Stronger nursing means better care

If you want to improve patient care, it makes sense to improve nursing. And a nationwide demonstration project worked to do just that. But surprisingly, many of the resulting changes seem at first glance to be only slightly related to nursing.

For example, a patient participation group helps evaluate and plan changes affecting care at a major Los Angeles-area hospital. A network of hospitals in Montana may create a regional staffing pool to meet the varying needs of institutions across Big Sky country. And in North Dakota, two patient-care units were redesigned after the architect listened to the needs of the therapists and clinicians who would work there.

These seemingly unrelated innovations have come about because of the project, Strengthening Hospital Nursing: A Program to Improve Patient Care, which gave $1 million each to 12 hospitals and eight consortia over five years. Some solutions may sound like they involve areas besides nursing. But in many cases, that’s the point.

The project focused “on the patient as the person who drives what we do,” said Mary Kay Kohles, MSW, RN, deputy director of the project and an administrator at Piedmont Hospital in Atlanta. “The lesson for nurses is to pay attention to the reason we exist—to the person receiving the service. It’s not focusing on one discipline, but on the collaborative efforts of all of us, with nursing being at the heart of that care.”

The grant program emphasized how collaboration can create efficient and effective care. When the study was in the planning stages in 1989, it was ahead of the wave of major changes in the way hospitals administer health care. By the time the field of participants had been narrowed from the initial 80 institutions, the nursing shortage of the ’80s had “all but disappeared,” said Barbara Donaho, MA, RN, FAAN, the project’s director and a health consultant. “The healthcare field was in the beginning stages of some of the most remarkable changes in the field that were not really anticipated,” she said.

But the institutions were far enough along to understand the benefits of thinking collaboratively. And that allowed them to respond quickly to the changes in health care because they were already on the road to change, according to Donaho.

“The main and most critical message for professionals, nursing as well as others, is that they will be more successful if they in fact collaborate with each other and look at ways to work together as opposed to in isolation or a single discipline at a time,” she said. “The work is too complex and systems and technology are changing so fast, that old ways have to be modified—but they need to be modified in collaboration with other professionals.”

Here are three examples of institutions that participated in the study, which brought about change in various ways.