Elizabeth McGann, DNSc, RN

June 14, 2012

June 14, 2012 — Editor's note: Nurses make significant contributions to the quality and safety of patient care. Each nurse needs to know how to assess the need for change, provide leadership, and measure effectiveness at the point of care. "Swimming in Quality Soup: What Every Staff Nurse Must Know About Quality and Safety" was featured as a podium presentation at the American Association of Critical-Care Nurses (AACN) 2012 Annual National Teaching Institute and Critical Care Exposition, held May 19 to 24 in Orlando, Florida.

To find out more about what staff nurses need to know about quality and safety, Medscape Medical News interviewed Susan R. Lacey, RN, PhD, FAAN.

Dr. Lacey is director of the newly launched AACN Clinical Scene Investigator Academy, which teaches staff nurses how to conduct quality-improvement projects at the point of care. The innovative curriculum she designed has provided didactic instruction and coaching to 23 staff nurses from 7 regional hospitals in an effort to improve patient outcomes. In 16 months, these 7 projects saved their organizations more than $2.3 million. Dr. Lacey is also director of strategic collaborations at Children's Mercy Hospitals and Clinics, a Magnet hospital in Kansas City, Missouri.

Dr. Lacey served as the lead investigator for the development and testing of the pediatric National Database of Nursing Quality Indicators, has authored numerous publications, and serves on several journal editorial boards. She is a Robert Woods Johnson Executive Nurse Fellow alumna (2006 to 2009), and is a Fellow of the American Academy of Nursing.

Medscape: What is the impetus for the current national agenda on quality and safety?

Dr. Lacey: The Institute of Medicine (IOM) report, To Err Is Human (1999), indicated that an estimated 98,000 patients die in hospitals every year due to errors during their care. Ten years after that report, there had been no significant change in this finding. The recent IOM report, The Future of Nursing (2010), recommends that nurses not only practice to the full extent of their credentials, but that they also pursue lifelong learning, advanced education, and lead change at the point of care. It is time that nurses are recognized for their contribution to quality and safety, but they need additional skills and competencies to do this.

Nurses need to know about the recommendations in The Future of Nursing IOM report. In my experience, many nurses do not know about this critical report, nor do they know how they can get involved regionally or nationally. It is crucial to recognize that the primary reason a patient is admitted to the hospital is for 24-hour care and surveillance by professional nurses. All other care can be performed in an outpatient setting.

Medscape: What is the staff nurse's role in ensuring safe, quality patient care?

Dr. Lacey: Each nurse's actions or lack of actions influence the outcomes of patients. Nurses need to understand their discreet and collective contribution, and be empowered to change processes when outcomes are not optimal. They must know their unit outcomes, be able to articulate how change must occur, lead that change, and most importantly be able to translate improvements into fiscal language to be at the table where key decisions are made. All nurses need to be able to do this, not just nurses in administrative roles.

Medscape: What acronyms and concepts should staff nurses know so that they can fully participate in quality and safety initiatives?

Dr. Lacey: Most of the quality work is conducted by others who impose new processes or edicts on staff nurses. Currently, there are methods such as Plan, Do, Study, Act (PDSA), Test of Change (TOC), Lean Six Sigma, and national benchmarking by various entities (regulatory and voluntary). Therefore, many nurses see quality work as that which is to be done by others. Instead, all staff need to recognize that quality is their responsibility each and every shift they work.

Nurses need to know how to conduct quality improvement using the traditional methods described above, which are not complex but are new to most nurses. In addition, they must recognize acronyms such as NDNQI (National Database for Nursing Quality Indicators) and NQF (National Quality Forum). They need to understand how these drive hospital initiatives that eventually impact their daily practice. Nurses also need to grasp the imperative of the financial constraints of today's healthcare industry that are linked to cuts in the Centers for Medicare and Medicaid Services and other payers, such as "never events."

Medscape: How does knowing the language of quality and safety contribute to interprofessional collaboration?

Dr. Lacey: If nurses do not know the language that other providers and administrators know, they are left out of the discussion. When The Future of Nursing report was unveiled in Washington, DC, Linda Burns-Bolton repeated an often-quoted phrase: "If you are not at the table, you might be on the menu." That truly is the case.

Medscape: What challenges do novice nurses face related to quality and safety initiatives in patient care?

Dr. Lacey: I believe nursing's key challenges related to quality and safety leadership lies in our own profession. It is up to us in both academic and healthcare system enterprises to embrace our power (there are over 3 million RNs) and demonstrate our ability to adapt to this new way of conducting our work — to lead change and be able to translate our worth in economic terms.

Medscape: What resources are available to healthcare providers regarding quality and safety?

Dr. Lacey: There are many national organizations providing quality and safety resources, including the Institute of Medicine, the Agency for Healthcare Research and Quality, Quality and Safety Education for Nurses, and the Institute for Healthcare Improvement.

Medscape: What was the most significant aspect of your presentation?

Dr. Lacey: The most significant aspect is the part that explains in plain English and simple math how to calculate the benefit of nursing care. It is basic math, similar to calculating your family or personal budget when you consider a purchase or expenditure.

Medscape: Is there anything else you would like to add?

Dr. Lacey: Nursing can and must do this work. There is no mystery or difficulty in doing the work to demonstrate best nursing practices in quality and safety. If nursing does not lead change at the point of care, the nursing profession is going to miss one of the most important times in the healthcare.

Dr. Lacey reports has disclosed no relevant financial relationships.

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