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Proving Our Worth in an Evolving Environment of Care

DEBI BOYLE MSN, RN, AOCNS, FAAN | March 04, 2019
Contemporary nursing practice can best be characterized by 5 major themes: constant change, rapid technological advancement, evolving workforce diversity, demands for documentation, and demonstration of outcomes.

Healthcare practices related to these prominent foci have evolved and grown exponentially since the 1990s. Beginning with the advent of novel technology such as pumps, central venous access devices, and finely tuned monitors and diagnostics, the landscape of cancer care radically changed. This evolution was further affected when more advanced technology and electronic medical records entered the practice setting.

GENERATIONS WORKING TOGETHER


The current nursing workforce is unique. It marks the first time that 4 generations with disparate characteristics are practicing side by side. Baby boomer nurses (the oldest in the workforce, born between 1946 and 1964, with many now considering retirement) practice alongside the Gen Xers (born between 1965 and 1976), the Gen Yers (or millennials, born between 1977 and 1995, who currently make up the largest generation within the overall US workforce), and the Gen Zers (the newest of nurses, born after 1995).1,2 Vast and rapid social changes that occurred during each distinct generation gave each one its own defining qualities. The intergenerational reality of these groups working together poses unique relationship challenges based on expectations and values of the various cohorts within the healthcare setting.3 Differences in work ethic, engagement, and professional commitment have been documented.

QUANTIFYING THE VALUE OF NURSES’ WORK


Contemporary nursing continues to struggle with the integration of computerized documentation and approaches to systematically quantify outcomes of nursing practice. Many nurses consider this “extra work” and see it as labor intensive. There is much we can learn from our colleagues in other areas of healthcare who view documentation as an unequivocal necessity. Physical and speech therapists, social workers, and surgeons readily describe the positive changes based on their interventions in range of motion and mobility, diction, swallowing, coping, home reentry, and the extraction of tumors with exquisite detail. This variance in value estimation between nurses and their colleagues may be related to reimbursement.

The lack of documentation and reticence in embracing the need to quantify outcomes has significant repercussions for the nursing workforce, in areas including staffing decisions, the creation of new positions, and the allocation of monies that fund quality projects. To embrace the challenge of quantifying nurses’ work, nurses could partner with experts in their institutions, whether in the quality or finance department, to learn how to assign measurable value.

DEFINING MEASURABLE OUTCOMES


Demonstrating quality outcomes alone may not get the message about the nurses’ role as agents of change across to major stakeholders and decision makers. Rather, every project to improve patient care or enhance the delivery of nursing care must have both quality and financially measurable outcomes. In my past, I had the unique opportunity to work as a clinical nurse specialist in a setting where the hospital’s quality division assigned its staff to partner with all units. These quality specialists were nurses who knew where to find patient and financial data. They were members of all our committees, whose main goal was to assist the unit leadership in calculating the effects of nursing interventions. For example, these quality nurse experts helped the critical care team quantify the impact of a nurse-led initiative to aggressively ambulate intubated patients and reduce their length of stay. Use of this ambulation protocol resulted in over $1 million in cost savings from decreases in ventilator requirements, the need for respiratory therapy, medications, and daily intensive care unit charges. The operating room nurses lobbied their way onto a materials management committee when they identified that products were being purchased based on cost alone and not also on quality.

These nurses’ highly specialized consultation on instrument and product procurement resulted in both reduced cost and increased efficiency. Finally, over a 6-month time frame, a 30% reduction in cases of acute confusion in older patients was documented when a delirium scale was used upon admission and an early intervention protocol was implemented. This led to a decreased use of sitters and an overall reduction of charges to the unit.

Although these examples offer poignant cases demonstrating the possibilities for comprehensive outcomes documentation, a caveat is in order. Respect of the nurse’s role as a vital member of the multidisciplinary healthcare team needs some serious public relations assistance. Nursing excellence must be appreciated by those in powerful positions, and a process to facilitate this recognition needs to be established. Ask to be put on meeting agendas to share nursing initiatives. Consider which institutional leaders need to be educated about nursing work. Send them exemplars that depict successful nurse-led change initiatives and annual reports citing nursing accomplishments. These written testimonies need to be disseminated widely.

INTO THE FUTURE


Again, there are 5 distinct contemporary expectations of nurses today. We must anticipate and embrace transition and consistently demonstrate flexibility. We must be technologically savvy and sensitive to generational diversity. Lastly, we must move beyond the perception of practice documentation and outcome measurement as extra work and embrace them as vehicles for demonstrating nursing excellence. One hundred and sixty years ago, Florence Nightingale said, “Nursing is a progressive art, such that to stand still is to go backward.”4 Are you on the move?

References

1. Generational breakdown: info about all of the generations. The Center for Generational Kinetics website. genhq.com/faq-info-about generations. Published 2016. Accessed January 15, 2019.
2. Jobe LL. Generational differences in work ethic among three generations of registered nurses. J Nurs Admin. 2014;44(5): 303-308. doi: 10.1097/NNA.0000000000000071.
3. Shacklock K, Brunetto Y. The intention to continue nursing: work variables affecting three nurse generations in Australia. J Adv Nurs. 2012;68(1):36-46. doi: 10.1111/j.1365-2648.2011.05709.x.
4. Nightingale F. Notes on Nursing: What It Is and What It Is Not. London, United Kingdom: Harrison Bookseller to the Queen; 1859.

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