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CLINICAL SCENE INVESTIGATOR PART 1
Redefining “time” to meet nursing’s
evolving demands By Marian Altman, MS, RN, ANP, CNS-BC, and William Rosa, MS, RN, AGPCNP-BC, AHN-BC, CCRN-CMC, LMT
The American Association of Critical-Care Nurses (AACN) developed the Clinical Scene Investigator (CSI) Academy for nurses at the bedside to hone leadership and innovation skills to create and sustain lasting change and improve positive patient outcomes. In this first part of a three-part series, we take a look at how the AACN CSI Academy helps clinical nurses cultivate skills that measurably demonstrate how nonproductive time is a misnomer that interferes with achieving optimal patient outcomes.
etc. in converting inputs into useful outputs.”1 Non-of the efficiency of a person, machine, factory, system,
enhance care quality. ing nonproductive time to lower costs while trying to increasingly focus on managing resources and decreas-side for education and committee work. Organizations deemed nonproductive, as is time away from the bed-Time required to assess, plan, and evaluate care is in direct care at the bedside is considered productive.Healthcare organizations imported the terms “produc-tive” and “nonproductive” from manufacturing. Unfortunately, this has meant that only time spent
A business definition of productivity is “a measure
productive time is defined as “time not directly associ-ated with manufacturing operations or performance of a job or task.”2 What if we considered productivity more broadly? What might this yield in the quest to improve patient outcomes and reduce reimbursement losses for hospital-acquired conditions?
Expanding productivity As the nursing profession evolves beyond the confines of unifocal, traditional bedside practice to include
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AACN CSIAcademyTM
Clinical Scene Investigator
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Redefining “time” to meet nursing’s evolving demands
the creation of new knowledge, research by nurse scientists, and cultivation of nurse-driven leader-ship initiatives, there’s a call to expand the current notion of pro-ductivity to include not only inter-vention implementation, but also the assessments, planning, and evaluations crucial to the successful provision of quality patient care. When colleagues meet to plan cur-rent unit-based initiatives, identify needs, modify program strategies, and evaluate outcomes, they aren’t being nonproductive. This detail and commitment to excellence
Never, in any regard, has Nightin-gale been referred to as “nonpro-ductive;” rather, she’s heralded as a visionary.
As nurses embody Nightingale’s principles on a more professional and global scale, a vision will reemerge to create the possibility that nurses are productive when-ever and wherever they act in the art and science of their discipline. Nonproductive time, which is sometimes called indirect care, supports the mission of those at the bedside taking care of patients. This means nonproductive time is, in
to ensure that nurses have the skills and knowledge to fulfill leadership roles.
In response to the IOM report’s vision and recommendations, the AACN created the CSI Academy to empower clinical nurses and sup-port their vital role in the transfor-mation of healthcare. The program was designed specifically for clini-cal nurses because they’re astutely aware of the clinical obstacles impeding the achievement of opti-mal patient outcomes. However, they often lack the leadership, advocacy, and financial skills to drive effective solutions.
regarding the work of nurses and nursing is synonymous with authentic leadership in which “nurse leaders must fully embrace the imperative of a healthy work environment, authentically live it, and engage others in its achievement.”3
Florence Nightingale’s singular leadership extended beyond direct bedside care to create previously unavailable opportunities in health advocacy, policy, and journalism.4
Her successes aren’t measured by the hours she spent “on the floor,” but by the countless hours she spent “off the floor.” It was through her myriad contributions that she inspired a profession of leaders who care, heal, and further the betterment of human dignity.
Nurses are productive whenever and wherever they act in the art and science of their discipline.
fact, productive because it leads to undeniable positive patient and clinical outcomes by contributing to the primary mission of patient care and advancing nursing practice.
The Nightingale vision continues to emerge and evolve through countless 21st century nursing and healthcare initiatives. Most recently, the 2010 Institute of Medicine (IOM) report, The Future of Nursing: Leading Change, Advancing Health, confirmed nursing’s vital role in healthcare and called for nurses to lead and collaborate in its transfor-mation. Nurses have the potential to be leaders throughout their work communities—from the bedside to the boardroom and from profes-sional organizations to policy and advocacy forums.5 The challenge is
Leading and innovating The AACN CSI Academy is a hospital-based nurse leadership and innovation training program. Its goal is to assist clinical nurses in strengthening their skills and influence as clinical leaders and change agents to affect positive change and leverage the clinical nurse’s expertise to enhance patient care and improve fiscal outcomes. Academy participants gain essential skills in leadership, project management, social entre-preneurship, quality improvement, data and financial analysis, and stakeholder engagement, as well as education regarding how healthcare policy impacts the nurs-ing profession and how nursing care affects a hospital’s bottom line. The program helps partici-pants guide their peers in creating unit-based change that’s easily scaled across the entire hospital, expanding opportunities for nurses to lead and diffuse collab-orative improvement efforts.
