Nursing Leadership Competencies Required to Influencing Excellence in Nurse Sensitive Outcomes and Nursing Satisfaction

Purpose:
In a pay-for-performance environment, implementing and sustaining evidence-based practice is no longer a luxury but a necessity. The purpose is to describe leadership competencies of Chief Nurse Executives (CNE) necessary to implement and sustain evidence-based improvements in quality and costs.

Significance:
Health care spending increased from 5.7 percent of the gross national product in 1965 to 16 percent in 2004 and is expected to reach 20 percent by 2015. Leaders are positioned to lead changes and require competencies to implement and sustain evidence-based improvements in quality and costs.

Strategy and Implementation:
Transformative leadership competencies of CNE include 1) creating structures to ensure access to information, resources and support, and 2) creating expectations for innovative, dynamic, empowering and accountable behaviors of other leaders and nurses in the system. This exemplar illustrates the design, and implementation of structures and processes designed to sustain evidence-based practice and nursing research within a multi-hospital system. Implementation included shared governance assessment and redesign, intentional practice-education partnerships, role redesign and accountability, scorecard accountability across all levels of nursing, and regularly scheduled review of progress toward evidence-base model empirical outcomes.

Evaluation:
Measurement included but was not limited to the following: NDNQI performance of nurse-sensitive outcomes, NDNQI PES nursing satisfaction, and number of nurses returning for advanced education.

Implications for Practice:
Implications for practice include an awareness and integration of strategic factors and infrastructure influencing the design and sustainability of evidence-based practice include the following: building EBP capacity; creating EBP roles and functions; and create EBP incentives.