Evaluating the quality of nursing care started with Florence Nightingale. In 1998, the American Nurses Association established the first nursing quality measurement program called The National Database of Nursing Quality Indicators (NDNQI). This program was developed to continue improving the quality of nursing care. During the last few years, NDNQI has submitted to the National Quality Forum (NGF) a list of nursing indicators which reflect staffing, nursing process and patient outcomes. The NDNQI collects and monitors data from participating hospitals and provides that data in order to help improve the relationship of patient care to outcomes. One of the latest researches by the NDNQI deals with how staffing and job satisfaction impacts patient outcomes. Do you believe that patient outcomes are effected by nursing care? If so, why? What are some of the staffing issues you believe to have an impact on patient outcomes?
I definitely believe that nurses are in the best position to affect patient outcomes either positively or negatively. Providing care based on the latest evidence leads to better patient outcomes. Inadequate staffing means the nurse has less time to spend in assessment of their patients and more time spent on completing tasks. This leads to a failure to rescue which was recognized by the Institute for Healthcare Improvement as a national crisis and led to the initiative to challenge hospitals to develop rapid response teams. These teams have made a terrific difference in our three hospitals and nationwide.
ReplyDeleteI agree with Karla. Evidence is the best way to help improve patient outcomes. The ANA has launced a national campaign to help determine what the safe staffing ratio should be. The goal is to have a set nurse/patient ratio that takes consideration to the different units and imput from nurses. What staffing ratios have you experienced? What can you do to help? Visit the website listed and find out. http://www.safestaffingsaveslives.org/
ReplyDeleteKarla, tell me more about your rapid response team. Has your facility conducted studies related to the program? I would love to hear what evidence you might have collected.
ReplyDeleteI truly believe that nursing care provides a BIG impact on patient outcome. Knowledgeable, compassionate, and skilled nurses who care about their patients and accept responsibility for a good outcome with their patients will always overcome the odds against a good outcome. Nursing responsiblities have changed over the years. The days of a nurse only giving pills and back rubs are over. Nurses must now accept their responsibility for the outcome of the patient's visit to their facility and in many cases be as knowledgeable as the physician. Staffing is a critical point in the end result. A nurse that has too much responsibility and tasks to perform and oversee in an 8 or 12 hour period cannot provide both the emotional and physical support and monitoring that the patient requires and deserves. An overloaded nurse is sometimes a frazzled and unattentive nurse. He/she will never perform at their best in that situation.
ReplyDeleteNursing is a very challenging profession. The abiltiy to multi-task is essential in today's world. Unfortunately, patients do not get the holistic care that is needed. Due to the nursing shortage, nurses are taking on a much heavier work. The nursing shortage has not yet had an impact on the facility where I work. The type and number of lincensed staff should play a very important role when deciding staffing. A mixture of RNs and LPNs and the fact that LPNs have limited responsibilties is the result of our facility using team nursing. Team nursing can provide better assessments, communication, and quicker recognition of a patient's condition. Positive feedback from the nurses was received and patient satisfaction scores increased from 4.2 to 4.5 on a scale of 1 to 5. I would like to know the mix of licensed staff working in your area and what type of nursing care is being provided. If you are working in an area where you provide total care to the patient, do you feel the workload is aappropriate for the scheduled shift?
ReplyDeleteI completely agree that nurses have the biggest impact on patient care. Regarding your question on the mix of staff, in the area where I most recently worked, in the ICU, there were only RNs and UAPs. The RNs usually have one to two patients, and the UAPs were only used if the RN needed help. Otherwise, the RN performed total care for the patients, and I loved it. The RN knew everything about the patient including how their skin actually looked (rather than a report from the UAP), how they ate, etc... and I found it to be successful because each nurse took personal stock in patient outcomes. Now, I know this is sometimes not feasible on other units due to different patient needs, amount of resources available, etc., but I really liked the way it worked there.
ReplyDeleteI also agree with my colleagues regarding the impact that nurses have on the outcome of patient care. I work in an area that is very demanding and controlled with the hands and contribution of a minimum of three health professionals caring for a patient at any one time. In the operating room, teamwork is the design for successful outcomes for every patient. You have the surgeon (s), anesthesiologist (MDA), certified registered nurse of anesthesia (CRNA), circulating RN, assistant, and scrub nurse involved in the care of every surgical patient. Many times, it is like a well-orchestrated dance that occurs during the process of perioperative patient care. If one person is not performing at their optimum, the entire process is negatively affected and has the potential to create a poor surgical outcome for the patient. We employee staff that fills the RN, LPN, certified surgical assistant (CST) roles, and PCA roles.
ReplyDeleteEach role has a well defined job description but there have been times that my PCA has had to circulate my case for a brief moment so that I could perform another task due to staff call ins and shortages. This is unnerving for the licensed nurse but when demands are being made at every angle we must perform and make the best of our staff resources.
