Answer

SDLC

It is the  Software Development Life Cycle. This describes the several stages of a software cycle and the structure in which these stages are carried out.  The outcome from each stage is implemented in the next stage of the software life cycle.

The knowledge of the workflow and processes associated with critical thinking skills make nurses to help identify objectives, establish project goals. Involvement of nurses in the implementation of new system is necessary to provide a clinical nursing perspective to assist in the development of safe and effective systems

Nurse manager should give importance in  both the benefits and challenges associated with involving a nurse leader on an implementation team to ensure that the new system will be usable and acceptable for all nurses impacted.

ROLE DESCRIPTION FOR NURSE LEADER USING STAGES OF SDLC

Planning and requirements

  The role of the nurse leader collaborates with the interdisciplinary team members to accomplish the tasks such as define the scope and problems, select potential solutions, think about required resources, establish a project schedule and timeline, and launch the project . Clinical knowledge of the nurse helps in the implementation through workflow and processes effectively.

In Analysis.

Role of a nurse leader is to help prioritize project requirements, initiate and evaluate possible alternatives, and provide recommendations for management. If any failure in completing the tasks efficiently and meet organizational and user needs can result in project delays, loss of data, errors, and breakdown of communication processes. an internal part of the analysis process includes analyzing the workflow processes, communication, and decision-making tools. Involvement of a nurse leader in the analysis stage is imperative to review relevant organizational policies and to know what all changes required to accommodate new work processes and new technology.

In the stage of design. 

Nurse leader plays a critical part in this stage to ensure the software’s overall configuration is defined properly and establish the architecture and operation of the system with regard to hardware, software, networking, retrieval of data, archiving and use, and user interface. The nurse reinforces the  purpose of the system to improve patient safety. She also assist in customizing the system to promote clinical decision support to accommodate practices in different specialties.

Implementation stage. 

The role includes staff training, system maintenance, and evaluation of outcome, to ensure two-way communication between the staff and management to solicit feedback that may be useful when redesigning the system for better outcomes. Feed backs from users help in making safety to identify workflow and system issues. The engagement of the nurse can provide an effective strategy.

Post-implementation Support. 

The nurse leader is involved in ensuring continual support and adequate training, understanding the technology and its implications, to make sure the  acceptance and compliance of the new system by the staff. It increases satisfaction and adherence to the best practices. It will also minimize any potential negative effects caused by technical failure and also identify flaws to reinforce the need for constant upgrade and maintenance of databases.

CONCLUSION

The nurse leaders play a vital role among the  members of the implementation team and in facilitating the SDLC for informatics in health care; the nurse role includes synthesizing knowledge of how technology can promote the quality of care.

NURSE/PATIENT EMPOWERMENT

As a nurse, you are the individual who has the ability to empower patients in the decision-making process pertaining to their health care. In addition, you are in a unique position to empower your nursing colleagues to improve job satisfaction and use performance indicator data from dashboards to effect social change.

In this week’s Learning Resources, you examined both the National Database of Nursing Quality Indicators (NDNQI) and the key role nurses play as advocates for patient rights. To assist nurses in being better prepared for this role, programs such as Patient Care Partnership provide guidance.

For this Discussion, you will analyze the use of quality improvement data and discuss how this data can help empower both patients and nurses. Review the Patient Care Partnership information presented in this week’s Resources. In addition, reflect on the media presentation and the information shared by Ms. Manna on patients’ rights.

Resources:

· Brown, D. S., Aydin, C. E., & Donaldson, N. (2008).  Quartile dashboards: Translating large data sets into performance improvement prioritiesLinks to an external site. .  Journal of Healthcare Quality, 30(6), 18–30. http://doi.org/ 10.1111/j.1945-1474.2008.tb01166.x Typically, references should be within five to seven years of publication. However, this publication is considered a classical research reference pertaining to quality improvement and the use of data sets.

