Demands on Nurses Grow as Hospital Quality Improvement Activities Increase

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    found at: center for studying health system change



    demands on nurses grow as hospital quality improvement activities increase

    march 20, 2008


    washington, dc—hospitals face growing tensions and trade-offs when allocating nurses between the competing priorities of direct patient care and quality improvement efforts, according to a study released today by the center for studying health system change (hsc).
    commissioned by the robert wood johnson foundation (rwjf), the study included interviews with hospital leaders in detroit, memphis, minneapolis-st. paul and seattle to examine the role of nurses in hospital quality improvement activities.

    "nursing has the biggest impact on a patient's experience in the hospital, so involving nurses in quality improvement is critical," said john lumpkin, m.d., m.p.h., senior vice president and director of the health care group at rwjf. "we commissioned this study to gain a better understanding of the role that nurses play in quality improvement and the challenges nurses face when balancing the competing priorities of direct patient care and quality improvement efforts."...

    other key study findings include:
    • hospitals face ever-growing demands to participate in more quality improvement activities, many of which are viewed as duplicative. the lack of standardization in quality measurement and reporting intensifies the challenge, according to hospital respondents.
    • respondents reported that nurses are well positioned to serve on the front lines of quality improvement since they directly affect the care patients receive during a hospital stay. as one hospital chief nursing officer noted, "nurses are the safety net. they are the folks that are right there, real time, catching medication errors, catching patient falls, recognizing when a patient needs something, avoiding failure to rescue."
    • the scarcity of nurses is a major challenge for hospitals. hospital respondents in two communities-memphis and seattle-reported being significantly affected by a nursing shortage, which some believed would only worsen, particularly as more nurses age out of the workforce and demand continues to exceed supply.
    • another dilemma hospitals face is that they want their best nurses at the bedside caring for patients and these same nurses leading their quality improvement activities. this poses an even greater quandary when nurses are in scarce supply. some respondents said that trying to balance nurses' work at the bedside with their involvement in quality improvement activities has sometimes resulted in nurses receiving mixed messages about the importance of their role in quality improvement.
    • respondents discussed that to optimize the role of nurses in quality improvement, it is important for nursing education programs to strengthen curricula to emphasize the concepts and skills needed to participate in quality improvement activities. respondents also emphasized the need for effective continuing education programs to help nurses be more adept at translating their observations of problems at the beside into an effective improvement effort.
    research report no. 3

    news release
    crazensweet, BBFRN, OC_An Khe, and 2 others like this.
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  3. 9 Comments so far...

  4. 18
    Quality is improved when nurses have more time for direct patient care.
    NOT QI documentation.
  5. 1
    Quote from herring_RN
    Quality is improved when nurses have more time for direct patient care.
    NOT QI documentation.
    you are correct as usual
    herring_RN likes this.
  6. 4
    So why don't they just take away all the B.S. they make us do and let us take care of the patients they way we should be taking care of the patients?
    2bNurseNickStat, imanedrn, CaLLaCoDe, and 1 other like this.
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    Got to disagree with above replies. It is important for bedside nurses to be involved in QI. If bedside nurses don't get involved then the nurses who are involved will all be the nurse managers. We all can figure out how that will turn out. Where I work bedside nurses have been involved in QI for well over a decade. It has been slow going but there have been considerable improvement in patient care, safety and nurse patient ratios. It is not perfect by any means but it is very much improved since before the QI initiatives began. Bedside nurses have played an important role in identifying what needs to be changed and enacting those changes. And we haven't been removed from the bedside for any substanial amount of time. When we are at the ocassional meeting we are replaced. All it takes is an administration that is serious about QI (not just doing it to satisfy JACHO or HHS) and respects the professional input of the staff nurse.
    imanedrn, sjt9721, Vito Andolini, and 1 other like this.
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    I agree that when working day-to-day at the bedside, it is difficult to see the value of quality improvement initiatives that are happening "over there in the board room". I think that the biggest mistake many health care systems make is not to involve front-line staff in these activities. This includes CNAs, RNs, pharmacists, medical residents, and all other staff who have daily interaction with the patients. This is the essence of what Magnet movement should be about- to get bedside nurses more involved how the hospital is run.