The AACN CSI Academy is a national expansion of a successful Partners Investing in Nursing’s Future grant provided by the Northwest Health Foundation and
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Redefining “time” to meet nursing’s evolving demands
the Robert Wood Johnson Founda-tion.6 For 16 months, a team of up to four nurses works with program faculty, an internal mentor, and the CNO to identify issues related to patient care, develop and implement unit-based projects, and evaluate results measured by quantifiable improvement in patient outcomes and decreases in hospital expenses. The program is conducted in the hospital where the nurses work so learning can be integrated into existing patient care responsibilities. In summary, the teams obtain pre- and postoutcome
The CSI Academy demonstrates that clinical nurses provide a remarkable, measurable contribution to patient and financial outcomes when given the time to do so.
data, develop and implement a unit-based project, and calculate the fiscal impact of their project on their units and institutions, thus refram-ing these activities as “productive.”
Throughout the 16-month period, participants attend a total of eight workshops facilitated by AACN fac-ulty that culminate in an innovation conference open to the entire health-care community, celebrating and shar-ing each team’s results. Program par-ticipants also electronically impart their project tools, experiences, and outcomes within an online database (http://www.aacn.org/csi) to foster industry-wide nursing innovation by extending its reach beyond individual participants and their hospitals.
The impact of the AACN CSI Academy projects to date has
resulted in more than $28 million of estimated savings for participat-ing hospitals. Outcomes include, but aren’t limited to, increased early mobility; prevention of delir-ium; and decreased pressure ulcers, catheter-associated urinary tract infections, central line-associated bloodstream infections, and ventila-tor-associated pneumonias. Nurse-driven initiatives have decreased patient length of stay, catheter days, and ventilator days. Hospitals that have participated in the program report sustaining projects, translating projects to
other clinical areas in the hospi-tal, and adopting additional projects initiated by neighbor hospitals.
Nurses paving the way As payers move toward Value-Based Purchasing, organizations will need to seek ways to leverage the power of our country’s 3 mil-lion RNs. The AACN CSI Acad-emy demonstrates that clinical nurses provide a remarkable, measurable contribution to patient and financial outcomes when given the time and skills to do so. It also shows that nonproductive time supports innovation. Florence Nightingale stated, “Never lose an opportunity of urging, a practi-cal beginning, however small, for it
is wonderful how often in such matters the mustard-seed germi-nates and roots itself.”7 In other words, innovate by every means possible. The current healthcare system as we know it is transform-ing, providing numerous opportu-nities to innovate and allowing the vision of nurses and nursing to become a reality. Let it never be overlooked or doubted: Nurses are innovators in the truest sense, transforming our reality and impacting patient outcomes. NM
REFERENCES 1. BusinessDictionary.com. Productivity.
http://www.businessdictionary.com/defini-tion/productivity.html.
2. BusinessDictionary.com. Nonproductive time. http://www.businessdictionary.com/ definition/non-productive-time.html.
3. American Association of Critical-Care Nurses. AACN standards for establishing and sustaining healthy work environments: a journey to excellence. http://www.aacn. org/wd/hwe/docs/hwestandards.pdf.
4. Dossey BM, Selanders LC, Beck DM, Attewell A. Florence Nightingale Today: Healing, Leadership, Global Action. Silver Spring, MD: Nursesbooks.org; 2005.
5. American Nurses Association Leadership Insti-tute. Why now? http://www.ana-leadershipin-stitute.org/Main-Menu-Category/About-Us/ Why-Now.
6. Lacey SR, Olney A, Cox KS. The clinical scene investigator academy: the power of staff nurses improving patient and organi-zational outcomes. J Nurs Care Qual. 2012;27(1):56-62.
7. Great-Quotes.com. Florence Nightingale quotes. http://www.great-quotes.com/ quotes/author/Florence/Nightingale.
Marian Altman is a clinical practice specialist for the American Association of Critical-Care Nurses in Aliso Viejo, Calif. William Rosa is a nurse educator for Critical Care Services at NYU Langone Medical Center in New York, N.Y., and a Caritas coach.
The authors have disclosed that they have no financial relationships related to this article.
DOI-10.1097/01.NUMA.0000463886.62598.3d
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