 

· Cole, C., Wellard, S., & Mummery, J. (2014).  Problematising autonomy and advocacy in nursingLinks to an external site. .  Nursing Ethics, 21(5), 576–582. http://doi.org/10.1177/0969733013511362

 

· Garrard, L., Boyle, D. K., Simon, M., Dunton, N., & Gajewski, B. (2016).  Reliability and validity of the NDNQI® injury falls measureLinks to an external site. . Western  Journal of Nursing Research, 38(1), 111-128. http://doi.org/10.1177/019394591454281

 

· Giancarlo, C., Comparcini, D., & Simonetti, V. (2014).  Workplace empowerment and nurses’ job satisfaction: A systematic literature reviewLinks to an external site. .  Journal of Nursing Management, 22(7), 855-871. http://doi.org/10.1111/jonm.12028

 

· Guglielmi, C. L., Stratton, M., Healy, G. B., Shapiro, D., Duffy, W. J., Dean, B. L., & Groah, L. K. (2014).  The growing role of patient engagement: Relationship-based care in a changing health care systemLinks to an external site. .  Association of PerOperative Registered Nurses Journal, 99(4), 517–528. http://doi.org/10.1016/j.aorn.2014.02.007

 

· Rock, M.J. & Hoebeke, R. (2014).  Informed consent: Whose duty to inform?Links to an external site.   MedSurg Nursing, 23(3), 189-194.

 

· American Hospital Association. (2003).  The patient care partnership: Understanding expectations, rights and responsibilitiesLinks to an external site. .  http://www.aha.org/content/00-10/pcp_english_030730.pdfLinks to an external site. Read through this document created by the American Hospital Association. This document was created for inpatient hospital stays. However, it is applicable to other practice settings as well.

 

· Montalvo, I. (2007).  The national database of nursing quality indicatorsLinks to an external site. .  The Online Journal of Issues in Nursing, 12(3). http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume122007/No3Sept07/NursingQualityIndicators.html

 

· Institute for Healthcare ImprovementLinks to an external site. . (2016). http://www.ihi.org/Pages/default.aspx The IHI offers numerous resources for improving nursing practice and patient care. Explore a variety of topics and examine some of the resources available.

 

· National Quality ForumLinks to an external site. . (2016). http://www.qualityforum.org/Home.aspx The National Quality Forum (NQF) strives to improve patient safety and reduce medical errors. Explore the NQF’s endorsed standards and consider how they apply to nursing practice.

Walden University, LLC. (2009). Topics in clinical nursing: Accountability and nursing practice [Video]. Walden University Canvas. https://waldenu.instructure.com/

 

Respond to the following:

· What are the best strategies the nurse can employ to empower patients and support patients’ rights to improve quality of care? (Some considerations to keep in mind may include: providing information on effectiveness, risks, and benefits of alternative treatments.)

· In what ways can NDNQI data from dashboards or quality improvement data be used to support nurse empowerment in practice?

· How has your institution empowered the nursing staff through the use of quality improvement data?

· Provide an example of how you have personally empowered either a patient or a fellow nurse.

Support your response with references from the professional nursing literature.

Note: Post a 3-paragraph (at least 350 words) response. Be sure to use  evidence Links to an external site.,   in-text citations Links to an external site. , and  essay-levelLinks to an external site.  writing skills, including the use of  transitional materialLinks to an external site.  and  organizational framesLinks to an external site. . Use the writing resources and the Discussion Rubric to develop your post.

 

Read two or more of your colleagues’ postings from the Discussion question (support with evidence if indicated).

Respond with a comment that asks for clarification, provides support for, or contributes additional information to  two or more of your colleagues’ postings.

 

Answer

1. What are the best strategies the nurse can employ to empower patients and support patients’ rights to improve quality of care? (Some considerations to keep in mind may include: providing information on effectiveness, risks, and benefits of alternative treatments.)

Ans:-

Noncompliance is a factor in any health situation, whether you work in sports medicine or help patients manage chronic disease. The healthcare industry likes to take credit for the successes, but it really boils down to people taking charge of their own bodies. Care management is a shared responsibility, but patients won’t know that unless nurses find ways to empower them.

There are many ways to empower patients.

The Models of Care are changing

The old-school approach of you telling patients what to do is gone in these days of health care reform, because today’s nurse is expected to educate as much as provide care. The new models of care are designed to give patients an understanding of their health and how lifestyle choices affect it.

It’s the day-to-day decisions a patient makes that impacts his or her health like opting to take the elevator instead of walking up two flights of stairs to the office or sitting on the couch watching TV in lieu of exercising. Even deciding to ignore a problem instead of seeing a doctor is a choice.

