Effective guidance from nurse leadership is priceless when it comes to establishing work systems that refine nursing care and the direction of the profession. Tomorrow and further into the future, nurses will continue to look for direction and support from their leaders. Nurse leaders will be expected to guide their teams to focus on patient care as trials, such as economic instability, the nursing shortage and proposed healthcare reform, whether mandated by Congress or spearheaded by individual facilities, healthcare systems or professional associations, loom ahead.
Many of the processes and systems that have driven the organization of care delivery have been in place for 50 years or longer, according to Pamela Thompson, RN, MS, CENP, FAAN, CEO of the American Organization of Nurse Executives and the American Hospital Associations new senior vice president for nursing.
But there is a different future in front of us, and its not going to be care delivery as we have always done it, Thompson says. We have a lot of history of weve always done it that way. That needs to change as we move forward.
Revolutionizing, or reforming, the healthcare system, regardless of whether the federal government dictates new standards, will be a major undertaking. A lot of challenges will go hand in hand with healthcare reform, says Pamela T. Rudisill, RN, MSN, MEd, NEA-BC, president of the American Organization of Nurse Executives. This includes providing the best in quality and patient safety in the most efficient manner possible. Leadership will be extremely important in this, not just at the executive level, but at every level of an organization.
No Shortcuts on Safety
Thompson says nurse leaders can anticipate that they probably will be facing tighter budgets. Congress is trying to control costs and create value for the healthcare dollars that are spent, so there wont be any new dollars in the system, she says. We will need to design safe, quality patient care that will operate more efficiently.
Nurse leaders also will be challenged to design care models that will function efficiently and safely with a smaller nursing workforce. Thompson says the nursing shortage will continue, compounded by the anticipated retirement of many nurses in the near future and the ongoing shortage of nursing faculty.
The nursing shortage and budget cuts will go hand in hand, she says. Having a smaller workforce means really looking at our roles and how we use our precious resource called nursing. We need to ensure that we are using nurses for what they are educated to do.
Nurse leaders also have a part in garnering support for legislation that supports expansion of the nursing workforce and facilitates safe practice. Leaders also will need to spearhead effective preceptorship programs for students and new nurses in which seasoned nurses can mentor students and new nurses to become successful, effective nurses.
Nurse leaders can expect short lengths of stay to continue to put the healthcare system to the test, Thompson says. Short lengths of stay will compound the challenges of preventing what Medicare designates as never events, which are not reimbursed. These include wrong-site surgery, retention of a foreign object in a patient after surgery; falls; hospital-acquired infections and death or disability resulting associated with a medication error, among others.
Nurse leaders will need to re-evaluate how care is delivered and develop new care delivery models that ensure the essential elements of care are performed in a short length of stay and care delivery models effectively cover the full continuum of care.
Patients are experiencing the fragmentation of care of the current healthcare system, and we need to make sure that every time there is a handoff, it is seamless, Thompson says.
To achieve this level of quality and safety, nurse leaders must evaluate processes and outcomes in their own institutions, have knowledge of evidence-based practices and be able to disseminate the information to each other and to staff and other professionals, Rudisill says
Its Not Just About Nursing
Rudisill stresses that maximizing patient safety and quality outcomes will require nurse leaders to foster a culture of safety throughout their organizations. Promoting a culture of safety is not just about nursing, says Rudisill, who also is vice president of nursing and patient safety at Health Management Associates Inc. in Mooresville, N.C. Its about every discipline collaborating effectively.
Cultivating partnerships and teamwork will be critical to the development of a culture of safety. According to Thompson, there has been evidence in the literature for 20 years that outcomes are better when there is a high level of collaboration between nurses and physicians.
Its clear that in the future, the best way to deliver care will be in teams, she says. But right now we dont start nurses, physicians and other healthcare providers out in teams. We graduate them in silos of their own professions. Then we expect them to know how to function in a team. There is a lot of reworking that needs to be done.
This involves redrafting how decisions geared toward quality improvement are made with such initiatives as shared decision-making and the Institute for Healthcare Improvement and the Robert Wood Johnson Foundations Transforming Care at the Bedside initiative. In these processes, nurses and other staff participate in making system, organizational and process decisions.
Nurse leaders need to bring out the leadership skills of all staff so everyone is actively working on the issues and there is no passive participation, Thompson says. The nurse managers are in a key role, because they can set the framework on the patient care unit about the decision-making, organization and how it all comes together.
Nursing leaders will need every skill they can muster to support nurses in giving safe, cost-effective, high-quality care. This includes redesigning entire organizational systems for managing care as well as revamping the way care is delivered on a specific unit.
We have done a lot with quality improvement over the years, Thompson says. Now we will need to move that into a complex systems perspective.
This will require nurse leaders to continue to develop their skills in communication and relationship building, knowledge of the healthcare environment, leadership, professionalism and business, Rudisill says. In order to make an impact, you have to have all five of those skills, Rudisill says.