Role Challenges of Quality Practice ... - Nursing Portfolio



Role Challenges of Quality Practice for the Nurse Administrator

Marilyn Dykwell

Lori Majeske

Cheryl Miller

Ferris State University

Abstract

The role of the nurse administrator encompasses many competencies. These competencies are defined in the American Nurses Association Scope and Standards of Practice. Measurement criteria are detailed for the successful fulfillment of this role. Quality of practice is very important in the professional performance agenda as it gives direction and substance to the nurse administrator. This paper will give detailed responsibilities that the administrator role requires to promote effective communication, nursing engagement, and optimal patient and staff experiences while establishing quality patient outcomes.

Keywords: quality of practice, nurse engagement, communication, optimal patient experience

Role Challenges of Quality Practice for the Nurse Administrator

The role of the nurse administrator is vital to the health and well-being of nursing practice in an organization. The Model of the Interrelationship of Leadership, Environments, and Outcomes for Nurse Executives (MILE ONE) is an evidence based source that helps administrators focus on staff engagement, empowerment and outcomes of practice by measuring quality indicators, staff recruitment, staff retention, and satisfaction (Adams, Erickson, Jones, & Paulo, 2009). These management goals are the key basis for excellent quality outcomes for staff satisfaction and patient outcomes. The ability of the nurse administrator to effectively develop these practices into the culture of staff environment will be the drivers for the success or failure in the pursuit of excellence and quality.

A study by Laschinger reflected when administrators have power and enable that empowerment in their staff; the quality of care was increased (Adams, Erickson, Jones, & Paulo, 2009). Therefore, the professional commitment of the administrator to focus on nurse empowerment is a key force to successful staff engagement. Within the nursing profession, staff satisfaction is interrelated to many forces of quality. Research by Aiken et al. determined staff dissatisfaction was prevalent in one third of all nurses globally (Mathews, Spence, Laschinger, & Johnstone, 2006). This dissatisfaction also was linked to negative patient outcomes as well as the lack of visible administrative support (Mathews, Spence, Laschinger, & Johnstone, 2006).

When leadership is not there to empower staff, the results are poor quality and outcomes for both staff and the patients they care for. Therefore leadership is challenged to address staff engagement and become change agents for enhanced staff behavior and permit exploration and enhancement of the quality of care. The focus of this paper is to submit when nurse administrators are involved in providing increased communication and nursing engagement, there will be an increase in the quality of practice in the organization.

Effective Communication and Nursing Engagement as a Quality Practice Challenge

The leadership role of a nursing administrator in promoting safe, quality, and cost-effective care within health care organizations is clearly defined according to the standards of professional performance set forth by the American Nurses Association (2004). Overall responsibilities include the development of organizational initiatives which enhance quality nursing practices, nursing administration, and optimal patient care services (ANA, 2004). Considering the current challenges present within health care delivery of increased patient acuities, shorter hospital stays, lower reimbursement, and nursing staff shortages, the development and implementation of quality care initiatives are of utmost importance.

One professional challenge, as identified by Draper, Felland, Liebhaber, and Melichar (2008), in the promotion of quality and effective nursing practice, is the creation and maintenance of a high level of nursing engagement. These authors note because nursing staff is the primary caregivers in most health care organizations; they may play a key role in the advancement of quality care. In addition to the role that nursing plays, it was found that a supportive hospital culture was directly linked to successful promotion of quality practices in the health care arena (Draper, Felland, Liebhaber & Melichar, 2008). Additional literature support is provided by Anker, Coughlin, and Holman (2010) who explain there is a direct and positive correlation between the level of nursing engagement and overall patient satisfaction results. As such, nursing administrators who are actively pursuing quality and effective nursing practices will be challenged to initiate and maintain strategies to foster a high level of staff engagement. The benefits of achieving greater nursing engagement include patients who are more satisfied with their hospital experience, improved patient outcomes, and patient safety (Harmon, Sey, Hinter, Faron & McAdam, 2010).

Communication plays a role in the overall quality of patient care. Various types of communication support are available to the nurse administrator. The use of effective communication strategies can decrease poor patient outcomes (Michigan Hospital Association, 2009). It is important for nursing leaders to understand the challenges facing staff and work to improve the level of communication.

