Engaging the Bedside Nurse in Quality Improvement

Purpose:
Unit based shared governance teams (UBSG) are in key positions to suggest and implement care improvement strategies. Our goal was to engage, support and empower direct level staff in using empirical data to govern their quality improvement and improve population specific clinical outcomes.

Significance:
Patient outcomes are impacted by the actions of bedside staff; actions that can vary from unit to unit due to unique working environments, staff relationships, patient populations and clinical skill levels. Customized staff led action plans promote involvement and compliance in quality and safety.

Strategy and Implementation:
A unit level team, including the quality council rep and UBSG chairs, were taught to analyze data elements on unit specific Nurse Sensitive Indicators (NSI). The team compared NSI rates to National benchmarks (i.e. NDNQI), to check performance quarterly. If an indicator needed improvement, they examined current processes on the unit impacting the NSI and developed actions to improve care. New actions may include: evidence based practice (EBP) projects, further monitoring for analysis, staff education or creative initiatives such as an "I will" project to increase accountability in falls prevention. Findings and new initiatives were shared with co-workers for implementation. Frontline staff gained awareness of the need for quality improvement through participation and data literacy. A template was designed to graphically display distinct data and action plans. The report chronicled the customized solutions showing how nurses influence desired results and promote a culture of safety.

Evaluation:
The hospital noted improved performance on several NSI (esp. falls and CAUTI) in comparison to benchmarks. The project enhanced staff buy in and awareness of the need for quality improvement thru elevated self governance. Staff worked toward a common goal by relating actions to outcomes.

Implications for Practice:
This project encouraged engagement in performance improvement. The shared responsibility created a culture of frontline accountability. The units used data to improve the practice environment and patient outcomes. The cyclic process and template was adopted by other departments to monitor outcomes.