Running head: NURSE SENSITIVE PATIENT OUTCOMES 1

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1 Running head: NURSE SENSITIVE PATIENT OUTCOMES 1 Nurse Sensitive Patient Outcomes Nicole Weiser University of Mary

2 NURSE SENSITITVE PATIENT OUTCOMES 2 Abstract Today s healthcare has a greater focus on performance and quality then ever before. Healthcare organizations are held accountable for the services they provide patients and to do this there is a focus on measuring data. Nurses and not exempt from the measurement and nurse sensitive patient outcomes are used in healthcare to measure the nurses contribution to providing quality care for their patients. As a leader it is important to know what nurse sensitive patient outcomes are, how these outcomes are measured, what can affect these outcomes and how to engage front line nurses in understanding and improving nurse sensitive patient outcomes. Keywords: nurse, patient outcomes, quality indicators,

3 Running head: NURSE SENSITIVE PATIENT OUTCOMES 3 Nurse Sensitive Patient Outcomes Nurse sensitive patient outcomes can give patients, employees, and organizations an understanding of the quality of care provided to patients by nurses. Nurse sensitive outcomes are defined by Albanese (2010) as those that are relevant, based on nurses scope and domain of practice, and for which there are empirical evidence linking nursing inputs and interventions to the outcomes (p. 228). By measuring nurse sensitive patient outcomes we can hold nurses accountable for the care they provide and also find areas for success and improvement in care. Certain variables will affect nurse sensitive outcomes including staffing, collaboration, education, experience and leadership. Nurses at the bedside also need to know what these nurse sensitive patient outcomes are, how they affect these outcomes and they must also feel empowered to improve these outcomes. The purpose of this paper is to inform the reader of what nurse sensitive patient outcomes are, what variables can affect these outcomes as well as the importance of engaging and empowering nurses to improve nurse sensitive patient outcomes What are Nurse Sensitive Patient Outcomes Nurse sensitive patient outcomes are used to measure quality of care and also patient satisfaction. In today's healthcare we are focused on looking at results and by measuring nurse sensitive patient outcomes we can see the success or areas of improvement in nursing care. Foulkes (2011) explain how managers, organizations, policymakers and insurers all look to this information to determine and measure quality in healthcare. The American Nurses Association (ANA) began measuring nurse sensitive patient outcomes in 1994 and the National Quality Forum (NQF) began reporting on nurse sensitive care performance measures in 2009 (Albanese, 2010). The ANA also developed the National Database of Nursing Quality Indicators (NDNQI) as a repository for nursing sensitive indicators

4 NURSE SENSITITVE PATIENT OUTCOMES 4 from both the ANA and NQF. With the NDNQI in place, organizations can submit their results on nurse sensitive outcomes to benchmark against other similar organizations. This data is then presented to organizations and employees on dashboards which provide results of data over eight quarters compared nationally to other hospitals (Montalvo, 2007). The specific indicators measured continue to grow and evolve as new indicators and matrix are approved. However, some of the various indicators measured include nursing hours per patient day, staffing levels, patient turnover and skill mix; patient falls (with and without injury); hospital-acquired infections; pressure ulcer rate; pain assessment; and nurse satisfaction and education (Foulkes, 2011). What Affects Nurse Sensitive Patient Outcomes Nurse sensitive patient outcomes can be affected by different variables. The work environment is one of the biggest contributors to nurse sensitive patient outcomes including staffing; collaboration; education and experience, and leadership. Though it is difficult to always control all of these variables it is important for leaders to be aware of which variables can affect nurse sensitive patient outcomes so strategies can be used to engage and motivate staff to give quality care and in turn improve outcomes for the patients they serve. Staffing and Nurse Sensitive Patient Outcomes Burston (2014) explain how proportion of registered nurses in the nursing workforce, nurse to-patient ratio, and nursing hours per patient day can all affect nurse sensitive patient outcomes. Adequate amounts of staff are needed to complete the interventions that affect patients outcomes. Nurses who do not have the time or resources they need to do their work are more likely to not complete tasks required to give patients quality care. Stalpers (2015) explain how the specific outcomes of decreased mortality rates, decreased length of stay, better pain