Evidence Based Support for Promotion of Nursing Engagement

A recent study by Kalisch, Curley and Stefanov (2007) provides evidence based support for the importance of developing teamwork and nursing engagement in order to achieve improvements in quality care and patient satisfaction. They utilized focused interventions aimed toward establishing unit objectives using a team based approach, fostered critical thinking to solve patient care challenges, provided education on an ongoing basis, and devised a detailed communication strategy to keep staff informed. As a result of these efforts, the overall quality of nursing care increased from 46% to 52%. Furthermore, Harmon, Sey, Hiner, Faron, and McAdam (2010), have found that focused efforts on improving staff engagement and fostering teamwork have increased staff satisfaction, improved clinical performance through nurse to nurse mentoring, and empowered staff through relationship building principles, all of which resulted in an overall increase in nursing retention. Additional literature support of the need to focus on quality nursing practices within health care is that quality care is also being mandated by initiatives from the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), Centers for Medicare and Medicaid Services (CMS), University Health System Consortium, Keystone Center for Patient Safety and Quality, and the Washington State Foundation for Healthcare Quality (Draper, Felland, Liebhaber & Melichar, 2008). The adoption of quality care as a major topic by these agencies serves to further exemplify the significance for nursing administrators to establish a working environment that promotes excellent quality care.

Plan to Promote Nursing Engagement

Effective nursing leadership is crucial to the development and support of an organizational culture which is dedicated to providing quality care and a high level of nursing engagement (Laschinger & Leiter, 2006). The nursing administrator, as an organizational leader, can utilize both the identification and awareness of this topic to create an action plan to promote nursing engagement practices as part of a quality improvement initiative. The first, and most important step, is raising awareness of nursing engagement on a system-wide basis. This accomplishment requires the ability of nursing leadership to provide financial support, people resources, and educational resources specifically devoted toward engaging staff in quality improvement activities. An organizational wide survey can be an effective tool for creating awareness of the need for nursing engagement within a health care institution, as well as providing education to staff. Leadership action by the nursing administrator “advocates for and participates in the development of clinical, operational, and financial process from which key outcomes, and indicators can be derived, reported, and used for improvement” which is a core measurement criteria for Standard 7: Quality of Care and Administrative Practice (ANA, 2004, p. 35). Results of this organizational engagement survey can then be utilized to formulate targeted action plans such as a nurse-to-nurse mentoring program or implementation of relationship building principles for providing patient care.

According to research, nurse-to-nurse mentoring programs help to establish a support network and partnership between new and seasoned nurses which enhances clinical care, and promotes the use of evidence based practice, thereby positively impacting quality patient care (Harmon, Sey, Hiner, Faron, & McAdam, 2010). Educating nurses on the importance of utilizing relationship based care principles in their practices in order to foster the development of meaningful relationships between patients, families, and nurses, is also an important quality initiative. Literature evidence shows the development of meaningful relationships empowers nursing staff to engage personally with patients and their families, and is directly linked to improved patient satisfaction (Harmon, Sey, Hiner, Faron, & McAdam, 2010). In addition, these authors note that nurses become engaged through active participation in the development, promotion, and outcome of organizational projects or initiatives because it honors their clinical expertise, and their ability to guide best clinical practices (Harmon, Sey, Hiner, Faron, & McAdam, 2010). Developing and promoting nurse-to-nurse mentoring programs and relationship care principles “support organizational and nursing core values and objectives” which is a core measurement criterion for Standard 7: Quality of Care and Administrative Practice (ANA, 2004, p. 35). As previously noted, fostering teamwork has also been shown to increase staff engagement and improve patient outcomes and patient satisfaction (Kalisch, Curley and Stefanov, 2007). Nursing administrators can promote a teamwork ethic within healthcare organizations by developing formalized structures such as multi-disciplinary teams dedicated to promoting and improving quality patient care practices; this validates the unique and important role of nurses to impact patient care outcomes (Paynton, 2008). The development of multi-disciplinary teams dedicated to improving patient care outcomes meets the measurement criteria defined as the “development, implementation, and improvement of care delivery models and services that meet or exceed customer expectations” (ANA, 2004, p. 35). These leadership actions are evidence based and serve to support nursing professional practice, while fostering a high level of nursing engagement, thereby creating a work place environment conducive to safe, and high quality patient care.

