AAMC Nurses, what do we own?
What do you own that is important to you—a home, a car, the latest electronic device, or maybe a pet? Now think even bigger. If you are a nurse at AAMC, you own patient care outcomes.
While nurses do practice within a multidisciplinary context, there are specific outcomes on which we have the greatest impact. These are referred to as nursing sensitive outcome measures. They are directly influenced by both the quality and quantity of nursing care.
Nursing sensitive outcome measures, affirmed by the National Quality Forum, include death among surgical inpatients with treatable serious complications (“failure to rescue”), prevalence of pressure ulcers, prevalence of inpatient falls, prevalence of inpatient falls with injury, prevalence of inpatients who are restrained, rate of urinary tract infections associated with use of catheters for ICU patients, rate of blood stream infections associated with use of central line catheters for ICU and NICU patients, and rate of pneumonia associated with use of ventilators for ICU and NICU patients.
Nurse sensitive outcomes do not occur in a vacuum. They are influenced by the structure and processes of care. Structure refers to the workforce elements that contribute to better patient care outcomes. Supply, skill level and education of nursing staff impact nursing sensitive patient care outcomes. Nursing staff skill mix, nursing hours per patient day, and nurse education and certifications are nursing sensitive structure measures. Process measures include nursing assessment, interventions, RN job satisfaction, and other elements that impact the outcome of patient care.
Nurses contribute greatly to the safety and quality of patient care at AAMC. Continuous measurement of nursing performance, through measuring processes and outcomes of care, are a critical step in recognizing nursing contribution to high quality patient care.
Through participation in the National Database of Nursing Sensitive Indicators (NDNQI), we benchmark several nursing sensitive indicators for many of our nursing units. It is important that nurses understand what structure, process and outcomes they own and use this data to drive their performance improvement projects.
Our unit-based nursing quality councils measure nursing sensitive indicators on their units and develop evidence-based quality improvement projects (see Table 1). Our nurses take these projects from start to finish. From using the PICO Model (Patient, Population, Problem, Intervention, Comparison, Outcome) to formulate a clinical question, to researching evidence-based solutions, to integrating that research into our nursing practice, AAMC nurses are own this process.
If your unit is not eligible to participate in NDNQI (Peri-operative, Obstetric, Observation, ED, and intervention units), it is important to identify and communicate to your unit’s nursing quality council what nursing specialty specific nursing indicators you should measure and benchmark.
We have ownership in our patient’s outcomes—and we are proud to hold ourselves accountable for what we own.
-Cathaleen Ley, Ph.D., A.P.R.N., B.C.