Rebecca Hendren, for HealthLeaders Media, November 15, 2011
The holiday decorations are going up in my neighborhood, Thanksgiving is next week, and my mind has already turned to end-of-year activities and planning for what's in store in 2012. With these things on my mind, I thought I'd turn to the annual retrospective/prediction column a little early this year.
2010 may have been the year when enormous healthcare changes began, but 2011 was the year these changes hit nursing. In addition, the Institute of Medicine's landmark Future of Nursing report was released at the end of 2010 and much of this year has been spent digesting its recommendations and searching for ways to put them into practice.
At last month's Nursing Management Congress I realized that the full ramifications of value-based purchasing have hit home in nursing and have trickled down to the unit level. It's no longer something that is only happening at the administration level and that only concerns nurse executives. Now every nurse leader and manager is actively planning for its impact.
Here's a quick rundown of the most pressing issues right now and into 2012:
1. Advanced degrees are no longer optional
I have been cheered that discussion of the IOM's recommendation for 80% of all RNs to have a baccalaureate degree by 2020 has not veered too intensely into the old ADN vs. BSN quagmire. Instead, the profession is focusing on ways to engage nurses in lifelong learning so that associate degree nurses can find realistic ways to obtain BSN degrees.
In addition, BSN nurses are encouraged to be leaders in evidence-based practice and research and it's becoming more common-and crucially, more expected-for nurses to pursue master's degrees. The creation of the doctor of nursing practice degree has taken off better than anyone could have expected.
In the last six months, any time I'm in a group of nurse executives, the conversation always turns to who has already entered a program and how long it's going to take the rest of the group to do so.
2. Patient engagement gets real
If you haven't found a way to drive home the importance of patient experience to direct-care nurses, find it now. You know how much reimbursement is at stake, but the rank and file caregivers still don't get it. I've written before that the term "patient experience" has a way of annoying bedside caregivers. '"We're not Disneyworld," is a common refrain; people don't want to be in the hospital. "I'm here to save patients' lives, not entertain them," is another common complaint.
Experience isn't about mollycoddling patients, however, or how flashy the in-room entertainment system is and that's what you need to help nurses understand. In fact, the nurse-patient relationship has always been about patient experience. Your best nurses instinctively know this. They already create a good patient experience. They help patients understand their care, involve families in decision-making, coordinate multidisciplinary care, sit with patients to explain complex diagnoses, and even, occasionally, have time to offer a quick hug or hand to hold. These are the nurses who get letters from patients and families after discharge and these letters are all about the patient experience.
This is how you need to phrase patient experience with nursing staff so they understand it's not just a program, but a way of life. At the same time, nursing needs to own the cause. They may not be responsible for it in isolation, but they are literally at the center of this issue. They should take the lead and drive the agenda.
In this column from September, I outlined 10 ways to help nurses improve patient satisfaction.
3. Patient safety
Just as nurses should own patient experience, they need to feel ownership for patient safety as well. I wrote last month that "quality improvement becomes one more meaningless directive from above unless nurses feel engaged in the process, involved in the plans, and accountable for the results."
Preventing healthcare-associated infections (HAI) is no longer simply the right thing to do, it's become the only financially viable option. Unless nurses are educated and empowered, real progress cannot be made.
4. Cost cutting
Nursing knows that hiring freezes and layoffs are a constant threat and healthcare organizations are forced to put cost cutting at the top of the agenda in 2012. As the largest budget in the organization, nursing is an easy target.
Organizations can get more agile with staffing and scheduling and find creative ways to reduce cost while maximizing efficiency. Embrace change and flexibility to create the mobile, agile workforce healthcare organizations need to adapt to changing economic realities and increases in patient population.
At the same time, staffing budgets can't be viewed in isolation. There are direct links between nurse staffing and length of stay, patient mortality, readmissions, adverse events, fatigue-related errors, patient satisfaction, employee satisfaction, and turnover. This article examines the danger of considering the cost of nurse staffing without looking at everything else. It's important to understand the relationship between length of stay, unreimbursed never events, and nurse staffing to understand the whole picture.
I've said it before, but ignore retention at your peril. The nursing shortage hasn't gone away simply because the recession has eased its immediate effects. We all know the turnover rate for new graduate nurses is always high, so invest in nurse residency programs that have proven results for retention and for increasing the competency of new nurses.
Take a look at the five reasons nurses want to leave your hospital and see whether you're doing any of these.
Source: HealthLeaders Media