Transparency about Care

Health care consumerism is another side effect of reform. Patients now consider health care a service oriented industry. They shop for the best hospital and primary care physician. They question which specialist they should see and what treatments are in their best interest.

Nurses can help build confidence by being fully transparent with their patient. It is not enough to say “a little pinch” when you give someone a shot anymore. The nurse must expand to explain what the drug is and why it is necessary. This knowledge both comforts and empowers a patient.

That type of open discussion also helps build the reputation of the hospital, clinic or private practice. Instead of leaving confused and unhappy, patients go home and brag about the quality of the facility on feedback sites like Yelp or to their friends on social media.

Patient Engagement

Nothing does more damage to the patient/provider relationship than poor customer service and lack of consistency. All nurses must learn to properly engage their patients as a standard of care. If one nurse sits down with the patient and explains what is going on and how they intend to treat the problem, then the next one just hands out a prescription with no engagement, the entire service suffers.

How can nurses learn to better engage their patient? Consider some ways that nurses can cultivate good customer service.

• Identify behaviors that isolate patients and make them feel like they are not in control of the situation. Create solutions for each item on your list.
• Learn to engage the patient early on by introducing yourself and making eye contact.
• Create interactive patient education models that focus on what to do to improve his or her health, as opposed to handing out cookie cutter forms or providing vague and confusing post-care instructions.
• Encourage the administration to offer continuing education on patient communication and engagement to all the staff, so they get that personal touch from everyone they come in contact with during their visit.

Be Responsive to the Patients Needs

Listening is one of the best tools available to a nurse. Nothing says you have no control over your situation like being ignored or summarily dismissed. Effective patient care requires a team that puts the patient at the center and makes them an active participant. That won’t happen unless you learn to listen and respond to the patient’s needs.

Nurses are patient advocates and that requires open communication, effective education, transparent treatment and responsive care – this is how you empower your patients to take control of their own health.

Improving patient care has become a priority for all health care providers with the overall objective of achieving a high degree of patient satisfaction. Greater awareness among the public, increasing demand for better care, keener competition, more health care regulation, the rise in medical malpractice litigation, and concern about poor outcomes are factors that contribute to this change.

The quality of patient care is essentially determined by the quality of infrastructure, quality of training, competence of personnel and efficiency of operational systems. The fundamental requirement is the adoption of a system that is ‘patient orientated’. Existing problems in health care relate to both medical and non-medical factors and a comprehensive system that improves both aspects must be implemented. Health care systems in developing countries face an even greater challenge since quality and cost recovery must be balanced with equal opportunities in patient care.

• Safe – minimizing risk and harm, avoiding preventable injuries, and reducing medical errors
• Effective – providing services based on scientific knowledge and evidence-based guidelines
• Timely – reducing delays in care
• Efficient – delivering care in a manner that maximizes resource use and minimizes waste
• Equitable – delivering care that does not differ in quality according to characteristics such as gender, race, or socioeconomic status
• People-centered – delivering care that takes into account personal and cultural preferences

An empowered activated patient:

• Understands their health condition and its effect on their body.
• Feels able to participate in decision-making with their healthcare professionals
• Feels able to make informed choices about treatment.
• Understands the need to make necessary changes to their lifestyle for managing their condition.
• Is able to challenge and ask questions of the healthcare professionals providing their care.
• Takes responsibility for their health and actively seeks care only when necessary
• Actively seeks out, evaluates and makes use of information.

Empowered patients will better understand how to navigate between the many players in the healthcare system including family, physicians, health insurers, healthcare regulators, pharmacists. When unsure about where to go or what to do next, the empowered patient will feel confident to ask for the information they need.

Essential Components of Patient Empowerment

· Information

· Health Literacy

· Digital Literacy

· Self-Efficacy

· Mutual Respect

· Shared Decision Making

· A Facilitating Environment

Strategies:

1. Access. Accessibility and availability of both the hospital and the physician should be assured to all those who require health care.
2. Waiting. Waiting times for all services should be minimised. In most developing countries, the high demand for services often makes this a huge problem. Nevertheless, it has to be addressed effectively through continual review of patient responses and other data and using this feedback to make the necessary changes in systems.
3. Information. Patient information and instruction about all procedures, both medical and administrative, should be made very clear. Well trained patient counsellors form an effective link between the patient and the hospital staff and make the patient’s experience better and the physicians’ task much easier.
4. Administration. Check-in and check-out procedures should be ‘patient friendly’. For example, for in-patients, we have instituted a system of discharging patients in their rooms, eliminating the need for the patient or the family to go to another office or counter in the hospital and waiting there for a long time. This has been favourably received by patients.
5. Communication. Communicating with the patient and the family about possible delays is a factor that can avoid a lot of frustration and anxiety. The creation of a special ‘Patient Care Department’ with a full time Administrator has helped our institution significantly and has enhanced our interactions with patients and their families.
6. Ancillary Services. Other services such as communication, food, etc. should be accessible both to patients and to attending families.

