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Don't Miss Out on Nurse-Led Quality Initiatives

 |  By Alexandra Wilson Pecci  
   February 05, 2013

There are lots of reasons that it makes sense for hospitals to align themselves with nursing schools. For one thing, it's a way for schools to funnel new grads right into their careers and for hospitals to save on nurse recruitment efforts.

For another, hospitals get a chance to instill current, real-world learning and values into the next generation of nurses.

But a study shows that there's yet another reason for hospitals to work with nurses before they're even out of school: To educate them about and get them ready to participate in hospital quality improvement (QI) efforts.

The study, which was published in the Journal of Nursing Care Quality and is part of the RN Work Project, finds that nurses who are early in their careers need to step up their game when it comes to getting involved in hospital QI efforts. Despite the value of nurse-led quality improvement efforts, too few are involved. And the number of participants is not growing.

That's a major missed opportunity for hospitals, considering the positive affect nurse-led QI efforts can have on organizations.

For example, the Agency for Healthcare Research and Quality points to nurse-led programs at Seton Northwest Hospital in Texas, "which has allowed nurses to be more efficient and spend more time with patients, reduced falls and nurse turnover, accelerated patient discharge, and yielded positive feedback from staff and patients."

Researchers in the QI-program participation study compared participation levels in hospital QI activities for RNs who were first licensed between 2004 and 2005, and RNs who were first licensed between 2007 and 2008.

The research team found little difference in participation levels between the two groups for a number of activities. They include performance measurement, working to improve processes or systems of care, monitoring sustainability of improved practices, and efforts at performance improvement. The only exception was "use of appropriate strategies to improve hand washing compliance to reduce nosocomial infection rates."

According to researchers, the findings not only suggest that nurses are being underutilized, they also show a real need for hospitals to work with nursing schools now to shore up their QI efforts down the road.

"These findings underscore the need for hospitals to collaborate with nursing schools to develop effective strategies to ensure that RNs expect and are prepared to engage in QI activities," researcher Maja Djukic, PhD, RN, assistant professor at the College of Nursing, New York University, said in a statement.

"Nurses are an important resource in efforts to improve care and patient outcomes, and right now, that resource is too often being underutilized."

Some hospitals are already working toward getting new grads involved in QI activities. Researchers pointed to the Integrated Nurse Leadership Program in California, and the Bi-State Nursing Workforce Innovation Center's Clinical Scene Investigator Academy in Kansas and Missouri as examples of successful initiatives.

The researchers also said that since 2008, there's been an increase in the number of hospitals who participate in formal programs aimed at increasing nurses' engagement in quality and safety initiatives, such as Transforming Care at the Bedside and National Database of Nursing Quality Indicators Program. Because of this, researchers expect to eventually see increased participation in QI efforts from nurses in later cohorts.

In addition, the researchers made a number of other recommendations for hospital leaders. They include:

  • Subscribing to programs that allow RNs to complete self-directed online modules to learn about QI
  • Having more experienced colleagues guide early-career RNs in translating newly-acquired QI knowledge into action
  • Ensuring that staffing levels are high enough and that RNs have sufficient release time to participate in QI activities
  • Ensuring RNs have access to an information technology infrastructure that provides meaningful, timely, and actionable QI data

In the meantime, if hospital leaders want current and future nurses involved in QI efforts, they'd do well to purse partnerships with nursing schools.

Alexandra Wilson Pecci is an editor for HealthLeaders.

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