The Role of Nursing Leadership in Hospital Quality Improvement - Term Paper Example

? Introduction: The recent era has witnessed a significant stress on quality improvement of hospitals. Even though this is not a novel concept, however, with the increasing pressure to participate and achieve the wide range of QI activities, the hospitals have to utilize all their resources in this regard. Kelly (2009) stresses on the significance of management and leadership assurance to the success of QI efforts. Nurses and nursing administrators are fundamental part of patient care and therefore have an enormous responsibility to participate in these activities (Draper et al. 2008). Chao (2007) demonstrated four main points in the role of nurses and nursing administrators in QI. These principles include, outline of QI programs at education level, approaches to implement performance improvement, barriers/challenges in progression of QI and indicators of success in these QI activities. This article focuses on the role of nursing administrators/managers in key quality improvement activities, factors or barriers affecting nursing manager’s involvement in hospital quality improvement activities and initiatives that can change the role of nursing managers in hospital quality improvement. The escalating demand of hospital quality improvement issues has serious implications on the role of nursing mangers and nurses. They are the largest deliverer of health care. Nursing executives are in particular well positioned to observe effective implementation of evidence based practice and work procedures that render support to professional nurses in delivery of care in health care institutions (Kelly, 2009). They affect the quality of care that patients receive during their hospital stay as they spend most of their time at patient's bedside. Nursing managers are vital in assessing the status and quality of health care services and efforts that lead to improvement of service processes of clients in a health care setting. They are at an optimal position to establish the need for transformation in service delivery processes. Vision of a nursing executive and utilization of necessary resources to initiate and implement the QI efforts are vital for a successful hospital setting. Nursing managers assist the reforming of health care environment through encouraging and empowering the nursing staff about their quality improvement of patient care (Moran and Johnson, 1992). QI is a persistent process that involves mutual efforts and labor at all the levels of an organization to deliver better services to health care clients. It is attained as a result of positive interactions among various departments of a hospital to devise a progressive system that constantly improves the processes and outcomes of health care. The concept of QI comprise of quality assurance and problem resolution (Moran and Johnson, 1992). The multitude of hospital quality improvement activities involves participation in external programs sponsored by accreditation and regulatory bodies, QI organizations etc. Also, several hospitals participate in internal QI activities which are derived from employee and patient feedback (Draper et al., 2008). According to Hassmiller and Needleman (2009), the integration of nursing managers into decision making bodies of hospital provides improved quality of care and hospital efficiency. The initiation and progression of Magnet accreditation programs escalates the participation of nursing leadership in hospitals. The basis of magnet appraisal provided by American Nurses Credentialing Center (ANCC) is based on strong nursing representation in organization’s leadership structure, deployment of nursing manager that have a role in hospital’s executive leadership, a shared governance operational system in nursing and authoritative powers of nursing leadership at all functioning level of hospital. Initially the concept of magnet status was based on attracting retention and job satisfaction among nurses however, later it was revealed that it is associated with improved hospital quality and patient care. Another accreditation program that focuses on strengthening of nursing leadership is Transforming Care at Bedside (TCAB) launched by Robert Wood Johnson Foundation and Institute of health care improvement. Nursing education is another important aspect of refining the QI skills of new graduates. In this regard, the development of Clinical Nurse Leader is a step forward towards the right direction. CNL is to be educated to implement QI strategies; outcomes based practice and management of various levels of systems of care delivery. Hospitals should be involved and participate actively in such programs to achieve organizational QI and efficiency of patient care (Hassmiller and Needleman, 2008). CNL role was developed as a result of considerable stress on health care delivery system and organizational effectiveness in terms of financial aspects. CNL offers an opportunity for revolutionary nursing role in implementing QI and exploiting health care quality while lowering financial burden (Stanley et al., 2008). Nursing leaders are the enterprise for quality improvement in hospitals with the help of their operational and clinical proficiency. Nursing administrators are responsible for the quality of care, formulating nursing quality initiatives that improve the patient outcomes in a health care setting (Mastal, Joshi and Schulke, 2007). Nursing leaders should be well acquainted with organization's goals and vision in