Performance measurement and nursing: How performance measures are raising nurses' competency and prestige
Every year, the Gallup Poll surveys Americans on the most respected professions. Nurses have ranked No. 1 every single year they have been included in the poll (since 1999), except one — 2001, when they were outranked only by firefighters. Americans again ranked nurses as the nation’s most-respected profession in 2010. With American respect for nurses and the nursing profession (not to mention average salaries) at an all-time high, where is that prestige coming from? Some leading nurses in the field believe it is due in large part to the national care quality improvement movement, which also dates to 1999, when the groundbreaking Institution of Medicine report "To Err Is Human" was released.
“This is a really great time for nursing,” says Pamela Hinshaw, MSN, RN, CCM, NDNQI® Account Representative at the American Nurses Association (ANA; www.nursingworld.org), and herself a University of Phoenix alum. “We nurses are finding our voice, and nurses are more engaged in quality improvement than they have ever been before.”
One reason nurses have shifted to the forefront of health care is via the ANA’s National Database of Nursing Quality Indicators® (NDNQI®). “The NDNQI allows hospitals to collect, share and analyze data on outcomes of nursing care,” she says. “This is the only national database dedicated solely to nursing-sensitive performance measurement. Hospitals can compare themselves to other hospitals of similar size and type, and evaluate their outcomes to determine if action plans are working.”
Participating hospitals can benchmark their own performance against others in the NDNQI database, which currently includes about one-third of all U.S. hospitals as well as hospitals in six other countries. “When it comes to improving overall patient care quality, you have to make changes at the nursing unit level,” says Hinshaw. “Structure and processes of care affect the patient outcome, and we offer a way for hospitals to analyze their outcomes.”
Ruth Ragusa, RN, is a senior-level nurse who is also Vice President of Organizational Effectiveness at South Nassau Communities Hospital on Long Island, N.Y., and she has seen the positive effects of the NDNQI and other quality indicators first-hand in her own hospital. Ragusa has been involved in various care-quality initiatives for about 15 years. Because she is responsible for the quality program at her hospital , she has a unique perspective. “Performance improvement is a continuum,” Ragusa says. “I think everyone had always understood that nurses are important, but it wasn’t until we started measuring care quality nationally via the NDNQI and other databases that we saw quantitatively the impact that nurses actually make.”
Ragusa also looks forward to the day when NDNQI data will be made available to the general public. “When the nursing care quality information is available to the public, the public can then make well-informed decisions on where to get the best care,” she says. “Then people will really begin to see and understand the real impact nurses and nursing make on their health care.”
Troy Garland, RN, BA-N, MBA-HCA, is Senior Director of Nursing at Chandler Regional Medical Center in metropolitan Phoenix, Ariz. as well as a current doctoral candidate at University of Phoenix, and he also serves on the board of directors of the Arizona Nurses Association. “I manage the inpatient side of our hospital, and I report directly to the Chief Nursing Officer,” says Garland. “When it comes to managing care quality, whether in my hospital or anywhere else, most of the accountability falls to nurses. Although some of the nationally reported quality measures and the supporting evidence may not be perfect, the NDNQI measures align well with nursing practice. While measuring quality in health care is far from perfect, at the end of the day you have to start raising standards somewhere, and NDNQI measures are a great place to start to allow us to make improvements.”
While Garland believes that there is still a lot to accomplish when it comes to developing good ways to measure care quality, he also believes that performance measurement has the potential to improve both care quality and nurses’ job prospects. “Measuring performance and tracking the data gives us a framework for giving the best care possible nationally,” he says. “In order to do that, your care data has to be known and quantifiable.” Garland cautions that in some care settings, collecting data at the bedside can put additional workloads on already overworked nurses, but the flip side of that is likely an increased demand for nurses, and places nurses in the center stage for creating innovative solutions. “At the end of the day, measuring quality is the right thing to do for the patient,” he says.
Ruth Ragusa is quick to point out the general public’s involvement in raising the nursing profession’s prestige. “The public are really great advocates for nurses,” she says. “And nurses are at the forefront of care. The more the public know how we impact them, the more prestigious our profession becomes.”
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