NR 451 Evaluating Quality Patient Outcomes Discussion
NR 451 Evaluating Quality Patient Outcomes Discussion
For this weeks’ discussion, we are discussing quality improvement and change. These improvements are not only necessary to decrease occurrence of harm and or wrongful death, but also in improving the quality of life for our patients. Data can aid in the evaluation of effectiveness, cost, planning delivery of care. It gives insight to the allocation and utilization of resources, and also assesses the accessibility of care for our patients in varied settings. These considerations allow for concerns in economic matters, ethical matters and social diversities. When discussing an example of data that reflects poor quality of care, I would like to use a personal experience with my own hospital setting. I do this, not because I feel the place I work is a poor place, but we experienced something that I believe is probably widespread and I think many could benefit. We were required to do an error prevention class for the hospital. The wrongful death and harm statistics were from our very own organization. These were people, families in our community effected directly by errors within our health system……. deaths in some cases, by mistake of personnel. It is an eye opener to see charts, graphs and data that reflect errors that you yourself could have easily made.
We have had a huge shift in error prevention and culture for error identification. We were shown that a 15% spike in error was seen during our go live with a new software system. This data absolutely identified areas of much needed improvement, more than that …….it identified that change was essential, our patients lives depended on it. We don’t talk about the astonishing numbers that reflect medical error and wrongful death enough. It is not easy to talk about. We are all human, but when you understand that your own life, the lives are your family members receiving care are at stake when healthcare has a “glitch”, it is a whole new perspective. In our assigned article this week it states,” today we may be doing what we can, but tomorrow we can improve”,(Hughes,2008). Quality improvement is definitely a part of daily workflow, because every day we can make strides to perform better, be more efficient, more cost effective. As nurses, we are in actual one on one contact with patients, more than other discipline in healthcare, (ANA,2015). We spend more time, often develop the relationship aspect of healthcare and are looked to for education, intervention, avocation and support by our patients and their families. We bring the “human” to the very technical, often harsh reality of healthcare. I read an article of the influence of quality improvement and how it effects not only our patients by our own work. I feel this sums up the need to change through improvement.
“As advances are made, patient’s needs and expectations of healthcare are changing as well. It is part of the dedication to the nursing profession to develop quality and safety measures, identify gaps of knowledge, share innovations of quality and performance improvement initiatives, incorporate technologies to impact workflow efficiency, safety, and cost,” (Weston&Roberts,2013). I read that, jotted in down, and when typing it, I read it out loud about three times…….try it. WOW……. Those are some BIG shoes to fill!! I have often stated about my own self,” I am just the bedside nurse”. Class and professor, I dare say that according to the above statement, in todays’ healthcare, there is no such thing. I have taken this statement from this article, as a personal challenge. I have placed it in a sticky note in my locker. For those days, those hard ones, like I just had last night,( you know when you think as you walk to the car at the end of a shift, checking out groceries at Walmart is looking pretty promising!! LOL) to remind myself, the BIG picture is not mine to “fix”, however, if I commit to these things in the experiences and in the lives of patients I am dealing with a day to day basis, if we all do, the BIG picture will improve without a doubt!
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Weston, M., & Roberts, D. (2013). The influence of quality improvement efforts
on patient outcome and nursing work. The Online Journal of Issues in
Nursing, 18(3). https://doi.org/10.3912/ojin.vol18no3Links to an external site.
Hughes, R. G. (Ed.). (2008). Patient safety and quality: An evidence-based handbook for nurses(AHRQ Publication No. 08-0043). Agency for Healthcare Research and Quality. Retrieved from https://archive.ahrq.gov/professionals/clinicians-providers/resources/nursing/resources/nurseshdbk/ Links to an external site.
American Nurses Association. (2015). Nursing: Scope and standards of practice (3rd ed.). Silver Spring, MD: Author
Wow, that’s’ a pretty big question to answer. Honestly, I do not have any idea where it would begin. So, classmates, I would love to hear some of your ideas. And now , I will attempt to give some insight . First, the question, why are nurses leaving the bedside? I found an article discussing this topic . It states the three top reasons for leaving clinical nursing: “1. unfriendly work environment, 2. emotional distress related to patient care, 3. fatigue and exhaustion”, (AACN,2010). This was described as issues with sexual harassment, verbal and physical abuse from coworkers, managers, physicians in the workplace and consistent lack of support from other RNs. The second issues was having to do with conflict in the decision making aspect of patient care, and perception that patient and family desire was ignored.
The third issue was simply a feeling on being overwhelmed with emotional and physical fatigue. I know organizations have approached all of this with education on sexual harassment, what it is, and how to report it. Our organization, and many others, have programs and encourage involvement in things like “VOICE” to allow for participation at the nurse level in policy and structure of the health system. There is education and “support” for work life balance. However, healthcare has become, for lack of a better word, big business. In nursing we are asked to stay on top of increasing technical demands, increased acuity of patients. Suggestions to retain nursing would be mentoring program to facilitate new nurses into nursing practice, zero tolerance policy for harassment, support networks for nursing staff that are experiencing distress. We have an employee assistance program , that offers a variety of things, including free counseling for up to six sessions. However, our organization is experiencing great turnover in a lot of areas. It becomes difficult for those like myself who have no intention of leaving, despite how negative the climate becomes. We just increased our mandatory call requirements again, many are very upset. We are staffing a NICU in one of the “sister” hospitals that is a 50 minute drive for our facility. We are pulling the call people to that location first.
The nurses at that hospital are not required to take call. We feel as if we are taking mandatory call shifts to be sent to the sister hospital to work as supplemental staff. Why are they a NICU unit with no call mandated? Supposedly we are under the “same umbrella” , or this is the terminology the director has used when we have voiced our feelings, so why not the same requirements of staff from each location? This sister hospital opened over 18 months ago, we have been staffing it from day 1. So this is not a new issue, just one that we feel has only gotten worse , despite our concern for the past 18 months. Some of our nurses drive over two hours and a half to this location, one way! No travel pay, nothing, just this statement form management, “if you refuse , you will be written up for insubordination “. People have refused and were written up, and eventually have migrated to other work opportunities elsewhere. You no longer work for a “hospital”, but a healthcare “system”. We now have three “locations”. Nursing staff is expected to “cover” for all three locations in certain departments. This is the “big business” part of it , that is distasteful to me, personally. You feel like a chess piece, just waiting to be placed in a different spot as needed. So, I will have to say , there is no “one stop” solution. American Association of Colleges of Nursing(AACN). (2010). Nursing shortage fact sheet. retrieved form http://www.aacn.nche.edu/Media/pdf.NrsgShortageLinks to an external site.
I can relate to what you are saying. I am guilty of this feeling as well. Bedside nursing has become quite the challenge. I am planning to get my Masters in nursing education and hoping to step away from the bedside.
In my opinion in order to retain beside nurses the patient to nurse ratio should be no more than five. A nurse should not take on more than five patients. The other aspect is patient satisfaction. Patient surveys and satisfaction reports have become such a big deal. Documentation has also become more important than the care. I not sure if these problems can ever be fixed. The healthcare industry is one of the highest regulated industries. Nurses are often in a rush for the whole 12 hours hands on has almost become impossible. What I’m trying to say is that nursing has become more of a factory type job. According to Robert Field, “The array of regulations that govern health care can seem overwhelming to people who work in the industry. Almost every aspect of the field is overseen by one regulatory body or another, and sometimes by several. Health care professionals may feel that they spend more time complying with rules that direct their work than actually doing the work itself.”https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2730786/Links to an external site.