The purpose of this assignment is to identify nursing care models utilized in today’s various health care settings and enhance your knowledge of how models impact the management of care and may influence delegation. You will assess the effectiveness of models and determine how you would collaborate with a nurse leader to identify opportunities for improvement to ensure quality, safety and staff satisfaction.
Completion of this assignment enables the student to meet the following course outcomes.
CO1: Apply leadership concepts, skills, and decision making in the provision of high quality nursing care, healthcare team management, and the oversight and accountability for care delivery in a variety of settings. (PO2)
CO2: Implement patient safety and quality improvement initiatives within the context of the interprofessional team through communication and relationship building. (PO3)
CO3: Participate in the development and implementation of imaginative and creative strategies to enable systems to change. (PO7)
CO4: Apply concepts of leadership and team coordination to promote the achievement of safe and quality outcomes of care for diverse populations. (PO4)
CO6: Develop a personal awareness of complex organizational systems and integrate values and beliefs with organizational mission. (PO7)
CO7: Apply leadership concepts in the development and initiation of effective plans for the microsystems and/or system-wide practice improvements that will improve the quality of healthcare delivery. (PO2, and 3)
CO8: Apply concepts of quality and safety using structure, process, and outcome measures to identify clinical questions as the beginning process of changing current practice. (PO8)
References and important information:
Week 5 leader Exemplar Audio Transcript
After working a number of years in home health, I made the decision to return to the acute care setting and accepted a full time night position on a very busy and high acuity step down unit. Upon learning of the unit that I would be working on, many of my nurse friends and former colleagues began warning me about the current supervisor on that unit and filling me with self-doubt regarding my ability to perform up to this person’s expectations.
On my first day, I was introduced to my supervisor and preceptor who was none other than Sue, the very person that I had been warned about. Hoping for the best but fearing the worst, I decided to put all of the bad things that I had heard out of my mind and see what happened.
In doing so, I quickly discovered that Sue would become the best supervisor and preceptor that I had ever had. She immediately took a vested interest in my success by sitting down with me each week for coffee and discussing what was going well and not going so well. Together, we worked to establish both short-term and long-term goals for not only my time with her in orientation but my future ones as a member of the staff on the unit. Sue helped me to identify weaknesses within myself by allowing me to reflect on situations rather than immediately pointing them out to me. Likewise, she made it a point to highlight my strengths and provided me with opportunities to put them into use in the practice setting. She provided support and encouragement when needed while at the same time allowing me to grow in my independence and autonomy.
I truly believe that I am the nurse, educator, and leader that I am today because of the leadership, support, and guidance that Sue provided me all those years ago.
Amy Sherer MSN, RN
Assistant Professor, RNBSN Option
Chamberlain College of Nursing
[End of Transcript]
How do we promote quality? Some of these activities include: problem solving to improve communication, integration of the NAS quality and safety standards into everyday practice, and dedication to the National Patient Safety Goals in healthcare as implemented by The Joint Commission (2017). Provider curricula were reviewed, and the performance of root cause analysis of errors and near misses became part of strategies. The result has been an improved work environment and increased nursing leadership in these areas.
Nursing is a key collaborative discipline in addressing patient quality and safety concerns. According to the study by Squires, Tourangeau, Spence-Laschinger, and Doran (2010), nurse leaders and managers create a positive safety climate through quality relationships based on fairness and empathy. It seems that the transformational leader, a leadership style introduced earlier in this course, would be driving quality and safety outcomes.
PI (performance improvement), CQI (continuous quality improvement), TQM (total quality management), QA (quality assurance), QC (quality control), and QI (quality improvement) are all acronyms for programs and initiatives that have been used over the years to monitor the delivery of quality care. Are we dizzy yet with all these acronyms? For the purposes of this lesson, we will concentrate on QI, or quality improvement. And, who should inspire others in these initiatives?
Inspiring quality improvement is a goal for all nurse leaders. It is geared toward unlocking individual potential and assisting staff to provide high quality, safe care at all times while continuously looking for ways to improve that care, as well as the environment where patients receive that care. QI is about inspiring change, a topic discussed in a previous lesson. Fostering an environment where change is encouraged and improvements are expected must be linked to the mission, vision, and values of the healthcare organization regardless of size, care delivery model, or geographic setting.
In addition to the core competencies designated by the NAS, nursing education has placed an increasing emphasis on quality and safety through the Quality and Safety Education for Nurses (QSEN) initiative funded by the Robert Wood Johnson Foundation (2015). These should sound familiar to you. QSEN provides resources and strategies to facilitate learning as it relates to the five competencies of NAS plus safety.
