made by hospitals for various operational areas.
Investment in technology is one area that benefits from nurse involvement in decision-making. Technologies are evolving at a rapid pace in hospital care. These technologies of course affect the IT staff but they affect nurses, too, because many require them not only to learn the new technology, but also to integrate it effectively into their already overburdened workflow. Wireless medical devices are one example of a new technology that affects both the IT staff and the nursing staff. The IT staff has to figure out whether or not they have the infrastructure to support the wireless device and what happens to data collection when that device is roaming wirelessly. If the network drops the signal it is important to know whether the vitals are still being collected and whether the device can properly handle patient association during that time. If a nurse were involved with decision-making about these wireless devices, these potential issues would be addressed. The hospital could make proper adjustments to the installation or possibly avoid the expense of purchasing a device — or at least a certain version of a device — that is ahead of its time and therefore not helpful to building the right environment for safe and effective patient care and integrated caregiver workflows.
Another example is facilities design. Hospitals are often expanding or remodeling. Frontline nurses can provide great insight into the design of the hospital environment and provide input on relatively minor but important physical changes within a space. For example, distribution points of supplies and medications could have a major impact on improving nurse workload. When the design hasn’t considered such implications, nurse workload suffers. Simply involving nurse leaders and frontline staff early on in the process of facility design can improve the overall quality of patient care.
The bottom line is that nursing involvement with decisions related to all operational areas of the hospital helps ensure the highest quality of patient care and safety and can help hospitals avoid spending resources on solutions that don’t deliver the best patient care environment and best work environment for the nursing staff. A holistic approach is best whereby nurses, technology, and work processes come together in new physical space to produce a safer care environment with maximum efficiency.
How do hospitals find nurse leaders? Perhaps the easiest thing hospitals can do is find out if any of their frontline nursing staff are involved in the growing number of movements offered in today’s environment of care, and if they aren’t involved, to encourage involvement.
Let’s review some recent examples of nurses working together to prove their value as leaders, with data to support their recommendations. For example, nurses joined together to work on a ground-breaking Time and Motion Study that showed nurses spend only 19.3% of their time on direct patient care. And nurses aren’t stopping with just indentifying the problem. They are working together on recommendations for change to ensure that they have answers to solve today’s challenges. For example, the recent Proclamation for Change offers evidence-based recommendations to transform the patient care environment and help eliminate inefficiencies in the hospital work environment that threaten safety and sustainability of care.
There are also groups that have formed to show their appreciation for hospitals that embrace change and nurse leadership. Magnet, for example, is a system designed to recognize hospitals for quality patient care, nursing excellence, and innovations of nursing practice. Hospitals receive Magnet recognition when they can prove that their nursing staff delivers excellent patient outcomes, that their nurses have a high level of job satisfaction and low turnover rate. The idea behind Magnet recognition is that nursing leaders value staff nurses, involve them in shaping research-based nursing practice, and encourage and reward them for advancing in nursing practice.
Another way that hospitals can embrace nursing leaders is to review and incorporate the action plans and solutions recommended by the T.I.G.E.R. Initiative and the Institute of Medicine’s Future of Nursing Initiative. T.I.G.E.R. (Technology Informatics Guiding Educational Reform Initiative) aims to enable practicing nurses and nursing students to identify best practices for information management and effective technology capabilities for nurses. Its goal is to create and disseminate action plans that can be duplicated within nursing and other multidiscliplinary healthcare training and workplace sessions. The initiative is currently embraced by over 2,000,000 nurses from major nursing organizations including ANI, ANA, AONE and AACN and is quickly gaining momentum around the world.
The Institute of Medicine has assigned a committee that is currently managing a two-year Future of Nursing Initiative designed to identify solutions of nursing care that will not only address many issues facing the profession but also transform the way Americans receive healthcare. The study committee will review innovative models of nursing care and education with the goal of producing a transformational report on the future of nursing, with solutions that nursing can provide to improve the quality of patient care while controlling costs. Donna E. Shalala, PhD, former Secretary of the U.S. Department of Health and Human Services and the current president of the University of Miami, is leading the study. She has stated that, “to successfully transform the way health care is structured and delivered in our country, it is absolutely essential to actively engage nurses for their leadership, expertise and proven solutions. Nurses and their concerns must be a part of our national discussion about health reform, and viewed as a key to the solution.”
What all of this proves is that nurses want to be heard. They have a voice and are looking for ways to come together to ensure that they have data to back up their concerns, that they have actionable ways to address and initiate change within hospitals, and can work in environments of care that embrace nursing leadership. Organizations can prove their commitment to nursing by taking an integrated, holistic approach to improving the hospital work environment and by viewing investments in technology, facilities, and work processes not as stand-alone solutions, but as pieces of the whole. The key to providing the highest quality, safest patient care environment possible, is for executive leaders of hospitals to embrace these nurses and their initiatives and to make sure that all nurses are heard. Hospitals may have one official nurse leader on the organizational chart, but all nurses in the hospital — representing the largest percentage of all hospital staff—are leaders at heart because it takes a leader to become a nurse.