Bringing Economics and Quality Together: Imperatives for Nurse Executives: Part 2-What's Making a Difference at the Bedside?
What's Making a Difference at the Bedside? Isn't that the essence of leading nursing practice in any environment? How will the shakeup in Congress affect the current health care reform legislation? I think of all the efforts in the "70"s to create family-centered care for all patients from the elderly to newborn infants and am concerned that as we experience so much conflicting interests in attempting changes in health care, we will bypass the patient care we are such strong advocates for. It was an exhilarating experience to be able to attend the Magnet conference in Phoenix in October 2010 and see almost 6500 nurses excited about our profession and what we stand for---the patient and the family. It reminded me of the American Nurses Association Conventions of old, which I attended faithfully for years, since graduating in 1955 from Marquette University College of Nursing. With renewed energy and excitement about the profession of nursing and patients we serve, this issue of NAQ has special meaning as we face tremendous challenges to meld together fiscal responsibility, quality-of-care concerns, and keeping the "patient" foremost in our vision.
Elaine L. Cohen, EdD, RN, FAAN, Associate Chief, Nursing Quality Improvement/Safe Patient Handling & Movement at the James A. Haley Veterans' Hospital in Tampa. Florida is guest coeditor for this issue, part 2 of Bringing Quality and Economics Together: Imperatives for the Nurse Executive. Dr Cohen is known nationally and internationally for her work in nursing case management, leadership, care coordination, quality, and patient safety. She is a very prolific writer and presenter, influencing the greater health care community. She holds 2 AJN Book of the Year Awards: 1996 and 1999. She is an inspiration to colleagues and students alike to realize the impact of nursing practice on quality patient care.
Patti Crome, MN, RN, CNA, FACMPE, Principal and Senior Partner of the Rona Consulting Group, which uses lean methodologies to support organizations in the transformation of health care and pursuit of patient safety and quality, is coeditor and brings a strong leadership background as former senior Vice President of Virginia Mason Medical Center in Seattle, Washington. In this integrated health care system, her administrative responsibilities included daily operations, strategic planning, and fiscal management of a $300 million budget and 2500 employees. Her leadership in quality and patient safety, integrating ambulatory care with hospital care, paves the way for nurse executive imperatives, making a difference at the bedside.
Patti Crome, MN, RN, CNA, FACMPE, Principal and Senior Partner of the Rona Consulting Group, which uses lean methodologies to support organizations in the transformation of health care and pursuit of patient safety and quality, is coeditor and brings a strong leadership background as former senior Vice President of Virginia Mason Medical Center in Seattle, Washington. In this integrated health care system, her administrative responsibilities included daily operations, strategic planning, and fiscal management of a $300 million budget and 2500 employees. Her leadership in quality and patient safety, integrating ambulatory care with hospital care, paves the way for nurse executive imperatives, making a difference at the bedside.
Making a difference at the bedside is a challenge for all nurse leaders, and when you have the opportunity to lead such powerful change and create a truly professional practice environment for the primary benefit of the patient and his or her family, there is unlimited potential. I was fortunate to be able to plan and lead a national family-centered care conference: "Changing the Health Care System: Family-Centered Care," June 20 and June 21, 1975, at Family Hospital and Nursing Home, Milwaukee, Wisconsin. The conference was based on all the changes made, transforming a former Doctor's Hospital and Nursing Home to Family. The administrator, Walter G. Harden, challenged me, as an academic leader (I had been Chair of Nursing at Alverno College and faculty at Marquette University) to "put my money where my mouth" is and help to create a professional practice environment with nurses making a difference at the bedside. He indicated that it is one thing to teach nurses to be fully accountable at the bedside, but it is another thing to enable professional nursing practice as an administrator of a hospital and nursing home.
So, I took the challenge and accepted the position of administrator of patient care, which included nursing and all disciplines involved in patient care---physical therapy, occupational therapy, respiratory therapy, speech therapy, and even music therapy. It was an amazing opportunity to transform and enable a multidisciplinary integrated quality assurance program, as we called it in the 70s.
At the recent Magnet conference:"A Culture of Caring," Dr Patricia Pittman, a public member of the AANC (American Nurses Credentialing Center) board, spoke of the need for family-centered care. As we talked during a break, I shared some of my experiences and hope that these will help nurse leaders today face the patient and family care needs with a renewed enthusiasm and family-centered care vision.
To move in a new direction, we had to set the stage with a new philosophy and vision for patient care. The following are excerpts from the family-centered care conference report:
"--each patient must be viewed as an individual, a family member, and a member of the larger community, and is the master of his own life. Since this self-mastery may be threatened by illness and hospitalization, we are committed to helping each patient regain or maintain control of his/her own environment and life style.
Each patient has the right to expect that we will:
* Treat him/her with dignity and respect.
* Be gentle with due regard for his/her physical and emotional suffering.
* Render highly competent medical, nursing and supportive health care.
* Encourage his/her participation in planning care and daily activities.
* Give him/her information and education in order to best deal with stress and changes in his/her life resulting from hospitalization or physical condition.
Enable him/her to remain in close contact with loved ones whenever desired and possible.
The family is a group of people who value and love each other and whom the patient declares are close to him/her and involved with on a daily basis. Although there are legal constraints on us regarding the rights of relatives by blood or marriage, we recognize that a patient's family may well consist of others. (An interesting concept in the early 70's.) We believe the family is vital in the health of each patient. The family has the right to expect:
* To be treated with respect and kindness.
* To be informed about and participate in the care of the patient where desired and possible.
* To be educated with regard to (role or life style) changes resulting form the patient's condition.
* To be included as important people.
We are committed to raising the health awareness in our community in order that people may be motivated to seek health care and lead a more healthful life."
June 1974, As I reflect on the work done to develop a family-centered care theory model and truly deliver care at the patient side, whether in long-term care, the community or the hospital, reviewing this report from 1975, and the Magnet status received by Family, Hospital, and Nursing Home in the original study brings me full circle. The resonating renewal in nurses, who are excited at being acknowledged as achieving the best through the Magnet Recognition Program, was unbelievable to experience at the Magnet conference.
On September 28, 2010, I participated in a telephone conference call with First Lady, Michelle Obama, as did more than 1000 nurses from across the country. The teleconference was led by Mary Wakefield, PhD, RN, FAAN, administrator of the Health Resources and Services Administration, and focused on nursing's role in helping patients understand what's going on with patients' health care. As she listed some of the effects of the health care reform legislation, like covering Americans with preexisting conditions, and other essential health promotion and illness prevention benefits, the strong support for advancing nursing through education and the nurse practitioner role recalled how I was able to advance my education in the 60s through the Nurse Training Act. Yes, so many changes are needed in health care and focus on the interdisciplinary care team approach will mandate strong, energetic, intellectually based leadership as the imperative for nurse executives.
Although there is skepticism on the political front line of health care reform, there is so much hope for nursing and patient care. That hope is in your ability to be proactive, not reactive, as a transformative nursing leader in a very complex time, to make a difference at the bedside.
Barbara J. Brown, EdD, RN, CNAA,
FNAP, FAAN
Editor-in-Chief
Nursing Administration Quarterly