    As infection control nurse, I am now responsible for maintaining databases of infection control data, generating reports, attending numerous QI meetings throughout the month, and attempting to direct new QI initiatives when the data shows that they are warranted. All of this paperwork is a tremendous administrative burden for my department. However, the Joint Commission and other regulatory groups demands this level of documentation when they do site visits. If we do not document our activities, there is no way to assure the regulators and patients that we are complying with their expectations. In addition, without constant surveillance, it is possible that problems will pop up and remain undetected, leading to a very negative consequence. It is important to be proactive to prevent these things from happening rather than reacting after something terrible has occurred and it's too late to do anything about it.
  9. 4
    Quote from ocankhe
    Got to disagree with above replies. It is important for bedside nurses to be involved in QI. If bedside nurses don't get involved then the nurses who are involved will all be the nurse managers. We all can figure out how that will turn out. Where I work bedside nurses have been involved in QI for well over a decade. It has been slow going but there have been considerable improvement in patient care, safety and nurse patient ratios. It is not perfect by any means but it is very much improved since before the QI initiatives began. Bedside nurses have played an important role in identifying what needs to be changed and enacting those changes. And we haven't been removed from the bedside for any substanial amount of time. When we are at the ocassional meeting we are replaced. All it takes is an administration that is serious about QI (not just doing it to satisfy JACHO or HHS) and respects the professional input of the staff nurse.
    A big part of the problem is the fact that nurse managers don't know what to do to improve quality.They need to do this. It is their job.They can gain the ability to understand the problems by 1) working a shift on the floor occasionally or 2) listening to their staff nurses. The QI of the nurse managers needs to improve significantly to lift this additional burden from the staff nurse. I am perfectly capable of informing my manager and the CCO of problems on a weekly basis, with the information presented in a cohesive and understandable format, and with suggestions for improvements.They could take this information and run with it.They just don't seem able to do that. It is like I work for a manager and CCO who cannot hear the employees.
    Vito Andolini, herring_RN, psalm, and 1 other like this.
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    The most important part of QI for the direct patient care nurse is to have input into the changes that are needed to be made in order to improve quality based on the evidence. Just communicating the need to managers is often not enough. It still works best when administrators (non RN) treat the RNs in direct patient care as professionals and listen to their professional advice. Too often the direct care givers are viewed just as a cost to be controlled. By having direct contact with the direct care giving RN this view can be changed.
    herring_RN and NRSKarenRN like this.
  11. 5
    Quote from ocankhe
    The most important part of QI for the direct patient care nurse is to have input into the changes that are needed to be made in order to improve quality based on the evidence. Just communicating the need to managers is often not enough. It still works best when administrators (non RN) treat the RNs in direct patient care as professionals and listen to their professional advice. Too often the direct care givers are viewed just as a cost to be controlled. By having direct contact with the direct care giving RN this view can be changed.
    That's it in a nutshell. We aren't listened to when we bring concerns forward, and all the QI activity in my hospital is top-down. We're told what we need to fix and how to do it with no input at all. And every new QI initiative brings its own checklist, flowsheet or other task that has to be fitted in to the time between getting report and rounds, along with assessments, blood gases, meds and a myriad of other direct care activities. I'm tired of hearing, "Tsk, tsk, you haven't filled out your pink goal sheet," when I've spent the last hour starting epi and giving fluid bolus after blood transfusion after fluid bolus. Never mind picking up all the syringes that fell out of the drawer when the front pulled off in my hand when I opened it to get one to draw up my epi... but that's a whine for another time.
    RN Power Ohio, lindarn, Altra, and 2 others like this.
  12. 5
    Quote from janfrn
    That's it in a nutshell. We aren't listened to when we bring concerns forward, and all the QI activity in my hospital is top-down. We're told what we need to fix and how to do it with no input at all. And every new QI initiative brings its own checklist, flowsheet or other task that has to be fitted in to the time between getting report and rounds, along with assessments, blood gases, meds and a myriad of other direct care activities. I'm tired of hearing, "Tsk, tsk, you haven't filled out your pink goal sheet," when I've spent the last hour starting epi and giving fluid bolus after blood transfusion after fluid bolus. Never mind picking up all the syringes that fell out of the drawer when the front pulled off in my hand when I opened it to get one to draw up my epi... but that's a whine for another time.
    I gotta agree with you there. I'm glad at my current job, the nurses' concerns are actually listened to. At my last job, it was one stupid check off list after another. No input taken seriously by management even though they asked what are thoughts were. They started doing these 3 page computerized safey assessments and I would here "you didn't do you safety assessments on such and such patient". Nevermind that I'm swamped with my four acutely-ill-should-have-been-sent-to-ICU-but-dumped-on-a-progressive-care-unit-because-the-nurses-can-handle-it -patients.
    RN Power Ohio, lindarn, Altra, and 2 others like this.


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