Overall strategies to cope with the changing economics of acute care facilities include sophistication of information systems to integrate clinical/financial cost accounting and provide computerized decision support systems, enhancement of services offered, prudent application of new technology, reduction of costs, improvement of communication and education, and monitoring of performance with risk identification and analysis-Nursing's responsibility is to identify its product clearly and its program output relative to its mission. - Barbara J. Brown 1
While we did not call this evidence-based management of nursing, nursing administration leaders were striving for proof, confirmation, corroboration, facts, data-based authentication of the value of nursing, and the capability to measure nursing productivity. This then was among the initial efforts to establish evidence-based nursing management data. Today, we are striving for evidence-based nursing administration knowledge to develop management solutions that support the nursing workforce and healthcare systems' goals and outcomes. Evidence is proof that a best practice in nursing administration is demonstrated through measurement and outcome evaluation, which supports decision making in practice environments.
With a worldwide emphasis on evidence-based practice in all aspects of the healthcare industry, there has been a paucity of information in the nursing administration arena. Tim Porter-O'Grady, EdD, APRN, FAAN, senior partner of an international healthcare consulting firm focusing on restructuring services for a changing environment and editor of the recently published book Introduction to Evidence-Based Practice in Nursing and Healthcare (with Kathy Malloch; Jones and Bartlett), is a most qualified issue editor. He aptly challenges readers of Nursing Administration Quarterly to explore what currently exists and pause to contemplate what should be in the evolution of "Evidence-based Practice: Impact on Nursing Administration." Tim has led many organizations worldwide to create innovative changes in practice environments and develop evidence-based management practice outcomes.
With little published evidence of management successes and failures based on outcome data, how can we determine what our best administrative practices are? Nursing Administration Quarterly recently published "Patient and Staff Safety," Vol. 29:1, January-March, 2005, which presented evidence-based outcomes in medication administration, patient restraint use, and other demonstrable patient care scenarios. What kind of situations will lead us to better management and administration practices? How can we use data to increase our knowledge and expertise in order to develop strategies that enhance our overall nursing and healthcare administration practice?
We have many lessons to learn:
1. One size does not fit all as we see the difference in rural healthcare settings as compared to major urban medical centers.
2. Proactive decision making based on evidence is overwhelmingly preferred over reactive, defensive management decision making.
3. Flexibility and anticipation of challenging changes are key to assuring the most positive administrative outcomes.
4. The nursing shortage is here to stay and will worsen. Measuring the work of nursing is critical.
We cannot afford to live with "doing it my way" as we have always done it this way mentality. Using data (evidence) to change the way in which nursing is practiced is essential to our future. Best administrative practices need to be nurtured and rewarded as in Magnet Hospital recognition. After more than 50 years of nursing, more than 30 in administration, I am excited to see the changes ahead. Systematic evaluation, concern for effectiveness, efficiency, and accountability, and changes based on evidence will be most welcome in my senior years. We need strong, dedicated nursing leadership to keep patient-centered care values at the forefront while exercising data-based testimony with unified voice and power for nursing.
Barbara J. Brown, EdD, RN, CNAA, FAAN, FNAP, Editor-in-Chief
Nursing Administration Quarterly
REFERENCE