Rebuilding Nursing Quality and Safety

Jennifer E. Engen

As hospitals and health systems regain solid ground after two years of constant pressure and overwhelm, nursing quality and safety are top of mind.

Nurse leaders from leading health systems convened to discuss these topics at the recent HealthLeaders Nursing NOW summit panel “Rebuilding Quality and a Culture of Safety in the Wake of the Pandemic,” sponsored by Lippincott Solutions—part of Wolters Kluwer. The panel, led by HealthLeaders Nursing Editor Carol Davis, offered an unveiled look at top challenges, including extreme burnout, workforce shortages, and the pressing need for more competent bedside nurses. Below is a summary of their discussion.

Innovating through monumental challenges

It’s no surprise that the ongoing worker shortage was cited as one of the most debilitating challenges. The entire healthcare system is “facing, a workforce challenge—whether it’s finding enough people or retaining the people that we have,” said Phyllis Doulaveris, DNP, RN, NEA-BC, CPHQ, SVP of patient care services and chief nursing officer at Banner Health. She noted that in addition to leaning on academic partnerships to find more nurses and other key workers, the organization is also “thinking differently around models of care and top of license practice.”

Panelists are also troubled by caregivers continued moral distress due to trauma and the overwhelm of not being able to provide the care they want to provide due to high patient numbers. Solutions range from adding agency nurses and new nurses to changing care models and onboarding philosophies, said Shannon Pengel, MSN, RN, NE-BC, chief nursing officer with Cleveland Clinic. “Embracing this new workforce and knowing that you have to onboard and train differently is incredibly important.”

“We’re fighting for workforce wellbeing and finding joy again in what we do as nurses,” agreed Anne Dabrow Woods, DNP, RN, chief nurse of Wolters Kluwer, Health, Learning, Research, and Practice. Dabrow Woods is also a critical care nurse practitioner at Penn Medicine health system. “The way to do that is we need to fix the staffing issue.” She added that a recent research project showed that leaders want scheduling programs with additional components that address patient acuity and nursing competency on each shift, as well as the ability to offer flexible work hours.

The other panelists agreed that scheduling flexibility and providing more balance in the workday are essential. “Our response has been to offer serenity rooms and engage people in dialogue about what’s going on in their work and personal life,” said David Marshall, JD, DNP, RN, FAAN, senior vice president and chief nursing executive at Cedars Sinai.

Boosting quality and safety

During the pandemic hospitals stepped up to meet different safety challenges through innovation and collaboration, including addressing the lack of PPE and switching to multidisciplinary care models to address the nursing shortage. However, panelists agreed that the pandemic has impacted quality metrics. “We saw increases in most of our nursing sensitive indicators such as CLABSI and CAUTI and hospital acquired pressure, injuries” said Marshall at Cedars Sinai. “Many of the hospital acquired pressure injuries were a result of proning” he added, noting that best practices were created, putting the organization in a better position than before the pandemic.

According to Dabrow Woods with Wolters Kluwer, research prior to the pandemic clearly shows that nurse education and experience impact quality metrics. “Organizations that invest in continuing professional development for their staff actually have better retention than those hospital systems that don’t because it shows that they truly value the nurse and what that nurse can achieve.” To this point, panelists are addressing education needs more creatively. “We have a robust program to support any of our nurses who want to get a BSN, degree,” including automatic approval for tuition reimbursement and a new policy that reimburses nurses up front,” said Doulaveris with Banner Health.

Healing from COVID-19

While COVID 19 infections and hospitalizations have scaled back to manageable numbers, the pandemic’s toll on nurses’ mental health requires short and long-term solutions. Both Cleveland Clinic and Banner Health offer onsite counseling. Cleveland Clinic also offers moral distress debriefs led by a nurse ethicist that focuses on how nurses are feeling and dealing with the pandemic, while Banner Health also has a program that helps people debrief after a difficult event. Moving into the future, the panelists agreed it will be critical in to continue to establish a culture of safety and high reliability. “It’s important now more than ever that we hear from our frontline caregivers and embrace shared governance so that issues can be addressed,” concluded Pengel.

To watch the entire panel discussion and to hear more of what the panelists had to say, click here!

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