This initiative has provided nursing programs, as well as staff development and continuing education professionals with many tools to teach these six competencies. Visit http://www.qsen.org (Links to an external site.)Links to an external site. to review the pre licensure KSAs (knowledge, skills, and attributes or abilities) and graduate KSAs. While browsing the site, investigate the teaching strategies section to glean ideas about how to integrate QSEN competencies into your nursing education and staff education endeavors.
The Nurse Leader Ponders
“We have utilized several of these initiatives here. Most staff are involved but how do I need to get more of them involved? I wonder if QSEN was discussed in their nursing education programs. Perhaps this is the frame of reference I should use to get more buy in from the staff.”
Just as a dashboard in a car tells you at a glance about its performance, so can a dashboard of the organization help you monitor its performance measures. Remember the Windshield Survey from Community Health. A dashboard (electronic) holds all the quality indicator outcomes in one picture.
Anyone working in an acute care environment has probably heard of nurse-sensitive quality indicators. These have been profiled over the past few years as payment restrictions were instituted by the Centers for Medicare and Medicaid Services (CMS) in October of 2009. Subsequently, insurance companies have followed suit. According to the Managed Care First Report (2011), the no-pay policy is an effort to reduce medical errors. This brought attention to nursing because many of the no-pay situations could be managed or controlled through nursing care. Since then, staffing levels and staff mix have become a major factor in measuring performance.
Somewhat new to the quality scene is Lean Daily Management (LDM). What is it? It is a much disciplined process that gives staff the power to solve problems by providing them with the leadership support and various resources to make improvements in care. On a daily basis, staff make their concerns about workflow problems known to the executive (top) leadership in the organization. A hallmark of the management process is the Safety Huddle. Many units/departments begin their day with a safety huddle which allows for identification and allocation of resources. Some of these resources can be staffing, acknowledging patient safety issues and concerns from various stakeholders. Prioritization of problems seems to be a hallmark of the safety huddle. Interestingly enough, this is led by the Chief Executive Officer. One cannot argue with a system that involves executive team involvement on a daily basis with the outcomes being directly related to patient safety and quality of care.
One cannot complete a lesson on Performance Improvement/Quality/Safety Initiatives without learning more about the term Just Culture. In early 2010 the American Nurses Association Board of Directors adopted its new position statement proposed by the Congress on Nursing Practice and Economics related to Just Culture (ANA, 2010). This updated position statement emphasized the support by the ANA of the Just Culture concept and how it is used in health care to improve safety. The ANA continues to support collaboration of the various boards of nursing, professional nursing organizations, hospital associations and others in developing Just Culture initiatives. The just culture model (from the aviation industry) provides for an environment where one is encouraged to report mistakes instead of ignoring or hiding them. In this environment practitioners should not be accountable for failures related to systems over which they have no control. It operationalizes a non-blame principle where process improvement is the outcome. Prevention of future errors is a result.
The Nurse Leader’s role in promoting a Just Culture work environment cannot be overestimated. Staff need to know that patient safety is everyone’s responsibility, avoiding blame and supporting a culture of safety for patients, their families and the staff who provide the highest quality care for them.
“This has been a busy week but since my job is all about improving quality in home care, I found the topics very interesting. I still have much to learn and I may share some of this with my Nurse Leader. I know I have one more Assignment to complete but that is not until the end of next week. I have not done a PowerPoint assignment….ever…so I need to use the website that was recommended by my instructor and get started on this.”
This week, we broached the subject of quality improvement, an issue that faces nurses in all practice settings. This core competency is important to all nurses, especially nurse leaders. QSEN was introduced as an initiative providing resources for nurse educators. And, Lean Daily Management and Just Culture were introduced. Becoming more familiar with these topics is important. The emphasis on safety in today’s healthcare environment cannot be ignored. Our patients are counting on us.
American Nurses Association. (2010). Position statement: Just culture. ANA. Retrieved from http://nursingworld.org/psjustculture
Centers for Medicare & Medicaid Services (CMS). (2011). CMS is the latest to deny payment for hospital-acquired conditions. Managed Care First Report Daily News. Retrieved from http://www.mccfirstreport.com/show_story.php?newsid=6697
Finkelman, A. (2016). Leadership and management for nurses: Core Competencies for quality care (3rd ed.). Boston, MA: Pearson.
National Safety Academy. (1999). To err is human: Building a safer health system. Retrieved from http://nationalacademies.org/hmd/reports/1999/to-err-is-human-building-a-safer-health-system.aspx
Quality and Safety Education for Nurses (QSEN). (2015). Competencies. QSEN. Retrieved from http://qsen.org/competencies/
Squires, M., Tourangeau, A., Spence Laschinger, H. K., & Doran, D. (2010). The link between leadership and safety outcomes in hospitals. Journal of Nursing Management, 18(8), 914–925.
The Joint Commission. (2017). National Patient Safety Goals. TJC. Retrieved from http://www.jointcommission.org/standards_information/npsgs.aspx