Registered Nurses Leading Innovative Changes

Timothy W. Thomas, BSN, RN; Patricia C. Seifert, MSN, RN, CNOR, FAAN; Jane Clare Joyner, JD, MSN, RN

Online J Issues Nurs. 2016;21(3)

Abstract and Introduction

Abstract

As innovators, all registered nurses (RNs) act as agents of change to drive processes and policy and leverage technology to prove better, more affordable care for individuals and the community. The authors consider examples of RNs leading innovative ideas and practices to create new knowledge; develop healthcare policies and practices; improve the quality of care; and advance health information technology. This article describes a number of key innovation goals identified by the American Nurses Association Professional Issues Panel, Barriers to RN Scope of Practice, discusses relevant literature related to overcoming barriers to innovation, and identifies recommendations for leading innovative change to achieve innovation goals.

Introduction

The American Nurses Association (ANA) Professional Issues Panel, Barriers to RN Scope of Practice (SOP Panel), was established to identify and clarify barriers to registered nurses (RNs) practicing to the full extent of their education, experience, and scope of practice (SOP) as determined by the relevant nurse practice act. The Panel's Steering Committee identified barriers that prevent RNs from working to the full extent of their education and training, and explored the basis and developed recommendations to address these barriers. Panel members organized the findings based on four key roles of RNs in the healthcare delivery system: RN as professional, RN as advocate, RN as innovator, and RN as collaborative leader.

Separate articles in this OJIN topic have addressed each role; this article explores the theme that as innovators, all registered nurses (RNs) act as agents of change in driving processes and policy and leveraging technology to advance the three aims of the National Quality Strategy (IHI, n.d.): "(1) better experiences with health care, (2) better population health, and (3) lower costs" (Mason et al, 2015, page 549). The authors consider examples of RNs leading innovative ideas and practices to create new knowledge, develop healthcare policies and practices, improve the quality of care, and advance health information technology. The article describes a number of key innovation goals identified by the American Nurses Association Professional Issues Panel, Barriers to RN Scope of Practice, discusses relevant literature related to overcoming barriers to innovation, and identifies recommendations for leading innovative change to achieve innovation goals.

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Next Section

Abstract and Introduction
Registered Nurses as Leaders of Innovative Ideas
Overcoming Barriers to Leading Innovative Change
Recommendations and Conclusion
References

Table 1. AHRQ Guide to Innovation: Questions to Consider
1. Does the innovation fit? What is the innovation? Does it further our goals? Is it compatible with our organization?
2. Should we do it here? What are the potential benefits? Costs? Can we build a business case? What are the risks?
3. Can we do it here? Are we ready for this change? What changes will we have to make? Do we have the ingredients for success?
4. How will we do it here? How will we measure the impact of the innovation? Can we try the innovation first? How will we implement the innovation?

Agency for Healthcare Research and Quality (2008). Public Domain.

Table 2. Expanded and Enhanced Roles for RNs
Examples of Roles, Functions and Opportunities
Eight RN roles in Pioneer Accountable Care Organizations Pittman and Forrest (2015, p. 556–557)	Enhanced RN roles in primary care Substitution of RNs for providers for certain acute conditions in primary care Delegation of tasks to licensed practical nurses and medical assistants Increased in demand for RNs in care coordination roles Transfer of services from hospitals to primary care and from skilled nursing facilities to home care Relocation of nurses from hospitals to primary care clinics Use of nurses as liaison care coordinator across settings Partnerships between nurses in primary care and hospitals
Nine RN roles in primary healthcare Smolowitz, et al. (2015, p. 133)	Delegated care for episodic illness management Telephone triage Medication reconciliation Health coaching Assessment and documentation of health status Intensive care/case management with a focus on chronic illness Hospital transition management Practice management and staff supervision Quality improvement and team leadership
RN roles and opportunities in a transformed healthcare system Fraher et al. (2015, p. 2–5)	"Boundary Spanner" connecting patients with resources in the community Public Health Nurses and Population health Long-term services and support for complex older adults and their caregivers Care coordination and transitional care Use of data, evidence, and other performance improvements skills Interprofessional collaboration

Table 2 extrapolated from Pittman and Forrest (2015); Smolowitz et al. (2015); Fraher et al., (2015).

