Engaging nurse residents in a campaign to improve nurse sensitive quality outcomes

Purpose:
Suboptimal performance on falls and hospital-acquired pressure ulcers catalyzed nurse resident involvement in an innovative campaign to improve care delivery. Sustained improvement confirms the efficacy of integrating nurse residents in evidence-based strategies that ensure optimal patient care.

Significance:
Falls and pressure ulcers impact patients' quality of life and represent a significant cost to society. Nurse residents can critically examine unit structures and processes, and identify areas where nursing practice and patient care can be improved upon through focused, evidence-based strategies.

Strategy and Implementation:
Newly graduated nurses participate in a University HealthSystem Consortium residency program; a one year journey to transition them to competent professionals. As part of the program, residents incorporate into practice research-based evidence linked to nurse sensitive outcomes and complete an evidence based project. Suboptimal performance against NDNQI benchmarks related to falls and hospital-acquired pressure ulcers revealed opportunity to improve practice on 12 adult care units. An innovative, cost neutral model incorporated residents in grassroots efforts allowing them a hands-on approach to examine and identify breakdowns in care processes. Nurse leaders engaged and supported residents toward this effort. 16 resident-led quality improvement projects were implemented, with successful results. Continued examination of performance against NDNQI benchmarks will direct future resident projects toward promoting higher levels of nursing practice to sustain positive clinical outcomes.

Evaluation:
Total falls, injury falls and hospital acquired pressure ulcers decreased on units with active resident involvement. Individualizing projects to a unit's unique needs enabled these nurses to effectively assimilate into their unit's culture and facilitate positive patient outcomes as a result.

Implications for Practice:
Using NDNQI benchmarks to drive nursing care excellence is enhanced by involving nurse residents in unit-specific quality improvement initiatives. Integrating residents into the quality work on their units enables awareness of their contribution to improved nursing practice and patient outcomes.