Topics: Nursing, innovation, quality

“Nurses are the heart of healthcare.” Donna Wilk Cardillo
In the OR, in the wards, and at the bedside – nurses have some of the most intensive contact with patients and perform many, if not most, of the numerous front-line tasks required to keep the care process working. Whether it’s caring for wounds, taking patient histories or capturing documentation in the EHR, nursing is a very high-touch profession – and is, perhaps, the most patient-centric role within the hospital. With such rich and intensive daily work, one might guess that nurses would be at the forefront of medical innovation, however it is still uncommon to have the words ‘nursing’ and ‘innovation’ in the same sentence. This disconnect is mirrored in the world of funding as well: at the National Institutes of Health, the National Institutes of Nursing Research (NINR), the institute dedicated to nursing innovation, commanded only a steady ~0.5% of the NIH budget over the last decade, despite being one of just 27 institutes.

It’s a question worth asking: why aren’t nurses more central to the innovation process?

The answer is undoubtedly a complex one, however the following list contains some potential barriers to nurse-driven innovation:

  1. TRAINING: Nurse education has historically been tightly focused on clinical knowledge rather than new process development, strategic thinking or business-driven analyses. As a result, the do-ers are left with fewer tools to solve the problems they know so well.
    THE GOOD NEWS:This may be starting to change, with the American Association of Colleges of Nursing supporting deeper academic training and more emphasis on the nurse as a strategist rather than solely the ‘doer.’ New programs specifically focused on Nursing Innovation have recently been developed at Drexel (MSN in Innovation) and Arizona State University (MHI Health Innovation). For this education gap to close, however, nurses need to understand more about the cost of the care they are providing.

  2. STATUS QUO: As a front-line staff-member, challenges and pain-points for nurses were long seen as part of the role rather than solvable problems. As a result, difficulties in care and information sharing were shared, and workaround collected, however the systematic definition of new value seemed too disruptive for the traditional nursing role.
    THE GOOD NEWS: Human resource pressures in healthcare mean that staffing shortages are a regular occurrence, and necessity is the mother of invention. Nurses are taking on increasingly innovative leadership roles as they work to do more with less. Healthcare is changing, especially with the penalty regime instituted as part of the Affordable Care Act, and the key foci – readmissions, preventable errors and patient satisfaction – all lie directly in the domain of the nursing staff.

  3. ORGANIZATIONAL HIERARCHY: In the hospital the administrators and physicians have the primary operational and clinical authority, and the nurses, while acknowledges as critical to the function of the clinical environment, weren’t seen as a primary source of data for clinical or workflow problems, nor were they empowered to address the problems that were acknowledged as pressing issues. The higher status of physicians in the healthcare hierarchy is long-standing, and physicians have a highly competitive screening educational process. At the same time, the physicians with the most specialized clinical knowledge often lack systems knowledge of the breadth of care within the hospital, as well as some of detailed mechanics of care that happen between their patient rounds. While in no way is this gap in perspective due to lack of intelligence or competence – quite simply, it’s just the nurse’s job. Finally, for nurse-focused initiatives, it is often administrators who design changes to nursing staff protocol and process, with nurse engagement seen as a means to get buy-in rather than a source of independent value.
    THE GOOD NEWS: Nurses see workflow and care-related problems in a way few other stakeholders do. Nurses tend to have a greater awareness of and priority on patient satisfaction, and overcoming the widespread logistical hurdles to effective care delivery are a critical part of their daily activity. Luckily, there is space for nurses to be drivers of innovation, rather than solely the ‘doers.’ After administration-driven approaches have been completed, and problems remain, nurses’ role becomes elevated in the discussion of strategic approaches to improving hospital quality. Increasingly, front-line teams are being asked to contribute to the design of new solutions, however there are still challenges in supporting risk-taking due to the hierarchy within teams and organizations.

  4. Although there are more reasons why nurses don’t fill as many of the leadership roles as might be justified by their critical role within the hospital, there is one big reason why nurses need to be at the center moving forward:

    Nurses have the best vantage-point on hospital workflow and the patient experience.

    With tremendous time and exposure to direct patient care, nurses have first hand experience with the barriers to higher quality care and, often, a good idea of what avenues for exploration can yield innovation. Hospital workflow has caught the attention of the healthcare world – both because good workflows provide efficiency, and because because well-designed workflows support higher care quality care delivery and minimize the likelihood for error. As primary executors of care, the day-to-day work of nurses makes them irreplaceable experts and a rich source of data and awareness of front-line needs. Looking forward, clear focus and priority on the most important needs is the heart of meaningful innovation, and few can do that better than nurses.


    Tico Blumenthal

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