Here are three ways nurses can improve patient satisfaction:

1. Integrate effective patient-provider communication tactics. Take a minute to set up a positive rapport with patients, building on common interests to establish trust before transitioning to clinical matters. Fear can keep patients from retaining important clinical information and following care instructions. It is critical for nurses to detect that emotion and allay those fears.

2. Boost nurse teamwork and care coordination. Provide a framework for staff and leadership to share in responsibility, problem solving and authority to give everyone in the unit a voice in the way patients are cared for and how staff are treated. The perception of teamwork and strong care coordination are key indicators of positive patient experiences.

3. Ensure adequate nurse staff levels. Have enough nurses on staff to cultivate higher patient satisfaction levels and reduce the likelihood of miscommunication.

Alternative medicine has been playing a large role in the healing industry for centuries and its popularity is showing no sign of slowing down.

The numerous benefits directly linked with alternative or natural medicine has created a wave of interest, especially in the western world, that seems to continue to grow at a rapid rate.

Alternative medicine includes a range of treatments that, while considered unorthodox, have various advantages that many modern forms of medicine simply cannot achieve.

Due to its practices being generally not accepted as a traditional or standard approach in the medical field, alternative medicine consistently receives criticism and backlash for being “backwards and unreliable.”

Unfortunately natural medicine is also commonly associated as a remedy that is only used by those who are unable to afford modern treatment despite the countless studies focused on the subject that say otherwise.

One study, for example, found that majority of individuals who use alternative medicine use it “because they find these health care alternatives to be more congruent with their own values, beliefs, and philosophical orientations toward health and life”

There is no denying the substantial difference between a standard hospital room with sophisticated tools and equipment and an acupuncture table where needles are inserted into specific points of the body to help cure ailments such as depression or anxiety.

Just because the former is considered superior doesn’t mean the latter isn’t as effective.

There are several common forms and their benefits of alternative medicine are extraordinary and have been helping people in need for hundreds of years.

Chiropractic

Herbal Medicine

Acupuncture

Acupressure

2. In what ways can NDNQI data from dashboards or quality improvement data be used to support nurse empowerment in practice?

Ans:-

NDNQI Measures Aim to Improve Healthcare Safety and Quality

To help you compare your quality measures against national, regional, and state norms for hospitals of the same type, the National Database of Nursing Quality Indicators (NDNQI) has compiled a database and quality measurement program. NDNQI was established in 1998 by the American Nurses Association (ANA) in response to ANA’s Safety and Quality Initiative. Used by 2,000 hospitals nationwide, NDQNI is the largest provider of unit-level performance data.

NDNQI data allows staff nurses and nursing leadership to review and evaluate nursing performance in relation to patient outcomes. Hospitals can use the information to establish organizational goals for improvement at the unit level, and mark progress in improving patient care and the work environment. It can also help your facility avoid costly complications.

NDNQI resources are drilled down to unit-level data. Examples of units are adult critical care units, pediatric med-surg combined units, and operating rooms. Participating hospitals submit data on each eligible nursing care units. The NDNQI Unit Structure classifies units by patient population and unit type.

To identify important safety topics, NDNQI works with the National Quality Forum (NQF), a not-for-profit organization whose mission is to “improve American healthcare through the endorsement of consensus-based national standards for measurement and public reporting of healthcare performance data that provide meaningful information about whether care is safe, timely, beneficial, patient-centered, equitable and efficient.”

