Quality counts: Illuminating the Value of Nursing though a Healthy Working Environment

Purpose:
To articulate the importance of nursing in the provision of safe quality care through a clearly delineated strategy and measurable outcomes

Significance:
A recent report published by the Institute of Medicine (IOM) promotes the advancement of nursing and recommends that nurses be full partners in redesigning health care. The critical care environment offers particular challenges for attaining quality outcomes in a new era of healthcare

Strategy and Implementation:
The IOM report offers opportunity for articulation of the value of nursing practice. The six pillars of a Healthy Work Environment were utilized in an effort to create structure to target specific strategies. Nursing practice was restructured to influence key intended outcomes. True collaboration was addressed through interdisciplinary unit leadership. Effective decision-making involved data-driven decisions and implementation of best practices. Appropriate staffing was achieved through orientation restructure with a phased approach to skill acquisition synergizing clinical knowledge and critical thinking. Authentic leadership generated enthusiasm, provided resources, shared information, and appraised performance. Nurses were mobilized to participate and act as active members of the inter-professional team at all levels of experience to improve decision-making, facilitate active communication and improve patient safety.

Evaluation:
Project improvement for 2008-2010 include: sepsis mortality from 18% to 2%; CLABSI rates from 3.6 to 2.1/1000 patient days despite increased acuity(ERCI); reduced RN turnover from 52.8% to 20.5%; improved NDNQI job satisfaction from 44.7 to 51% and increased specialty certification from 7.5 to 30%.

Implications for Practice:
The project demonstrated positive trends in outcomes after implementation of a healthy work environment. Additional study is needed on the impact of cultural adaptation in allowing creative solutions for sustaining change, quality measurement, novel research, and mutual learning.