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Kansas City RNs Start Clinical Scene Investigation Program

Monday March 9, 2009
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Everyone knows what CSI means, thanks to the popular TV show, but clinical scene investigation differs from criminal scene investigation. Instead of crime scenes, nurses investigate patient health, which is why the Clinical Scene Investigation Academy of the Bi-State Nursing Workforce Innovation Center was created.

"When I see those shows I always think that's what we do, but we do it every time we go into a patient's room," says Susan Lacey, RN, PhD, FAAN, director of the Bi-State Nursing Workforce Innovation Center in Kansas City, Kan. "Nurses are like forensic scientists. When we care for a patient we do not know for sure, but we assume that something might not be right. Then we look at the vital signs and investigate."

The program's investigative nature gave program founders Lacey and colleagues Karen Cox, RN, PhD, NEA-BC, FAAN, and Mary McEniry, a social worker, the idea for the catchy name. The academy seeks to enable staff nurses to take leadership roles in identifying problems and facilitating change to improve patient outcomes and unit efficiency.

The birth of the center began after Lacey made a proposal to the REACH Healthcare Foundation while she was attending a Robert Wood Johnson Executive Nurse Fellowship Program. She outlined how to develop a nurse workforce center in the area to improve the quality of healthcare in underserved areas and increase access for the uninsured. As a result, the Bi-State Nursing Workforce Innovation Center was created in August 2008.

From the beginning it was clear a steady supply of RNs was crucial to achieve these goals. Instead of trying to find ways to increase nursing students, the center concentrated on how to retain working nurses by improving job satisfaction. "A lot of nurses leave the workforce within one or two years after starting at a hospital because they are not satisfied with their work environment," Lacey says. "They spend 20% to 40% of their time not doing direct patient care but duplicating documentation or looking for equipment instead. Our aim is to teach nurses how to improve processes so they have a better use of their time and they are able to create better work environments for themselves."

With financial help from the Health Care Foundation of Greater Kansas City, REACH, and the Robert Wood Johnson Foundation Partnership in Nursing Grant, the center started the CSI Academy and another project called Work Environment Assessment. In the project, nurses fill out confidential online surveys about their institutions, and the center makes specific recommendations based on the data to improve the RN work environment.

The CSI Academy had its first session Jan. 20 with 25 staff nurses from seven area institutions: Truman Medical Centers in Kansas City, Mo.; The University of Kansas Medical Center in Kansas City; St. Luke's Hospital of Kansas City (Mo.); Kansas City (Mo.) VA Medical Center; Providence Medical Center in Kansas City, Kan.; Children's Mercy Hospitals & Clinics in Kansas City, Mo.; and Lafayette Regional Health Center in Lexington, Mo.

Tiffany Day, RN, of the 5 North medical-surgical unit at Providence Medical Center, says the first day was informative. "It was a great group of nurses, and you could tell everyone was excited to be there," she says. "We did team-building exercises, and we also learned how to break down a complex idea to smaller parts so even if the entire idea cannot be executed, parts of it can still be used."

The nurses, who must be recommended by their supervisors to attend the program, will meet once a month on the University of Kansas School of Nursing campus until summer 2010. During that time, they will participate in 72 hours of classroom training, finish take-home assignments, and work on the project with the help of internal and external mentors and coaches.

"The external mentors are senior nurse executives who will give lectures on topics that are typically not included in a nursing curriculum, such as leadership styles, team-building techniques, and entrepreneurship, while the internal hospital coaches will help nurses complete their projects," Lacey says.

The topics of these projects are identified as areas of improvement, such as prevention of pressure ulcers or development of a patient care model. Mentors ensure projects are conceivable within the given timeline and that they are kept at the unit level. "We concentrate on keeping the scope of the project at the unit level," Lacey says. "The refined success on the unit level can then be scaled up through the organization mechanisms to other units within the organization. These methodologies can be used to identify new problems and develop solutions."

CSI nurses will teach their new skills to nurses in their institutions with the help and support of the center, which will provide training materials. The project will conclude with a Bi-State Nursing Workforce Innovation Conference in September 2010, where participants will share the results of their efforts.

Until then, at least one nurse plans to work hard to get as much out of the program as possible. "I hope to become a better nurse and a better leader by being a part of this program," Day says. "I am sure I will look at nursing from a whole new perspective."


Tamas Horvath is a freelance writer. To comment, e-mail editorIL@nursingspectrum.com.