5 NURSE SENSITITVE PATIENT OUTCOMES 5 control and fewer adverse event such as falls and pressure ulcers occur when staffing levels are appropriate. With that being said, it is important for nurse leaders to provide nurses with adequate staffing levels to assure nurses are able to provide quality care for their patients. Collaboration and Nurse Sensitive Patient Outcomes Collaboration includes the relationships between staff including physicians, managers, other nurses and support staff. Janita et al. (2015) explain that nurses working within positive collaborative environments are encouraged to work to best practice and work effectively with multidisciplinary team members which in turn promotes the quality of care provided and results in better patient outcomes (p. 3). Leaders need to promote positive collaborative relationships among staff including nurse and physician communication, teamwork among nurses and interdisciplinary cooperation to name a few. Experience, Education and Nurse Sensitive Patient Outcomes Nurses have a variety of backgrounds and experiences but research has shown that nurses with post graduate degrees were more likely to see the impact patient care has on nurse sensitive patient outcomes then those without post graduate degrees (Schreuders, Bremner, Geelhoed & Finn, 2012). Many of the nurses with post graduate degrees are not working at the bedside but rather in management, education or research. With this being the case the nurses working at the bedside are less likely to see the impact their care has on patient outcomes. As the bedside nurses may not have the background or education in outcome measures, leaders need to educate their nurses on the influence the quality care they provide has on the nurse sensitive patient outcomes. Leadership and Nurse Sensitive Patient Outcomes Leaders at all levels including supervisors, managers, and administrators can have a significant affect on the work environment and care provided to patients. These leaders can also

6 NURSE SENSITITVE PATIENT OUTCOMES 6 have an affect on nurse sensitive patient outcomes. Senior leaders contribute to strategic directions through participation in senior level decision-making and their ability to influence how nursing is practiced and valued at the department and unit levels (Wong, Cummings & Ducharme, 2013). Front line leaders engage nurses in decision-making about patient flow and staffing, quality improvement activities, and continuous learning opportunities to improve overall care delivery (Wong, Cummings & Ducharme, 2013). By influencing front line staff with their guidance and support these leaders are indirectly improving nurse sensitive patient outcomes. Wong, Cummings and Ducharme (2013) also found that a common and beneficial leadership style that improves these outcomes was transformational leadership. White and Griffith (2015) explain how transformational management includes five elements including shared values, empowerment, communication, service excellence and rewards of success. As leaders it is important to provide front line staff with the leadership support they need to give quality care and in turn improve nurse sensitive patient outcomes. Engaging Nurses in Nurse Sensitive Patient Outcomes As discussed, staffing; education and experience; collaboration; and leadership can all influence nurse sensitive patient outcomes. It is important as a leader to have the resources and work environment that can help nurses influence nurse sensitive patient outcomes. Having these resources in place will make the work nurses do easier and outcomes improve. However, front line nurses also need to understand nurse sensitive patient outcomes, the influence they have on these outcomes as well as be engaged in improving them. Burston (2014) explain how opportunities to integrate NSI (nurse sensitive indicators) into nursing care need to be taken to assist in hardwiring these strategies so that they become automatic and routine (p. 8 ). Just collecting and sharing the data is not enough to engage nurses in nurse sensitive patient

7 NURSE SENSITITVE PATIENT OUTCOMES 7 outcomes. Nurses need to be educated on the importance of evidence and outcomes in their practice as well as involved in the processes of measurement and reporting. Engaging by Educating Educating nurses on the importance of nurse sensitive patient outcomes will better engage them in not only measuring the data but improving upon the care they give to better the outcome measures. Front line nurses should be taught about nurse sensitive patient outcomes including terminology, metrics used to measure outcomes and bench marking of this data (Albanese et al., 2010). Front line nurses also need to know the importance evidence based practice has on the outcomes as well as the quality of care it provides for the patients. Jeffs et al. (2013) explain how nurses need to understand that evidence is research based and a proven practice, understand that experience can play into evidence, the relevance of evidence to practice and ultimately be able to link evidence to the outcomes. Teaching front line nurses about nurse sensitive patient outcomes needs to start with orientation and be ongoing through their career. Other strategies to embed nurse sensitive patient outcomes into practice include incorporating this information into meeting, agendas, minutes and hand offs and in documentation of care (Burston, Chaboyer & Gillespie, 2014). Engaging with Participation By involving nurses in the processes involved in nurse sensitive patient outcomes including data collection, measurement and sustainment they will also be better engaged in outcomes. Albanese (2010) explain how front line nurses need to be apart of quality initiative committees and councils to engage then in the work being done towards outcome measures. By allowing the nurses access to the information and involvement in improving quality they will be better engaged in improving the outcomes. Albanese et al. (2010) also explain how clinical

