As we approach the start of National Nurses Week, it’s once again time to commend the work of those in the nursing community for all they do to improve the health of communities across the world.
With more than 3 million members, nurses represent the largest segment of the healthcare workforce. Leading the way for this workforce are chief nursing officers (CNOs) at healthcare organizations everywhere. When I consider the various members of a hospital C-suite, I often see CNOs juggling the most diverse responsibilities compared with other members of the executive team.
CNOs are responsible for quality, safety, patient satisfaction, labor, regulatory compliance, budgets and the educational/professional advancement of the members of their team.
During the last 3 years, more than 270 nurse leaders have participated in Premier’s CNO Network, an effort that focuses on the advancement of the nursing profession through education, knowledge sharing and networking.
It’s apparent that the healthcare landscape is rapidly evolving, and the CNOs involved in our network are stepping up to share their experiences and challenges, so that the profession is better equipped to address issues facing the healthcare industry as a whole.
In an effort to meet the needs of its members, the CNOs in our network have identified several issues for which they have engaged in additional education and dialogue. Here are the top 5:
1. The future of nursing. Now the Institute of Medicine has called attention to the profession
In its report on The Future of Nursing, the IOM had 4 messages for nurses:
- Practice to the full extent of their education and training
- Achieve higher levels of education and training through an improved education system that promotes seamless academic progression
- Partner with physicians and other healthcare professionals in care redesign
- Effective workforce planning and policy making require better data collection and an improved information infrastructure
Of these messages, the one that has garnered the most focus by our network is the suggestion that nurses should achieve higher levels of education and training.
Many of our members are implementing strategies, processes and new policies to ensure that by 2020, 80% of their nursing workforce has attained at least a bachelor’s degree.
2. Quality and safety. Showing success is not for the faint of heart
Less than a decade ago, quality was measured by a handful of process measures that did little to assess the safety of care delivered or the associated patient outcomes.
That’s no longer the case.
For the last several years, CMS has mandated new and expanding measures. And the overall stakes have been raised through the Affordable Care Act.
Now, a hospital’s financial results are forever tied to performance on quality metrics, patient outcomes and safety results. Oh – and if that isn’t enough, nurse leaders need to ensure that there’s:
- A just culture
- Effective ways for reporting actual harm events or “near misses”
- Effective teamwork and communication
- Understanding of the various measures of performance and acting upon opportunities for improvement
Sound simple? Not so much.
3. Patient satisfaction is so “yesterday”… It’s all about patient and family engagement
For decades, hospitals have focused on improving patient satisfaction results.
However, CMS changed the game slightly when it decided to publish hospital-specific HCAHPS (patient experience) scores.
Then, to further raise the stakes, these HCAHPS scores became part of the value-based purchasing (VBP) equation effective with fiscal year 2012.
All of a sudden, new challenges were identified:
- Physician and/or nurse communication
- Appropriate education about medication or discharge processes
- Pain management
- Cleanliness of the patient’s room
- Quietness of the environment (What! A hospital is supposed to be quiet??)
But the bar is being raised again!
The new trend is to ensure effective engagement of patients and families in care delivery. More progressive organizations are picking up on these trends, such as:
- Eliminating “visiting hours” for families (families aren’t visitors!)
- Conducting bedside shift reports during which patients and families are involved in the discussion
- Multidisciplinary rounding at the patient’s bedside
- Ensuring that patients/family members serve active roles in all hospital committees
4. Healthcare reform/the Affordable Care Act. It’s a challenge to manage the complexity
With the rush to get the legislation passed, there was little clarity about the impact it would have.
With more than $270 billion being taken out of hospital reimbursement (due to greater transparency, and new and advanced performance measures tied to reimbursement), let’s agree that the legislation was a game-changer for the industry.
Nurse leaders now need to ensure that:
- Quality and safety targets are achieved
- Mortality declines
- Care is delivered efficiently – not only within the acute care setting, but in the 30 days post-discharge
- Readmissions are reduced (while trying to keep the CFO happy who advocates for “heads in beds” to meet financial targets)
- Patients are satisfied with their experience of care
As if that isn’t enough, nurse leaders are dealing with declining acute care admission rates, decreased levels of reimbursement and increased need for providing care in the non-acute setting.
No nurse leader feels he or she has it all figured out. Vigilance is the key. CMS periodically provides changes to the VBP and payment penalty programs, and new legislation is frequently signed which further complicates the process.
5. Nursing workforce. How effective is your crystal ball?
One of the greatest challenges for nurse leaders is the ability to prepare for workforce needs. If it was just staffing models that needed to be addressed, then there would be little need to focus on this.
However, with decreasing reimbursements and other financial pressures facing hospitals, we’re finding greater incidences of staffing reductions at hospitals across the country. And with declining admission rates, it’s often difficult to effectively project nurse staffing needs for the long term.
But staffing is just part of the equation.
There are other issues for consideration, such as staff engagement and satisfaction, safety, involvement in quality and safety improvement efforts and (as noted before) preparing the workforce to achieve the 80% baccalaureate target cited in the IOM Report.
The needs of the nursing workforce are changing quickly, and it’s incumbent on CNOs to effectively manage the numerous issues their workers face.
At no time in history have the challenges been greater for CNOs. However, progressive leaders in Premier’s CNO Network are continually networking and sharing information to better prepare for what the future holds. I am so proud of what this group has accomplished, and I know their efforts will positively influence hundreds of thousands of nurses across this country, as well as the patients they serve.
Have something to add to this list? Let me know in the comments below.
Carolyn Scott
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Excellent article outlying the many challenges Nurse leaders are dealing with day to day in this countries complex and ever changing healthcare system. We need more exceptional Nurse leaders like Carolyn Scott.