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Q&A: Nurse Leaders on Affecting Outcomes Through Leadership

Alexandra Wilson Pecci, for HealthLeaders Media, February 26, 2013

Watland: I think [healthcare reform] is a great opportunity for nursing to step up and get involved in shaping what this is going to look like, both in acute care settings and also in a community-based environment.

I read somewhere that 32 million newly insured people are going to be in the system with healthcare reform, and if we don't think that's going to change healthcare, we've got to really take that seriously. How [are] we in nursing going help shape [that and] take care of those additional people that are going to be covered and coming forward for healthcare?

I think there's a big opportunity for to have an impact on outcomes. I think about all the new nursing roles that have evolved, with monitoring outcomes, and making sure we've gathered all the data, and doing all of the documentations pieces right.

But the nurse at the bedside, the nurse that's taking care of the patient absolutely needs to be educated beyond their clinical expertise. They need to be educated about this whole process and be familiar with how to retrieve data, how to analyze data, how to use evidence-based practice in nursing care to shape those outcomes and to really at the bedside, understand that.

Because we can't afford to keep just putting more and more layers of people into the healthcare system, monitoring, and tracking data and then having the caregivers be totally separate. I think really expanding the role of the caregiver, the nurse at the bedside, to be able to embrace all of this and be engaged in all of this can really help strengthen their practice and shape the outcome that we're going to get. I think we have a big opportunity to improve care and also optimize our resources.

Davis: One of the critical ways that nurse leadership can really take an important role in this is through what I would consider a redesign of the care at the point of delivery. Really understanding how to utilize our quality, lean, process improvement tools to be very focused on the processes that produce value for patients [and] eliminating unnecessary steps to create a better experience, not only for the patient but also for the care team, and to leverage those tools to build not only new models, but to enhance the teamwork on a particular unit.

I know we have done a lot of work in both our ambulatory settings and our hospitals settings where we have looked at the care model on particular units and really worked to create more effectiveness and efficiency and at the same time, generate better clinical staff focus and patient experience outcomes.

So I see the nurse leaders, the CNOs, taking a really important role. We've done quite a few projects that we are now spreading to really help us diffuse those improvements and sustain those improvements over time. As Judy was saying, it's difficult in these complex environments to sustain improvement. How do we continue to build on the good work and create more value for patients?

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