8 NURSE SENSITITVE PATIENT OUTCOMES 8 nurses offer in site into specialty oriented outcomes, measureability of outcomes, development of data collection tools and methods for retrieving data. These front line nurses have valuable information the leadership may not see and their input will not only engage them in the outcomes but help to improve processes used to gather, report and sustain the outcomes. Conclusion Nurse sensitive patient outcomes are and will continue to be a important measurement into the quality of nursing care for patients. As leaders it is important to be aware of the measures that are followed as well as specifics of the work environment that may affect these outcomes. Staffing; collaboration of care; education and experience; and leadership style are all parts of the work environment that can affect the quality of care nurses provide and the nurse sensitive patient outcomes that occur. Leaders need to do their best to provide nurses with a positive work environment so they can do the work that improves care for their patients. It is known that an engaged employee leads to better care for the patients but leaders also need to engage the nurses in nurse sensitive patient outcomes as well. Having nurses educated and participating in these outcome measures will help them be more engaged in the quality care and outcomes for their patients. Though the outcomes are key measurements of quality care the most important element is having a cared for and satisfied patient population.

9 NURSE SENSITITVE PATIENT OUTCOMES 9 References Albanese, M. P., Evans, D. A., Schantz, C. A., Bowen, M., Disbot, M., Moffa, J. S., Piesieski, P. & Polomano, R. C. (2010). Engaging clinical nurses in quality and performance improvement activities. Nursing Administration Quarterly, 34(3), doi: /naq.0b013e3181e702ca Burston, S., Chaboyer, W., & Gillespie, B. (2014). Nurse sensitive indicators suitable to reflect nursing care quality: A review and discussion of issues. Journal of Clinical Nursing, 23(13-14), Foulkes, M. (2011). Nursing metrics: Measuring quality in patient care. Nursing Standard, 25(42), Janita P. C., C., Suzanne H. S., L., K. C., C., Eric L. S., C., Matthew D., M., Danny W. K., T., &... Lee, D. F. (2015). A longitudinal examination of the association between nurse staffing levels, the practice environment and nurse-sensitive patient outcomes in hospitals. BMC Health Services Research, doi: /s Jeffs, L., Beswick, S., Lo, J., Campbell, H., Ferris, E., & Sidani, S. (2013). Defining what evidence is, linking it to patient outcomes, and making it relevant to practice: Insight from clinical nurses. Applied Nursing Research, 26(3), doi:1016/j.apnr Montalvo, I., (2007). The National Database of Nursing Quality Indicators (NDNQI). OJIN: The Online Journal of Issues in Nursing. 12(3), 2. DOI: /OJIN.Vol12No03Man02 Schreuders, L., Bremner, A. P., Geelhoed, E., & Finn, J. (2012). Nurse perceptions of the impact of nursing care on patient outcomes: An exploratory study. Contemporary Nurse: A Journal For The Australian Nursing Profession, 41(2),

10 NURSE SENSITITVE PATIENT OUTCOMES 10 Stalpers, D., de Brouwer, B. M., Kaljouw, M. J., & Schuurmans, M. J. (2015). Associations between characteristics of the nurse work environment and five nurse-sensitive patient outcomes in hospitals: A systematic review of literature. International Journal of Nursing Studies, 52(4), doi: /j.ijnurstu White, K. R. & Griffith, J. R. (2016). The well-managed healthcare organization, 8th edition. Chicago: Health Administration Press. Wong, C. A., Cummings, G. G., & Ducharme, L. (2013). The relationship between nursing leadership and patient outcomes: a systematic review update. Journal of Nursing Management, 21(5),