A recent article in the New York Times by the Pamela Cipriano, the President of the American Nurses Association (ANA), addresses the chronic issue of hospital under-staffing and poor nurse to patient ratios. The national concern is that poor staffing conditions lead to reduced resources and potentiates medical errors and erodes the patient care delivery system. This October 2015 marks an important date in the history of Nursing in the US. Five years ago, the Institute of Medicine (IOM) released the much awaited report on the Future of Nursing: Leading Health, Advancing Change. This report was supposed to represent a road-map for the future of nursing, build human capital and professional development, and lead healthcare transformation at the local, regional and national levels. Unfortunately, almost 5 years later, as a CNO and frontline nursing expert, not much has changed. As Pam pointed out in her post, nurses who are “overloaded are more prone to burnout, exhaustion and stress, and have less time to educate, comfort and coordinate care. That is a toxic formula for patients’ health and safety.”
Nurses are the fabric of healthcare delivery on the frontline and in the community. Dedicated nurses around the world are present 365 days per year, 24 by 7 to care for patients in their time of need. Day after day, committed nurses, with many years of experience, education and training, come to the hospital to do a good job and are challenged by a poorly designed workflow. Something is fundamentally wrong in the system; more patient deaths, poorer patient outcomes, and disengaged providers. A recent article by David Knowleton, Chairman of the Board of St. Francis Medical Center in Trenton, asked a difficult but worthy question, where are nursing leaders on Hospital Boards? A great question always deserves a great answer. The distressing answer is, nurses are simply disengaged. Let us start with some data. Nursing engagement is lower than any other healthcare professional; 32.6% engagement for nurses; 37.4% for Physicians and Advanced Practice Nurses; and 42.9% non-clinical frontline staff, such as Social Workers (Advisory Board Company 2014). Researchers, Needleman and Hassmiller, have shown that limited frontline engagement is concerning in nursing, and that the discipline is 10 points lower than other healthcare professionals. Provider engagement is a vital behavior for nurses to embrace in order to improve patient safety and patient care outcomes. What does this mean? Low staff engagement levels are associated with reduced worker productivity and has a negative impact on the safety culture of the organization according to Lowe. Thus, staff engagement is a concern to the healthcare industry given its impact on worker productivity and hospital patient safety efforts. Lest we forget, 440, 000 preventable deaths occur per year.
What is the best plan forward? My suggestion is quite simple. FIRST, nursing leaders and CNOs need to be engaged and must lead by example. Make “rounding on the unit” a priority with a working knowledge of day-to-day staff activities to build trust. Spend a day with a frontline nurse, it’s priceless. Attend quality-safety rounds weekly, go to daily huddles, and sponsor a monthly CNO breakfast club to discuss specific safety issues on the units.
In order to support the vision of the 2010 IOM Report, nursing engagement needs to start at the top and bottom of the organization. As CNO’s, it’s our job to make nursing engagement a priority and provide staff nurses with the clinical resources to efficiently and effectively do their job. Additionally, it’s critical to track daily engagement data at the unit and organization level. Mobile solutions, like CloseCareGap®, can track and trend staff engagement by leveraging smart phones, tablets, and workstations. CloseCareGap® uses gamification reward strategies, and harnesses point of care (POC) technology to measure variances in patient care. This kind of technology is an important capability that can be embraced by leaders to improve frontline care delivery with real-time information. Let’s engage and empower our nurses of today, and help build our Board Room and future Nursing Leaders of tomorrow. Help us get to ZERO PATIENT HARM together by 2020.