The demand on licensed nurses is increasing due to the economic crisis. According to the American Hospital Association (AHA) News, 53% of hospitals are considering cutting staff or have already cut staff. I attended The Rural Constituency meeting at the Alabama Hospital Association in Montgomery, Alabama on Jan. 16, 2009. I was able to talk with some of the representatives of different hospitals and what changes they were experiencing. Most of them had placed a freeze on hiring and had decided not to give pay increases this year. Increase demands on nurses cause a decrease in job satisfaction which in turn affects patient outcomes.
ReplyDeleteThe challenge for practicing nurses is to work within the Code of Ethics and Standards of Practice within a healthcare environment which can, at times, be very unsafe. For example, many nurses are being pulled to areas that they have never worked in with little or no orientation under the guise that "a nurse is a nurse" and should be able to work in various speciality areas on a whim. I am particularly concerned with this increase in this practice as the shortage of nurses increases.
ReplyDeleteUltimately, the nurse is responsible to decline an assignment which is unsafe based on her or his personal knowledge of their competency in a given area. When will nurses truly find their voice and challenge the establishment? Just a different angle to the current discussion.
According to the latest research in 2007 by the NDNQI, RNs who float have a lower job satisfication and less intent to stay in their current position. Floating nurses to areas outside of their competency increases the chance of a negative patient outcome. Working in a rural facility has advantages in that most of the nurses can cross train in other areas. The nurses do not float until they are competent in that area. Most of the nurses like the change. I know this is not as easily done in larger facilties.
ReplyDeleteI am curious to know if anyone works in a facility that floats nurses often?
The facility I work in maintains a Float pool and at times asks assigned nurses to float to other locations. When a float nurse is assigned to our unit, the normal practice is heavier demand placed on the unit nurses as they accept the higher acquity patients. This is done for patient safety and patient outcome; however, some unit nurses believe that the float nurses should be trained to the level that an inequity in the division of work does not exist, especially since the float nurses' hourly rate exceeds the unit nurses'. The rate difference along with the unequal workload distribution at times leads to employee dissatisfaction.
ReplyDeleteAccording to a study involving eight ICUs that were participating in the Centers for Disease Control and Prevention's National Nosocomial Infections Surveillance System discovered that the risk associated with central line infections increased with patient care being done by a "float" RN (Page, 2004). I worked as a "travel" nurse for about 3 months in a ER in Huntsville, Al. I found out quickly that "travel" nursing was something that was not for me. The pay that is associated with travel nursing is great, but it results from nursing shortages. I felt the chances for me to make an error increased because of lack of orientation that was allowed. How would you feel if you or your family member was in the hospital and you found out the nurse providng the care was either floating from another unit or was a travel nurse there for a 6 week assignment? Would you question the care being provided? Just something to think about.
ReplyDeleteWhat a wonderful discussion!! We are truly facing rough times and I firmly believe graduates of this EARN program can start making a difference. I believe that lack of orientation to an area has the potential to have a major negative impact on patient care and nurse morale. On one hand, perhaps the nurse would be a little more vigilant because they are unsure of the area; however, I fear that there may be an element of no "buy in". After all, you are just passing through and unless it is a conscientious nurse committed to excellence, it would be too easy to truly give less than 110% if that is not "your" unit.
ReplyDeleteLisa you pose an excellent question about family questioning a float nurse. I would venture to say that most families have no idea what a float nurse means yet there is evidence to support that errors occur as a result of using nurses in this capacity. This is one of the benefits of the NDNQI, I believe that once the data is collected perhaps better decisions can result as to use of float nurses.
ReplyDeleteI accepted a travel assignment several years ago and worked on a telemetry unit for 6 months as a travel nurse. When I took the assignment I agreed to work as much as I was needed as long as I was not pulled to another unit. Night shift on this unit consisted of ONLY travel nurses. The others were often utilized as a float nurse and would work 2 to 3 different units on a 12-hour shift. I often questioned the administration in that hospital for allowing me to be the senior nurse on a unit where I was a traveler. Was the administration thinking that I, as a travel nurse, could function as well as their full-time nurses trained on that unit?
ReplyDeletebetheridge57, how interesting. Did you believe you were competent working on this unit? If you were the most qualified, I am not sure the fact that you were a travel nurse would enter into the decision. I do see a point being made about knowing the institutions polices and procedures, where supplies were, etc.. but as far as delivering nursing care, if you were competent and adm. had evaluated this...I do not see a problem
ReplyDeleteThis truly is a great blog Lisa. I know that you wish people would participate more. Perhaps you can keep the blog even after this project is over. I have enjoyed the information about the quality initiatives. I would love to keep informed in the future. I plan to use blogs for the next class of EARNS
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