• More Hospitals Meeting Nursing Standards, 4 of 10 Still Fall Short

    New Leapfrog Group report finds 40 percent of reporting hospitals fall short of safety standards relating to the nursing workforce

    By Debra Wood, RN

    Linda Walton: Nurses’ safe practices support quality care

    Although hospitals have made nursing workforce improvements, 40 percent of acute care facilities voluntarily providing data to The Leapfrog Group failed to comply with safe practices on nursing workforce, according to the nonprofit watchdog’s latest nursing standards report.

    “The ability to keep patients safe and have the [desired] outcomes is dependent on a number of things: we have the right number of staff, staff with the competencies and knowledge to care for that patient, and that we invest in them and provide an environment where nursing practice can flourish,” said Linda Walton, RN, MSN, CENP, chief nursing officer at South Lake Hospital in Clermont, Fla., which fully complied with the standards.

    Donna Giannuzzi: Nursing standards for safety are paramount

    “The outcomes oftentimes are reflected in the care we provide patients,” added Donna Giannuzzi, RN, MBA, NEA-BC, chief patient care officer at Lee Memorial Health System, which fully complied and has been on a safety journey for more than five years. Every unit has a safety coach to watch for unsafe situations and report them at daily safety briefings. When these incidents occur, involved departments must follow through with determining what happened and how to prevent something similar in the future.

    The critical role of nurses in safety practices

    Leapfrog Group created the Nursing Workforce Safe Practices Report, separate from their Hospital Safety report, “because nursing is critical to the quality and safety of every hospital in the United States, and we thought we had to highlight how hospitals were doing,” said Leah Binder, president and CEO of The Leapfrog Group.

    “It is important to have a key group of driven nurses,” said Christina McGuirk, RN, BSM, MSHA, NEA-BC, chief nursing officer of Health Central in Ocoee, Fla., which fully complied. “When you have an engaged team that understands the whys of what we want to do, it filters into creative ways to change process that enhance outcomes of our patients.”

    To meet the Leapfrog nursing standard, hospitals must comply with all 21 of the National Quality Forum-endorsed safe practices or achieve American Nursing Credentialing Center (ANCC) Magnet Status, which recognizes nursing excellence. Sixteen percent of Leapfrog-reporting hospitals have received the Magnet designation, including Holy Cross Hospital in Fort Lauderdale, Fla., and Loyola University Health System in Chicago.

    How hospitals engage nurses

    Ginger Hook: Safe practices rely on nurse staffing

    Ginger Hook, MSN, RN, vice president and chief nursing officer at Loyola Gottlieb Memorial Hospital, Melrose Park, explained how practice councils give bedside nurses a voice in decisions about quality improvements. Nurses monitor hand washing and pressure ulcer rates and come up with ways to enhance care.

    “Decisions are being made at the unit level, and from there the recommendations go up to administration saying ‘This is how we are going to do it,’ based on evidence,” added Tracey Melhuish, MSN, RN, CCRN, clinical practice specialist at Holy Cross.

    Hospitals are doing well on several nursing metrics. While the vast majority of hospitals have a nurse at the senior level, 15 percent of those reporting do not. Hospitals also are doing well with conducting staff education, dedicating staff time to reduce adverse events and holding staff accountable for performance. Hospitals are doing less well at providing unit level safety reports to leadership and the board and annually reporting to the public about staffing goals.

    Walton attends South Lake board meetings and reports progress on quality measures. South Lake has reduced pressure ulcers since implementing a wound and skin resource nurse on the units and had decreased catheter-associated urinary tract infections.

    Nurses can view the complete report on nursing best practices in the Hospital Survey Report, or access data on the top hospitals via the Leapfrog Hospital Survey results.

    Christina McGuirk: Transparency engages the nursing workforce

    Sharing the good and the bad

    If a hospital doesn’t report or the score is low, Binder suggested nurses ask leadership about reporting and what the hospital is doing to improve the score and to promote the level of safety. Nurses also can discuss the standards at staff meetings.

    Those hospitals that complied with all of the nursing standards routinely post data about quality and safety.

    “You have to share the data and opportunities, and then engage front line staff to be active in those changes,” McGuirk said.

    Health Central has posted learning boards in the nursing unit, with quality data and opportunities for team members to come up with solutions for improvement. Team members huddle before and at the end of shift to discuss potential risky situations, so everyone is aware of concerns and can focus on that. Since implementing the board, annual hospital-acquired infections have dropped from eight to zero the following year.

    “It’s about providing an environment that the team feels ownership, and they make the change,” McGuirk said. “Our job as leaders is to listen, provide a vision and remove barriers for them.”

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