change gears often in the course of their day. This, in turn, can lead to shortcuts, rushed processes, and less-than-optimal care.
Balancing clinical care with the business that surrounds care is always difficult. Nurse leaders must always weigh staffing needs in order to minimize overtime while ensuring adequate resources for patient care demands.
HOW NURSE LEADERS INFLUENCE
“Over the next 10 years nurses and nursing leadership will be judged as to whether patients are safer and better outcomes are achieved. As leaders we must collaborate with those who serve the patient and balance imperatives that surround the delivery of health care.”
—Judith K. Walker, MS, RN, NEA-BC, PLNC;
Past President, AONE Council of Nurse Managers, Firestone, Colorado
CASE STUDY
Norma, RN, is the charge nurse on a 16-bed pediatric unit. The most frequent medical diagnosis among patients on the unit is respiratory syncytial virus (RSV). A total of 27 medical staff members have privileges to care for this population of patients.
The medical staff includes neonatology, pediatric cardiology, general pediatrics, family medicine, pediatric pulmonology, trauma surgeons, and family medicine residents.
On one particular day, Norma, observed great variation in the ordering practices of the physicians caring for this patient group. There were six patients in the unit, all diagnosed with RSV. Norma was a “curious” nurse and took it upon herself to monitor and evaluate a handful of indicators for these six patients. Her findings included several different medications, lengths of stay ranging from 2 to 8 days, and various respira- tory care protocols. At the same time, two different parents expressed to her that “my child is being treated differently than the one in the other room” and asked, “why is that so?”
Norma’s curiosity led her to ask her supervisor whether there was an opportunity to further study this situation and evaluate a more collaborative method of delivering care to this patient population. Subsequently, the pediatric supervisor and Norma, met with the chief of the pediatric service, Dr. Kopp. Dr. Kopp
acknowledged that variability existed in physician practices and suggested they all come to the table to evaluate opportunities to reduce variation. Also invited to participate were a pulmonary specialist, a case manager, and a respiratory therapist. Together this team developed a multidisciplinary practice guideline for the identified patient population.
Assessment Questions
1. How does practice variability affect staff caring for the patient, the organization’s financial viability, patient and family satis- faction, and clinical outcomes?
2. What role can nursing play in recognizing symptoms of practice variability?
3. What impact does variability have on patient safety measures?
4. What key competencies are necessary in order to evaluate variability, outcomes, and improvements in patient care?
5. Why is the role of leadership important in this situation?
• BBee aabbllee ttoo rreeccooggnniizzee vvaarriiaabbiilliittyy..
• CCoommmmuunniiccaattiioonn aanndd ddaattaa aarree kkeeyy iinn aaddddrreessssiinngg tthhiiss ssiittuuaattiioonn..
• MMeeddiiccaall ssttaaffff lleeaaddeerrsshhiipp aanndd nnuurrssiinngg lleeaaddeerrsshhiipp aarree kkeeyy iinn pprroovviiddiinngg aann eennvviirroonnmmeenntt ffoorr ccoollllaabboorraattiivvee pprraaccttiiccee tthhaatt iiss eevviiddeennccee bbaasseedd aanndd mmuullttiiddiisscciipplliinnaarryy..
• AAccaaddeemmiiaa mmuusstt rreeccooggnniizzee tthhee vvaalluuee ooff tteeaammss ffoorr tteeaacchhiinngg b
beeccaauussee iinn tthhee ““rreeaall wwoorrlldd,,”” tthhaatt iiss hhooww ccaarree iiss pprroovviiddeedd a
anndd pprraaccttiicceedd..
• EEnnssuurriinngg cclleeaarr ccoommmmuunniiccaattiioonn iiss vviittaall ttoo qquuaalliittyy aanndd ppaattiieenntt ssaaffeettyy..
• NNuurrssee lleeaaddeerrss ccaann hheellpp bbyy ccoonnssttaannttllyy mmoonniittoorriinngg ssttrruuccttuurreess a
anndd pprroocceesssseess iinn oorrddeerr ttoo mmiinniimmiizzee vvaarriiaattiioonnss iinn oouuttccoommeess..
• AAccaaddeemmiicc aass wweellll aass ccoonnttiinnuuiinngg eedduuccaattiioonn ccaann aassssiisstt iinn sskkiillll aanndd ccoommppeetteennccyy ddeevveellooppmmeenntt iinn tthhiiss aarreeaa..
Best Practice
REFERENCES
1. Joint Commission on Accreditation of Healthcare Organizations. (1992). Striving toward improvement: Six hospi- tals in search of quality. Washington, DC: JCAHO.
2. Straker, David, “What is Quantity.” Available at: http://sygue.
com/articles/ what-is-quality/what-is-quality-4.htm
3. New York Times, December 7, 2008. Available at: http:// nytimes.
com/2008/12/08/business/8hospital.htm? pagewanted=3&_1=1 4. ANA Nursing World. Available at: http://www.nursingworld.org 5. Jiang, H. J., Lockee C., Bass K., & Fraser, I. (2008). Board engagement in quality: Findings of a survey of hospital and sys- tem leaders. Journal of Healthcare Management, 53,121–135.
6. 2008 Nursing Leadership Congress, Driving Patient Safety Through Transformation; Transformational Leadership: achiev- ing the Tipping Point. Julie Morath, RN, MS, Chief Operating Officer and Vice President of Care Delivery, Children’s Hospitals and Clinics Minneapolis-St. Paul, Minnesota.
7. Ballard, K. A., Arbogasat, D., Boeckman, J., et al., & American Nurses Association. (2004). Nursing: scope and standards of practice.Silver Spring, MD: American Nurses Association.
8. “Agenda for Research and Development in Patient Safety,” National Patient Safety Foundation at the AMA. (1999, May 24). http://
www.ama-assn.org/med-sci/npsf/research/research.htm 9. Centers for Disease Control and Prevention (National Center
for Health Statistics). (1999). Deaths: Final data for 1997.
National Vital Statistics Reports, 47,19–27.
10. Institute of Medicine (1999). To err is human: Building a better healthcare system. Washington, DC: National Academy Press.
Summary available online at: http://www.nap.edu/books/
0309068371/html/
11. Thomas, E. J., Studdert, D. M., Newhouse, J., et al. (1999). Cost of medical injuries in Utah and Colorado. Inquiry, 36,255–264.
12. Agency for Healthcare Research and Quality. (November 2007). AHRQ strategic plan. Rockville, MD: AHRQ. Available at: http://www.ahrq.gov/about/stratpln.htm
13. Institute for Safe Medication Practices. Available at: http://
ismp.com
14. The Leap Frog Group. Available at: http://www.leapfrog.com