Nurse Leadership Development Tied to Improved Patient and Staff Experience

Added on Mar 16, 2017

Nurse Leadership Development Tied to Improved Patient and Staff Experience
By Whitney McKnight
Industry Edge March 2017

An innovative program at the University of North Carolina Medical Center (UNCMC) provides nurses with the leadership skills needed to build and sustain an engaged workforce and ensure that patients receive safe, effective, high-quality care.

Predicated on the understanding that nurses are the personnel who work closest to the patient’s bedside, the UNCMC Nursing Leadership Academy empowers nurses to help lead the organization in delivering the best in patient-centered care.

“As nursing goes, so goes the organization” is how Jeff C. Strickler, RN, DHA, vice president of UNCMC’s Hillsborough campus, described the importance of nurse leadership. “They know, understand and are sensitive to quality care. They understand what patients need to experience. Hearing what nurses have to say leads to lasting solutions,” he said in an interview.

Since creating its Nursing Leadership Academy about a decade ago, UNCMC has experienced three phenomena that Strickler said are directly related:

  • Increased loyalty to UNCMC among nursing staff, and significant savings in executive search costs for nurse leaders because the system is able to successfully promote from within
  • A culture of caring and innovation that generates proactive solutions to care systemwide
  • A track record of exceptional performance in its National Database of Nursing Quality Indicators© (NDNQI©) scores for nurse satisfaction and nursing-sensitive patient outcomes, including top 25th percentile performance for skin care and limb or vest restraint and outperformance on the NDNQI national average benchmark for falls prevention across many units

“We take the balanced score card approach,” Strickler said. “We want to improve the employee experience, which in turn improves the patient experience. That leads to better growth in programs, which ultimately leads to financial health. We believe our nurse leadership program supplements all our efforts.”

The Nursing Leadership Academy begins with a one-day foundational course in leadership, available to any nurse who has been promoted within the clinical ladder program. The idea is to provide nurses with the necessary tools to be effective in their roles as leaders within their respective units. The curriculum includes a discussion of the organization’s overall mission, core values and philosophy. It then reviews opportunities in nursing education, professional development, research, evidence-based practice, accreditation and compliance. The class also explores various leadership styles and what to expect as one takes on greater levels of responsibility.

Next is a simulation course that uses a game to emphasize communication and strategic decision-making skills in an intraprofessional setting. Friday Night in the ER, as the simulation is known, puts nurses in fictional situations where they are in charge of patient movement. At the end of the game, players are able to see how their decisions impact overall quality scores and patient and employee experiences.

A course in finance puts nurse leaders in touch with nursing directors and senior business analysts from across the system who provide them with the vocabulary and calculation tools necessary to increasing fiscal management responsibilities.

The fourth core portion of the Academy is a six-month fellowship program that offers a variety of in-depth courses in leadership, communication, professional development, crisis management and education. The courses are taught by UNCMC nursing directors and others who share their actual experiences and the tactical solutions they have found useful in practice.

Additionally, “in-house” field trips give nurses a behind-the-scenes look at key hospital departments and how each impacts overall patient care. Wrapped around these continuing-education-credited hours is a mentorship program that pairs nurses from across service lines, which, according to Strickler, is intended to help form bonds among staff members that continue after the training is complete.

When nurses enter the Academy, they are shown estimates for how much their participation in the class costs each division. “We want them to know how much the institution values them,” said Strickler. And although it was not the goal of the program, a happy consequence has been that annual savings from not having to hire search firms to help fill leadership openings far outweigh the investment in each Academy graduate, he said.

The result is that loyalty among the nursing staff is at an all-time high. The attrition rate for nurses at UNCMC is less than 10%, with 10 applicants for every vacancy, according to Strickler.

Such enthusiasm for the organization hints at the most important, yet hard to quantify, result of all: a robust nursing culture. “The value of the Academy is less about the information being relayed and more about the culture being established,” said Strickler. “It is a culture of empowerment, engagement and ownership. This leads to a much more proactive, innovative workforce. Those benefits are reaped across the board.”

As an example, when UNCMC nurses across various units and service lines sought opportunities for performance gains and safe reductions in costs of care, they zeroed in on the frequency of intravenous catheter line changes. Taking an evidence-based approach, the nursing staff determined that changing lines every three days, which had been the standard, was unnecessary, and so they adjusted clinical protocols accordingly. In a system with nearly 900 beds, Strickler said the cost savings were substantial.

Such nurse-led initiatives are common at UNCMC. “You name the metric—whether it is for the number of catheter-associated urinary tract infections, the number of central line-associated blood stream infections, our incidence rate of industry falls, our incidence of skin breakdown, our utilization of restraints, or the rate of adult rapid responses that help avoid cardiac arrest—we’ve benefited from a culture where our nurses know they are empowered to innovate and implement patient-centered solutions,” Strickler said.

Nurse leadership programs such as the Academy play an important role in helping hospitals and health systems meet the ever-changing challenges of today’s complex and evolving health care industry. In addition to the critical insight that empowered nurses bring to strategic decision making and the economic case for nurse leadership training, programs that help nurture and sustain a dedicated nursing staff help organizations stay focused on the needs of the patient.

“When we stay centered on the patient, and not on whatever health care reform or law comes along, we will always be able to do the things that are necessary to improve care and that best position us to whatever comes at us from a legislative and financial standpoint,” Strickler said.