Table 3. Summary: Goals and Recommendations for Leading Innovative Changes
GOALS	RECOMMENDATIONS
Consistent with the ANA Nursing Scope of Standards and Practice, nurses in all roles and settings lead innovative change to protect, promote, optimize, and advocate for the health of individuals, families, groups, communities, and populations (ANA, 2015a). This aligns with the goals of the Triple Aim (IHI, n.d.) and the National Quality Strategy (Mason et al, 2015).	Nurses develop leadership skills (financial, self-awareness, critical thinking) and skills in interprofessional collaboration and strategic reasoning to promote innovation in all aspects of healthcare delivery. Researchers work to identify key characteristics and attributes of successful nurse innovators. Nurses achieve positions of influence on national committees and workgroups that design and implement innovative changes to federal initiatives (e.g., National Quality Strategy, payment methodology, quality measures, and other healthcare initiatives). Employers invest in development of environments that foster nurse innovation. Nurses share and promote best practices developed through innovative initiatives.
Nurses lead in the development of innovations in health policies by applying nursing knowledge to advocate for patients, consumers, and the nursing profession.	Educators develop and implement curricula and continuing education reflecting health policy concepts and skills. Nurse leaders mentor new nurses to involve them in health policy development. Nurses achieve leadership positions throughout the healthcare system (e.g., organizational, local, state, and federal levels) to design and implement innovative changes to health policy. Nursing organizations monitor health policy regulations to ensure they are supportive of patient care and nursing practice.
Nurses lead, leverage, and advance innovations and technology from inception and development through implementation and evaluation.	Nurses advocate for nursing input to identify the value of nursing services and impact on quality. Nurses integrate informatics and technology into nursing education (including continuing education). Nurse educators develop and implement curricula and continuing education reflecting contemporary practice.

Authors and Disclosures

Timothy W. Thomas, BSN, RN
Timothy W. Thomas has worked as a registered nurse for 15 years, and started his career in the U.S. Army at the original Walter Reed Army Medical Center (WRAMC). At WRAMC, he wrote a policy on pressure ulcer prevention and treatment that was later utilized as the framework for a hospital-wide policy. After a short tour in Iraq, he did an inter-service transfer from the U.S. Army to the U.S. Public Health Service (USPHS). In the USPHS, he has been detailed to the Federal Bureau of Prisons (BOP) and has moved up from a clinical nurse, to the Improving Organization Performance/Infectious Disease Coordinator (IOP/IDC), to his current position as Regional Nurse Consultant/Medical Asset Support Team RN for the Southeast Region. In this position, he has led a team of nurses to develop evidenced-based nursing protocols for urgent/emergent situations and for non-emergent, routine care (sick call). He has also co-led the development of the Nursing Services Program Statement for the BOP. In December 2014, he was awarded a full scholarship through the American Nurses Association to complete his masters in Nursing in Leadership and Administration at Capella University, Minneapolis, Minnesota. Email: rntthomas@gmail.com

Patricia C. Seifert, MSN, RN, CNOR, FAAN
Patricia C. Seifert has more than 25 years of experience as a perioperative nurse. She has been a clinical manager in cardiac surgical services and has developed four cardiac surgical programs. She has also functioned as an RN First Assistant on over 3,000 cardiac surgery procedures. Seifert is a past president of the Association of periOperative Registered Nurses (AORN), past Lead Coordinator of the Nursing Organizations Alliance, a member of Sigma Theta Tau. She is a Fellow in the American Academy of Nursing. Seifert is the author of six books and numerous articles and chapters; she was a member of the writing group for the 2013 American Heart Association Scientific Statement: Patient Safety in the Cardiac Operating Room: Human Factors and Teamwork. She has presented educational programs locally, nationally, and internationally. Seifert was the recipient of the Inova 2015 Ronald S. De Volder Memorial Award for participation in the Cardiac Surgery QI Team Project: "Patient Handoff from CVOR to CVICU and CVICU to CVSDU;" she also received the Inova Health System's 2014 award for Service Excellence. Seifert has been recognized by her professional organization, AORN, receiving AORN's first President's Award (1991-1992), the 2003 Award of Excellence, AORN's 2007 Jerry G. Peers Distinguished Service Award, and AORN's 2014 Award for Mentorship. Email: seifertpc@verizon.net

Jane Clare Joyner, JD, MSN, RN
Jane Clare (JC) Joyner works in the American Nurses Association's (ANA) Health Policy Department (Nursing Programs). She is a Senior Policy Advisor for health systems and regulatory policy matters. JC is a nurse-attorney with an MSN in Nursing Administration. Prior to joining ANA, she was Deputy Assistant General Counsel for Health Care Operations within the General Counsel's office at the Department of Veterans Affairs, where she focused on legislation, regulations, policy, and litigation affecting the agency's integrated healthcare system. Email: jane.joyner@ana.org

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Registered Nurses Leading Innovative Changes

Abstract and Introduction

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Introduction

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References

Authors and Disclosures

Authors and Disclosures

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