Organization Structure and Support That Enable Bedside Nurses to Improve the Quality of Care

Purpose:
The issue addressed in this initiative is the creation and facilitation of a Quality Nurse Scholar Program which was created to engage and support nurses from all settings to lead quality improvement teams that will make a meaningful difference in the care provided.

Significance:
The importance of the issue addressed is that through this program, bedside nurses are empowered to apply quality improvement methods and nationally benchmarked data to drive quality improvement teams that result in improved patient outcomes.

Strategy and Implementation:
The program was developed to support and nurture the bedside nurse's clinical expertise, ability for creative problem solving, continuing education, shared governance and evidence-based practice. It is structured to teach nurses how to lead multidisciplinary teams to creatively and methodically examine a problem, and to work to identify best practices for change. To become a Quality scholar the nurse must agree to complete a three day curriculum which provides the structure, knowledge and expertise needed to equip the new nurse leader for the challenge of team leadership, to lead a minimum of one quality PDCA project a year, and to attend monthly quality scholar meetings. To emphasize the organization's commitment to the program, and in recognition of the scholar's personal commitment of time and achievements, the scholars are paid three dollars an hour above their base pay. The program is facilitated by a Nurse Quality Coordinator.

Evaluation:
Forty two staff nurses have completed the curriculum and are leading teams for individualized, unit based PDCA projects. Improved patient outcomes have resulted in such nurse sensitive areas as pressure ulcers, patient satisfaction and pain management.

Implications for Practice:
Scholar projects have resulted in system practice changes that include bed surface management, rounding, nutritional support, improved staff communication, patient education, ensuring a safe sleep environment for infants, and development of pain protocols for our youngest and oldest patients.