Current NDNQI measures include:

• Nursing Staff Skill Mix
• Nursing Hours per Patient Day
• Assault/Injury Assault Rates
• Catheter-Associated Urinary Tract Infection Rates
• Central Line-Associated Blood Stream Infection Rates
• Fall/Injury Fall Rates
• Hospital/Unit Acquired Pressure Ulcer Rates
• Nurse Turnover Rate
• Pain Assessment/Intervention/Reassessment Cycles Completed
• Peripheral IV Infiltration Rate
• Physical Restraint Prevalence
• RN Education/Certification
• Ventilator-Associated Pneumonia Rates
• Falls in Ambulatory Settings
• Pressure Ulcer Incidence Rates from Electronic Health Records
• Nursing Care Hours in Emergency Departments, PeriOperative Units and Perinatal Units
• Skill Mix in Emergency Departments, PeriOperative Units and Perinatal Units
• Hospital Readmission Rates

How is NDNQI used?

According to Sachs (2010), NDNQI is the richest database of nursing performance in the country. Hospitals can compare performance and job satisfaction levels of individual nursing units to similar units locally, regionally and nationally.

NDNQI Data Significance

The data reported in NDNQI are nurse sensitive indicators. NDNQI data are used to show the impact nurses have on quality of care. These indicators are nursing sensitive, so they show how nursing care, such as good oral care, or skin care or the interventions that prevent patient falls, are so important to patient outcomes.

IPFW Hospital

Total Falls per 1000 Patient Days

IPFW Hospital Medical Unit

NDNQI data would be posted on the unit as a dashboard. A dashboard is a one page print out that graphically represents whether a unit met, exceeded, or fell short of target goals for each indicator and how the unit compared against unit based national benchmarks (Trossman, 2006).

TCAB: Transforming Care at the Bedside

Trossman (2006) stated that NDNQI data help nursing administrators and RN staff plan quality improvement activities, such as designing interventions that test nursing protocols and practices.

On the medical and surgical units at Parkview Hospital, NDNQI data is reported to the TCAB committee. TCAB stands for:

T: Transforming

C: Care

A: At

B: Bedside

TCAB is a committee meets once a month to discuss progress made on improving the quality patient care as noted through NDNQI data. TCAB pays special attention to many nursing sensitive indicators such as:

• Safety and Reliability: Amount of falls
• Patient Centered: Patients perception of care and discharge calls
• Efficiency: Productivity and Controllable Cost Per Unit Service

Just like NDNQI, TCAB produces graphs and diagrams for medical and surgical units to show progress. Benchmarks are noted on each graph to illustrate goals. These easy references show the staff where they stand and how much they need to improve.

NDNQI is Cost Effective

NDNQI data is used to help improve the care of patients and the work environment of nurses to avoid costly complications.

According to the Agency of Healthcare Research and Quality (2000), preventable health care-related injuries (such as falls, pressure ulcers, medication errors, ect.) cost the economy from $17 to $29 billion annually.

It is estimated that 44,000 to 98,000 people each year die from medical errors. This is higher than annual mortality rates from:

• Motor vehicle accidents (43,458)
• Breast cancer (42,297)
• AIDS (16,516)

This makes medical errors the eighth leading cause of death in the United States (AHRQ, 2000).

Trossman (2006) informs us that NDNQI data also can be used for other budget requests. For example, if there is a high incidence of pressure ulcers on some units, nurse administrators can request specific equipment, such as pressure redistribution mattresses.

In the era of consumerism, quality of care is inevitable regardless of the health care setting. Nursing leaders, in employment settings or in professional organizations, exercise power in making professional judgements in their day to day activities. Power is authority over others. Empowerment, in contrast, it is authority purposefully shared with others. Nursing empowerment means the ability to effectively motivate and mobilize self and others to accomplish positive outcomes in nursing practice and work environment. Quality improvement is an organised process that assesses and evaluates health services to improve practice or quality of care. The nurse’s empowerment and patient quality care are both the sides of same coin. The empowered team influences staff morale, productivity, staff retention and associated costs, patient care quality, and patient safety. Enhancing leadership skills, being a positive change agent, education upgradation and being an Evidence Based Practice

(EBP) cheerleader abilities are required for nurses to become an empowered professional to render quality care.

The factors contributing to nurse empowerment are: Decision-making, Autonomy, Manageable workload,

Fairness, Reward and Recognition. Nursing empowerment becomes an inevitable component to achieve quality improvement in any health care settin

Nursing empowerment:

Nursing empowerment means the ability to effectively motivate and mobilize self and others to accomplish positive outcomes in nursing practice and work environment.