order to implement QI strategies. Nursing leader's approach to the solution of QI issue is based on improvement strategies and initiatives of staffing related, work process associated and environment related improvements (Mastal, Joshi and Schulke, 2007). Some of the fundamental principles which nursing leadership should imply in the course of their practice to improve quality of health care setting include: Identification and assistance of nurses and physicians to champion quality improvement activities which not only aids in empowering staff but also in progress of these QI initiatives (Draper et al., 2008). Work in coordination with hospital management team to highlight the important features of patient care and safety. Constant training of QI measures and nursing sensitive measures to the staff nurses. Practical interpretation of evidence based data and the integration of such data to overall organizational QI goals. The manifestation of association between nursing quality care, patient safety and financial and management aspects of a hospital to the decision making committees. Highlight the importance of team work at all levels of a hospital and serve as an effective and efficient model for quality care delivery. Recommendations: Quality is a mutual responsibility and along with nursing mangers every nurse and employee should participate in it (Draper et al., 2008). Some of the QI efforts recommended for nursing administration include establishment of standards and making staff liable for individual roles, inspiring nurses to champion efforts, maintenance and presentation of valuable feed back to the nursing staff for future motivation and encouragement, engaging nursing staff at all levels of QI activities from bedside to management and modification in traditional nursing education that does not prepare nursing staff for their advanced role in contemporary health care settings. In this regard, emphasis on QI skill development and effective implementation of these activities in a hospital setting are required. Mastal, Joshi and Schulke, (2007) recommend the integration of nursing administrators in quality improvement initiatives and decision making committees is vital due to the presence of a knowledge gap among hospital governing bodies and quality health care. Also, the limited knowledge about quality of care and patient safety makes the hospital leaders unlikely candidates for quality improvement strategies. According to Stanley et al., (2008), the general strategies for quality improvement of hospital care is unusually similar worldwide i.e. directed towards organization’s macro levels whereas, these measures should focus on nursing leadership and staff. Similar results were reported by Krogstad et al., (2005) concluding that in order to achieve QI goals and organizational success efforts should be focused on micro levels i.e. nursing ward management instead of macro levels i.e. hospital management. Challenges: Nursing administration may find it difficult to manage high level of administrative burden linked with these activities. Similarly, the conversion of scientific data into useful form of experiential learning is a tiresome process which involves patient hospital stay and feedback etc; however, the involvement of nursing staff in such experiential learning is foundation for QI strategies and measures (Chao, 2007). Conclusion In the recent decade, hospital quality improvement is a challenge as the demand for quality is escalating day by day, with crucial resources like financial shortages, scarcity of nurses etc becoming limited. Nursing leadership play a focal role in QI of health care settings. The hospitals have to adapt and pursue schemes/projects that significantly contribute to achievement of quality, patient care and performance goals. In this regard, optimization of nursing administration roles is vital for smooth operation of QI activities. Challenges and barriers should be identified and effectively removed for sustainable QI of a hospital. References: Chao, S. (2007).Advancing quality improvement research: challenges and opportunities. Institute of Medicine (U.S.).Forum on Science of Health care quality improvement and implementation.National Academies Press, Washington DC.4-19. Draper, D. A., Felland, L. Liebhaber, A. and Melichar, L. (2008).The role of nurses in hospital quality improvement. Centre for studying health system change. Research brief no. 3. www.hschange.com/CONTENT/972/972.pdf Kelly, P. (2009). Essentials of Nursing leadership and management.Cengage learning. U.S. 299-303. Krogstad, U., Hofoss, D., Veenstra, M., Gulbrandsen, P. and Hjortdahl, P. (2005).Hospital quality improvement in context: a multilevel analysis of staff job evaluations. QualSaf Health Care. 14:438-442. www.qshc.com. Mastal, M., Joshi, M. and Schulke, K. (2007).Nursing leadership: championing quality and patient safety in boardroom.Nursing Economics. http://findarticles.com/p/articles/mi_m0FSW/is_6_25/ai_n24946894/ Moran, M. and Johnson, J. (1992).Quality improvement: The nurse’s role. American Nurses Association Publications (NP-807.5M): 45-61. Needleman, J. and Hassmiller, S. (2009). The role of nurses in improving hospital quality and efficiency: Real world results. Health Affairs 28, no. 4. Pp. 625-633. Stanley, J., Gannon, J., Gabuat, J., Hartranft, S., Adams, N., Mayes, C., Shouse, G., Edwards, B. and Burch, D. (2008).The clinical nurse leader: a catalyst for improving quality and patient safety. Journal of Nursing Management, 16, 614-622. Read More