Nurses are always developing innovations and improving the quality of care in various ways. Sometimes innovative thinking helps one patient overcome a troublesome symptom. Other times, initiatives aimed at quality improvement and clinical practice innovation can benefit millions of patients system-wide.
ANA is highlighting nurses’ quality and innovation contributions in health care for National Nurses Week 2013 (see this article in The American Nurse for more detail), and is offering a webinar on how innovations in processes, technologies and best practices lead to improved patient outcomes.
Enhancing Quality to Improve Patient Outcomes
The Nursing Quality Database: 1 Million RNs and Counting
ANA is improving patient safety and outcomes through the National Database of Nursing Quality Indicators® (NDNQI®), a program of ANA’s National Center for Nursing Quality®. More than 1,900 hospitals employing 1 million nurses – one-third of all U.S. RNs – participate in the performance database. Hospitals compare their performance, then devise and implement more effective nursing care strategies to improve patient outcomes.
Hospitals that won the 2012 NDNQI® Award for Outstanding Nursing Quality™ reduced patient fall rates and decreased hospital-acquired infections, among other improvements.
2012 NDNQI® research findings on the quality of care indicate:
- Hospital units with low RN turnover where RNs also rate their work environments highly have fewer negative and costly outcomes, such as pressure ulcers.
- RNs on units with more nursing care hours per patient and lower job turnover gave higher ratings to their unit’s quality of care.
Benefits of Nursing Services More Broadly Recognized
Other nursing advancements in quality care include:
- Care coordination, a core component of nursing, helps patients understand their care plan, self-manage their condition, take medications properly, obtain equipment, and get referrals. Now care coordination is commanding more attention as a way to improve value, efficiency, and patient outcomes and satisfaction.
- Up to 20 percent of Medicare patients are re-admitted to hospitals, often because of inadequate care coordination. But now Medicare is paying for certain care coordination services for the first time, recognizing that the quality of transitional care provided by RNs is crucial to reducing re-admissions.
- Patient falls are preventable, but causes must be assessed to reduce incidence. Nurses are urging incorporation of nursing quality measures, such as the National Quality Forum’s endorsement of NDNQI® measures for patient falls, into national standards for health care performance.
Innovation: Researching New Ideas to Improve Patient Care
Nurses find better ways to care for patients and improve outcomes through research and evidence-based practices. Nurses serving as “innovation advisers” to the Centers for Medicare and Medicaid Services proposed these improvements:
- A new role of “attending” nurse to promote continuity of care over a patient’s stay
- A model predicting the likelihood of hospital re-admissions and interventions to address causes
The American Nurses Foundation, ANA’s philanthropic arm, makes grants to nurse researchers for innovative exploration of health care issues. Studies include:
- Analyzing coping strategies for nurses who are victims of workplace bullying
- Evaluating how loneliness affects the health of older adults with chronic illness
Nurses’ Innovative Solutions That Make a Difference
The Edge Runners – RNs recognized by the American Academy of Nursing for contributions to care strategies and health policy – are innovators. Their projects often lead to changes in the health care system and clinical practices and become permanent solutions to vexing problems.
For example, Edge Runners from the University of Pennsylvania School of Nursing developed these solutions to help older Americans remain healthier and more independent:
- Living Independently for Elders has adapted a chronic care model to provide care to seniors in their own homes rather than a nursing home
- Transitional Care Model, led by RNs, assists seniors with health risks during and after hospitalization, with the aim of reducing re-admissions
New Ways to Provide Care to More Patients
Nurses are integral participants in collaborative multi-professional models of care designed to improve patient outcomes and reduce costs, such as accountable care organizations and medical homes.
The Affordable Care Act is spurring creation of such performance-based models, and the Institute of Medicine’s Future of Nursing report calls for the full contribution of nurses’ skills and knowledge to transform health care.
APRNs: Increasing the Reach
Advanced practice registered nurses (APRNs) are operating more independent practices, creating an emerging health care trend and providing primary care to more patients. About 100,000 APRNs directly bill Medicare for services provided to 30 percent of beneficiaries.
APRNs are increasingly serving all populations through retail-based health clinics. These clinics treat minor illnesses and provide services such as screenings and diagnostics. Retail clinics have grown from 202 in 2006 to 1,355 in 2011, with projections to reach 2,854 by 2018.