Quality Resource Nurse: Improving Quality and Safety to Influence Patient Outcomes and Nurse Satisfaction

Purpose:
Extended work hours and excessive job demands adversely influence patient care quality and outcomes. As a result, direct care nurses report frustration and dissatisfaction. Little is found in literature related to supportive strategies for delivery of quality care in a demanding work environment.

Relevance/Significance:
Thousands of patients die yearly from preventable safety events. With the risk of lost reimbursement from hospital-acquired conditions (HAC), healthcare organizations collaborated to adopt standardized bundles of care. Compliance with HAC bundles falls to frontline nurses who must maintain and perform in work environments conducive to safe quality care. The purpose of this project was to examine the influence of a quality resource nurse on quality initiatives and nurse satisfaction scores.

Strategy and Implementation:
The strategy was to improve the nursing work environment in light of new budget constraints. Rather than requesting additional nursing hours, two nurse managers, on a pediatric specialty unit, chose to compensate for the addition of a quality resource nurse by staffing the unit for twelve hours weekly. During this trial period, the quality resource nurse devoted two half shifts a week to quality benchmark audits and face-to-face bedside clinical education. This innovative staffing model created no additional unit costs. Three goals of the quality resource nurse implementation were: (1) improvement in patient care and outcomes, (2) enhancement of the level of frontline nurse comfort in caring for complex patients despite increased job demands, and (3) an opportunity for an experienced nurse to expand her professional role on the unit. Anticipated by-products of this endeavor were that nurse managers could conduct more frequent staff rounding and respond timelier to staff needs.

Evaluation:
With the first three months, improvements in central line care, pain assessment and reassessment, home medication reconciliation, staffing acuity, and compliance with medical center policies have been documented. The quality resource nurse has reported increased personal satisfaction with the additional responsibility; bedside nurses are appreciative of the timely feedback she is able to provide.

Implications for Practice:
Initial results are very promising; the next goal is to conduct quantitative research measuring the impact of a quality resource nurse on patients, work environment, and frontline nurses. The nurse managers will also explore alternative staffing models allowing expansion of the quality nurse role.