Nursing empowerment is instilling a sense of power by granting decision-making authority, and/or creating opportunities to influence decisions, and providing ability to make choices by nurses.

Quality improvement:

Quality improvement can be defined as “an organised process that assesses and evaluates health services to improve practice or quality of care”

When the nurse committed to enhancing her/his knowledge base and incorporating evidence-based practice (EBP) research findings, they become a positive change agent and can serve as a role model for their peers, supervisors, and the community.8

Creating an empowered team is a vital nurse leadership function that can significantly influence staff morale, productivity, staff retention and associated costs, patient care quality, and patient safety.8

And also expecting and receiving the quality health care is the basic human right of the consumers. Nursing empowerment facilitates nurses in delivering quality care to the clients.

Common tasks to improve the ability to be empowered;

1. Enhancing leadership skills

2. Be a positive change agent

3. Get certified

4. Be an EBP cheerleader

1. Enhancing leadership skills:

Nurses should be encouraged to participate in leadership and management internship programs. Inquire if your employer has formal or informal opportunities for nurses to shadow organizational nursing leaders. Many healthcare organizations encourage nurses to participate in organizational committees that make decisions and develop policies that impact nursing job responsibilities and practice.

These programs allow nurses to enhance your global view of leadership styles, develop a rapport with organizational leaders, and attain insight into how your organization operates. Nurses also should consider enrolling in leadership continuing-education classes at a local community college, university, or online.

2. Be a positive change agent:

Evaluate the environment to find areas for improvement that will increase the efficiency of working area, heighten job role satisfaction, or improve patient outcomes. Consider forming a workgroup or committee.

Workgroups allow nurses to collaborate to accomplish specific tasks, such as initiating a new protocol for a procedure that will improve patient safety and systems efficiency, resolve knowledge deficits, or increase nurses’ workplace satisfaction.

3. Get certified:

Speciality certification reflects level of expertise in a specialized area.Forming a study group with co-workers for specialty certification exams. Research has shown that when hospitals are staffed with baccalaureate- prepared nurses who hold specialty certifications, 30-day patient mortality is dramatically lower. Nurses who attain specialty certification are more invested in the success of their organization, collaborate more effectively with their healthcare team, and are more empowered in their work area.

4. Be an ebp cheerleader:

Evaluate new EBP data to find more efficient ways to perform tasks and procedures or provide patient care.

When nurses implement EBP and research councils into their practice, patient care outcomes are improved, as well as patient satisfaction with the level of care received. Nurses must enhance their knowledge base by completing continuing-education courses offered by employers, community colleges, or universities or by attending workshops held by employers or nursing conventions at the local, state, or national level. Many state and national nursing associations offer virtual learning continuingeducation opportunities that allow you to acquire new EBP data from home.

Factors contributing to nurse empowerment

· Decision-making: Control of nursing practice within an organization.

· Autonomy: Ability to act on the basis of one’s knowledge and experience

· Manageable workload: Reasonable work assignments

· Reward and recognition: Appreciation received for a job well done

· Fairness: Consistent, equitable treatment of all staff

· Key strategies help foster quality improvement

· Supportive hospital leadership actively engaged in the work;

· Setting expectations for all staff not just nurses –that quality is a shared responsibility;

· Holding staff accountable for individual roles;

· Inspiring and using physicians and nurses to champion efforts and

· Providing ongoing, visible and useful feedback to engage staff effectively.

· Challenges specific to nurses’ involvement in quality improvement:

· Hospital respondents reported several challenges related specifically to nurses’ involvement in quality improvement, including:

· Having adequate nursing staff when resources are scarce;

· Engaging nurses at all levels from bedside to management

· Facing growing demands to participate in more, often duplicative, quality improvement activities

· Dealing with the high level of administrative burden associated with these activities; and

· Confronting traditional nursing education that does not always adequately prepare nurses for their evolving role in today’s contemporary hospital setting

 

3. How has your institution empowered the nursing staff through the use of quality improvement data?

Ans:-

Discussions of hospital quality, efficiency, and nursing care often taken place independent of one another. Activities to assure the adequacy and performance of hospital nursing, improve quality, and achieve effective control of hospital costs need to be harmonized. Nurses are critical to the delivery of high-quality, efficient care. Lessons from Magnet program hospitals and hospitals implementing front-line staff–driven performance improvement programs such as Transforming Care at the Bedside illustrate how nurses and staff, supported by leadership, can be actively involved in improving both the quality and the efficiency of hospital care.