Evidence Based Support for Effective Communication

Social Support

The use of social support as means of communicating with others can increase well-being and function as it increases satisfaction and health outcomes among nurses (Maze, 2005). A recent study among early researchers demonstrates collaboration among nurses can enhance expertise and improve practice (Carroll, et al., 2010). It may also be reasonable to conclude collaboration can assist with work-life balance (Carroll, et al., 2010).

Staffing

Research in Australia illustrates some key indicators to quality initiatives (Batch, Barnard, & Windsor, 2009). This study has two-fold significance to support communication issues among nurses. Hiring many employees can bring multiple viewpoints which can enhance the knowledge base of the facility. On the other hand, effective communication may decrease due to variable shifts causing delays in important information sharing because nurses have extended time away from the workplace. The study further notes that half of a workforce may be comprised of part-time or casual workers. Nurse administrators will need to determine the best course of action based on the particular circumstances within their organization to decrease the communication issues from this occurrence.

A recent study by Andreatta presented evidence in the health care arena, revealing how diverse teams must function differently based on their area of expertise and the types of healthcare members on the team. Support indicates these members need to be able to communicate openly, while being able to manage conflict within the team (Andreatta, 2010). This study also examines the financial implications of poor communication, relating increased costs associated with increased infection rates, and poor pain control. By not controlling these variables, the nurse administrator may face high turnover rates resulting in increased costs to train new employees. In turn, these new employees will need to become effective team members.

Administrator Duties

Obligations are vast for nursing administrators as part of the process of quality improvement. Understanding the data, determining the best method to improve the outcome, and acquiring any resources needed are some of the elements to achieve healthy outcomes. Networking with peers, communicating pertinent data to physicians and board members to gain support, and educating employees in a timely manner can increase compliance with new goals.

Empowering staff has proven to be an effective method of improving compliance and satisfaction. There are five factors influencing nurse motivation: autonomy, work relationships, resource accessibility, nurse factors and leadership practices (Brady Germain & Cummings, 2010). Autonomy develops when leaders express positive comments to nurses giving them a higher sense of value within the organization. Trust and cooperation are important factors influencing workers as well as having adequate resources available. Giving clear guidance and gaining respect from nurses will improve relationships between staff and administrators.

Plan to Promote Communication

Nurse administrators have the ability to influence outcomes for patients and workers. Understanding motivation and having the correct supportive aids in place are methods discussed in leadership seminars. The concept of motivation and ability sources influencing behaviors is demonstrated by Grenny, Maxfield, McMillan, Patterson and Switzler, (2008). These sources of influence, when correctly identified by leaders, are essential elements to change behavior within an organization.

Cheeks and Dunn (2010) discuss providing retreats for novice nurses allowing them time away from direct patient care to better understand the affect they may have on the overall patient outcome. Novice nurses tend to be task-oriented, whereas quality improvement measures may need to be managed from a nursing process method. Nursing administrators can also attend regular staff meetings or conduct informal meetings to improve communication and increase their visibility to staff (Pardini-Kiely, Greenlee, Hopkins, & Szaflarski, 2010). Meeting with physicians, becoming involved in facility meetings, and networking with others that may have similar issues are also part of the process to improve communication, not only with direct reports, but with other departments and nearby facilities.

Summary

The overall abilities of the nurse administrator to accomplish the standards for quality of practice within the guidelines of the Scope and Standards of Practice of the ANA are vital to the overall quality of care administered under her direction. These criteria are measured by an ability to be creative and innovative in leadership; by the outcomes of activities that are initiated; by the knowledge and empowerment conveyed to staff; by the implementation and development of new measurement programs for quality of service; by the evaluation of evidence based research forming the basis for care; by the enthusiasm that staff works to increase their own knowledge and expertise; and overall by the improved quality that exists under her direction (American Nurses Association, 2009).

Communication is a vital role of the nurse administrator in establishing and encouraging effective staff engagement. The areas of staff satisfaction and patient satisfaction have been documented as being closely related and entwined to be key drivers in promoting and executing quality care initiatives. Without a competent nurse administrator at the helm, the direction of staff will be lost, thereby reducing quality practices. The interelationship of communication, mentoring, staff engagement and quality practice are indicative of the importance of the abilities the nurse administrator exhibits to provide guidance and direction for this standard of professional performance.

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