For healthcare organizations seeking to improve the quality of their patient care, empowering and supporting direct care nurses is a proven path to innovation.
As the closest clinicians to patients, direct care nurses (DCNs) are uniquely positioned to understand patients’ needs and initiate innovative solutions. But too often, DCNs do not feel empowered to use their expert knowledge to improve outcomes. In a top-down approach to change, front-line nurses may not be consulted, even though they may ultimately be held accountable for project implementation.
Recognizing the untapped power of DCNs, the American Association of Critical-Care Nurses (AACN) created AACN Clinical Scene Investigator (CSI) Academy, a nationwide program to instill greater confidence in nurses to lead change. Now in its tenth year, CSI Academy notes that 469 DCNs from 127 units representing 82 hospitals across the United States have participated in its 12-month project-driven program.
As the following examples demonstrate, when DCNs are empowered, patient health is markedly improved. In addition, participating health organizations have saved an estimated $84.2 million, with a 660% median return on investment per project.
Decreasing catheter-associated UTIs
The nursing staff at Denali Center in Fairbanks, AK, had provided feedback that the center’s current practices for catheter-associated urinary tract infections (UTIs) were not user-friendly, making it difficult to interpret requirements.
Three nurses — Aminat Alarape-Raji, Teresa Hrubes, and Sandy Plummer — completed a survey to identify practices and knowledge deficits related to the number of overall UTIs and asymptomatic UTIs being treated inappropriately.
After six months of educating the nursing staff and introducing a revised process, the UTI rate at Denali Center was reduced 49.3%, and the use of antibiotics for asymptomatic UTIs was reduced 44%. These outcomes resulted in an estimated annual fiscal savings of $124,137, and the CSI nurses are working to replicate the process for the center’s other protocols, including pneumonia and gastrointestinal and skin infections.
Improving early stroke detection
Tammy Dickinson, Celeste Hingle, Tara Porter, and Kathryn Smith, nurses at Ochsner Medical Center – North Shore in Slidell, LA, sought to decrease the number of rapid response calls for strokes and decrease the time of treatment from the onset of stroke symptoms.
The four CSI nurses worked closely with the hospital system’s integrated stroke team to host teaching events and share data. They held traveling “coffee and conversation” events, where they took a coffee cart to different units and offered guidance on how to assess for a stroke and what to do when a patient seems to be having a stroke. They introduced new stroke code verbiage at the hospital’s mandatory skills fair, calling it “Code Stroke.”
Through the use of Code Stroke, the appropriate staff treated patients and began stroke treatment more quickly. The team also observed a downward trend in the average length of stay. These outcomes resulted in an estimated annual fiscal savings of $146,250.
Reducing falls through better communication
At Massachusetts General Hospital in Boston, MA, personal care assistants (PCAs) felt they didn’t have enough information to take optimal care of patients.
With the specific aim of decreasing patient falls and hospital-acquired pressure injuries (HAPIs), three RNs — Lisa Bourgeois, Christina Carmody, and Katherine Guanci — collaborated with the PCAs to develop a “worklist” tool designed to communicate important information about tasks, safety concerns, and pertinent patient information. The night nurses fill out the worklist for the day shift. Next, the charge RNs huddle with the PCAs in the morning to review the patients and answer any questions.
Once the new tool was implemented, falls on the unit decreased 25% and HAPIs decreased 33%. The tool has already been shared with other units in the hospital, and the CSI team is working to implement more PCA-specific information into the electronic health record.
When DCNs have leadership skills and tools, protected project time, and organizational support, they provide better care for all of us. As the 10-year history of CSI Academy shows, growing and supporting DCNs’ innovation and leadership is a return on investment — a win-win for patients, nurses, and organizations.