The impact of nurses on hospital safety, quality, and costs

Safety and quality.

Nursing services are central to the provision of hospital care, “little empirical evidence is available to support the anecdotal and other informal information that hospital quality of care is being adversely affected by hospital restructuring and changes in [nurse] staffing patterns.”

Since that report, and in part in response to it, the number of studies examining the association of staffing and quality in hospitals has exploded. Major studies demonstrating the association of nurse staffing and patient outcomes, including lengths-of-stay, mortality, pressure ulcers, deep vein thromboses, and hospital-acquired pneumonia have been published in first-tier journals, and several major literature reviews, syntheses, and meta-analyses have been published confirming the association of nurse staffing with patient outcomes.

COSTS.

Much work has examined the association of nursing and quality; less has examined nursing’s impact on costs. A number of studies have assessed whether there is a business case for increasing nurse staffing in hospitals that is, whether simply increasing staffing would pay for itself in reduced complications and lengths-of-stay. One key finding of this work is that improving nurse staffing does not completely pay for itself, although recent efforts to reduce hospital payment for poor quality may change this conclusion.

These analyses also find that the biggest cost savings of increased staffing result from reduced lengths-of-stay. Shorter stays reflect not just reductions in complications that extend stays, but the ability of nurses to do their work and coordinate the work of others in a timely and effective manner. They reflect nurses’ ability to affect efficiency as well as quality.

A key limitation of these cross-sectional studies is that they do not consider how changes in nursing organization, systems, or work environment might improve outcomes or efficiency without increases in staffing. Other research studying nurses’ work environments suggests that such improvements are possible.

Hospital nursing: key issues

Tapping nurses’ knowledge of the system.

Increasing the visibility and participation of nursing leadership within hospitals: magnet accreditation.

Engaging front-line staff in improving hospital performance

Participants’ contributions.

Evaluation of tcab.

Impact.

Discussion and policy implications

 

4. Provide an example of how you have personally empowered either a patient or a fellow nurse.

Ans:-

Being empowered means that you have the ability to effectively motivate and mobilize yourself and others to accomplish positive outcomes in your practice and work environment. When you’re committed to enhancing your knowledge base and incorporating evidence-based practice (EBP) research findings, you become a positive change agent and can serve as a role model for your peers, supervisors, and the community. The final outcomes of nursing empowerment are increased workplace satisfaction, enhanced nursing autonomy, and improved patient outcomes.

Here are some common tasks that can improve your ability to be empowered.

• Enhance your leadership skills. Nurses should be encouraged to participate in leadership and management internship programs. Inquire if your employer has formal or informal opportunities for nurses to shadow organizational nursing leaders. Many healthcare organizations encourage nurses to participate in organizational committees that make decisions and develop policies that impact nursing job responsibilities and practice. These programs allow you to enhance your global view of leadership styles, develop a rapport with organizational leaders, and attain insight into how your organization operates. You should also consider enrolling in leadership continuing-education classes at a local community college, university, or online.
• Be a positive change agent. Evaluate your environment to find areas for improvement that will increase the efficiency of your work area, heighten job role satisfaction, or improve patient outcomes. Consider forming a workgroup or committee. Workgroups allow nurses to collaborate to accomplish specific tasks, such as initiating a new protocol for a procedure that will improve patient safety and systems efficiency, resolve knowledge deficits, or increase nurses’ workplace satisfaction.
• Get certified. You can gain personal and professional satisfaction by obtaining specialty certification that reflects your level of expertise in a specialized area. You may want to form a study group with your coworkers for specialty certification exams. Research has shown that when hospitals are staffed with baccalaureate-prepared nurses who hold specialty certifications, 30-day patient mortality is dramatically lower. Nurses who attain specialty certification are more invested in the success of their organization, collaborate more effectively with their healthcare team, and are more empowered in their work area.
• Be an EBP cheerleader. Evaluate new EBP data to find more efficient ways to perform tasks and procedures or provide patient care. When nurses implement EBP and research councils into their practice, patient care outcomes are improved, as well as patient satisfaction with the level of care received. You can enhance your knowledge base by completing continuing-education courses offered by employers, community colleges, or universities or by attending workshops held by employers or nursing conventions at the local, state, or national level. Many state and national nursing associations offer virtual learning continuing-education opportunities that allow you to acquire new EBP data from home.

