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| |  Demands on Nurses Grow as Hospital Quality Improvement Activities Increase
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
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Jul 12, 2008, 10:17 AM
Re: Demands on Nurses Grow as Hospital Quality Improvement Activities Increase
Quality is improved when nurses have more time for direct patient care.
NOT QI documentation.
| | No. 5 |
Jul 12, 2008, 07:51 PM
Re: Demands on Nurses Grow as Hospital Quality Improvement Activities Increase
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.
| | No. 8 |
Jul 13, 2008, 06:23 AM
Re: Demands on Nurses Grow as Hospital Quality Improvement Activities Increase Originally Posted by 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.
| | No. 9 |
Jul 13, 2008, 08:06 AM
Re: Demands on Nurses Grow as Hospital Quality Improvement Activities Increase Originally Posted by 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.
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