Читать книгу Kelly Vana's Nursing Leadership and Management - Группа авторов - Страница 274

Source: Adapted from Jeffs, L., Baker, G. R., Taggar, R., Hubley, P., Richards, J. et al. (2018). Attributes and actions required to advance quality and safety in hospitals: Insights from nurse executives. Nursing Leadership, 31(2), 20‐31. doi:10.12927/cjnl.2018.25606

Discussion: The article describes qualitative research conducted to explore nurse executives' understanding of and engagement with patient safety and quality improvement. Three themes emerged: 1) being a strategic and system thinker while possessing emotional intelligence and influencing staff; 2) building credibility and relationships with point‐of‐care staff, board of directors, and the leadership team; and 3) creating a culture of safety and high reliability.

Implications for Practice. Study findings are helpful for nurse leaders at all levels to enhance their knowledge, attitudes, and skills in quality and safety.

The Structural Empowerment component of Magnet addresses the need to create structures and processes that allow nurses to practice safely and effectively. For example, one source of evidence related to Structural Empowerment calls for clinical nurse involvement in interprofessional decision‐making groups at the organizational level. Five of the 13 Structural Empowerment sources of evidence address nursing's role related to quality and safety. Both the Transformational Leadership and Structural Empowerment components of Magnet require the active engagement of nurses.

The Exemplary Professional Practice component of Magnet indicates that “achievement of exemplary professional practice is grounded in a culture of safety, quality monitoring, and quality improvement” (ANCC, 2017, p. 40) and that “[n]urses participate in safety initiatives that incorporate national best practices” (ANCC, 2017, p. 41). Many of the Exemplary Professional Practice sources of evidence require documentation of safe nursing practices. For example, all organizations that provide inpatient care are required to report on two nurse‐sensitive clinical indicators: patient falls with injury and hospital‐acquired pressure injury, stages 2 and above. The hospitals must report two additional measures from a list that includes: central line‐associated blood stream infection, catheter‐associated urinary tract infection, Clostridium difficile, Methicillin‐resistant Staphylococcus aureus, venous thromboembolism, peripheral intravenous infiltrations, physical and sexual assault, and device‐related hospital‐acquired pressure injury. Two ambulatory indicators must also be reported. The performance on each of the six indicators must exceed the mean or median value for the majority of units the majority of the time to meet Magnet standards. Other sources of evidence require examples of nurse partnership with patients and/or families to influence change in the organization; and improved outcomes related to the professional practice model, interprofessional collaborative plan of care, interprofessional quality improvement activity, interprofessional education, and clinical nurse involvement in the evaluation of patient safety data at the unit level. Last, nurse safety is also addressed within the Exemplary Professional Practice component. Organizations must provide an example of an improved workplace safety outcome for nurses specific to workplace violence.

The New Knowledge, Innovations and Improvements component of Magnet requires nurses to use evidence and innovation for safe, high‐quality care. Last, the Empirical Outcomes component of Magnet requires the organization to continually assess and monitor a variety of indicators for nursing leadership and clinical practice. Sustained quality performance on empirical outcomes will move an organization on the journey to becoming an HRO.