Healthcare is a complex, ever-changing industry that requires strong, collaborative leadership across the continuum, specifically nursing. It is estimated that there are 3.6 million nurses in the U.S., making the nursing profession the largest segment of our nation’s healthcare workforce.

While the struggle for quality talent continues to rise, managers must search for new ways to motivate and inspire great nurses to become effective, positive leaders in their community.

Here are three things you should consider.

1. Provide Leadership Development

Experts say that leadership skills can be learned through effective training programs. However, Maureen A. O’Reilly suggests leadership development must include an understanding of how humans relate and interact with each other. More often than not, advancements to leadership positions in medicine have been centered on the candidate’s academic and clinical accomplishments, rather than their ability to foster team building, establish effective communication and apply emotional intelligence (EI).

Training programs should include essential and universal leadership skills (conflict management and negotiation) as well as strategies to develop personal traits (empathy, listening and innovation), states Roberta Sonnino, Executive and Career Coach at RES Coaching LLC and author of “Health Care Leadership Development and Training: Progress and Pitfalls.”

Significant individual benefits follow training programs. It may include personal growth, career satisfaction and advancement, and most importantly, networking, Sonnino states. “[Participants] who spend significant periods of time learning together often develop special camaraderie, which encourages ongoing collaboration and synergy among colleagues and institutions.”

2. Involve Nurses in Shared Decision-Making

Giving nurses a voice in key hospital decision-making can offer a great sense of inclusion and appreciation. Nurses often feel like hospitals and healthcare facilities don’t give enough recognition, support or appreciation—resulting in high turnover, decreased productivity and poor patient outcomes.

As a result, Dr. Tim Porter-O’Grady, a Clinical Professor and Leadership Scholar at The Ohio State University, developed a shared governance model that turns traditional hierarchal structures into flat, decentralized systems where decision-making power lies in the hands of those who are most closely affected by those decisions (e.g., nurses at the bedside), rather than with senior leadership. “This means looking past simple notions of empowerment and seriously looking at empowerment as a frame of reference for engaging the staff more fully in those decisions that affect what they do, how they do them, and the outcomes of their work,” Porter-O’Grady states.

To support the strengthening of relationships through shared governance, Porter-O’Grady suggests these four principles:

1. Accountability: The mutual commitment to positive patient-care outcomes.
2. Equity: The valuing of every role in the organization.
3. Partnership: Nurses’ relationships with one another, the patient, or other disciplines.
4. Ownership: Membership in the nursing profession, clinical practice, and the work that nurses do as individuals.

3. Offer Continuous Feedback

Continuous improvement is a valuable system to keep employees motivated and engaged. When employees can give and receive critical feedback with their management, it lets them feel more appreciated, less stressed out, and helps build confidence as well. It is important for managers to connect with their teams on a regular basis to ensure each employee is equipped with the necessary tools to remain productive and engaged.

 

Examples:

My facility has put an emphasis on quality improvement over the past few months. How can I identify the roles of nurses at every level in the quality improvement initiative?

A: The role of professional nurses in quality improvement (QI) is twofold: to carry out interdisciplinary processes to meet organizational QI goals and to measure, improve, and control nursing-sensitive indicators (NSI) affecting patient outcomes specific to nursing practices. All levels of nurses, from the direct care bedside nurse to the chief nursing officer, play a part in promoting QI within the healthcare provider organization.

Here is an explanation of the involvement each level of nurse should have in promoting QI:

The CNO: CNOs set the tone for the nursing department’s participation in QI. As a member of administrative leadership, the CNO must integrate nursing practices into the organizational goals for excellence in patient outcomes through communication of strategic goals to all levels of staff.

The nurse manager (NM) or nursing director: The NM or nursing director is responsible for communicating and operationalizing the organization’s QI goals and processes to the bedside nurse, identifying specific NSIs that need improvement according to his or her particular patient population, and coordinating QI processes to improve these at the unit level.

The direct care nurse: The direct care bedside nurse is the key to quality patient outcomes, carrying out the protocols and standards of care shown by evidence to improve patient care.