This is my classmate’s post about an article summary (article attached). Please respond with a page, this is a discussion post

Healthcare organizations imported the terms productive and nonproductive from manufacturing. Unfortunately, this has meant that only time spent in direct care at the bedside is considered productive. Time required to assess, plan, and evaluate care is deemed nonproductive, as is time away from the bedside for education and committee work. Organizations increasingly focus on managing resources and decreasing nonproductive time to lower costs while trying to enhance care quality.

A business definition of productivity is a measure of the efficiency of a person, machine, factory, system, etc. in converting inputs into useful outputs.1 Nonproductive time is defined as time not directly associated 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?

Is there really such a thing as nonproductive time for nurses? 

As the nursing profession evolves beyond the confines of unifocal, traditional bedside practice to include the creation of new knowledge, research by nurse scientists, and cultivation of nurse-driven leadership initiatives, there’s a call to expand the current notion of productivity to include not only intervention implementation, but also the assessments, planning, and evaluations crucial to the successful provision of quality patient care. When colleagues meet to plan current unit-based initiatives, identify needs, modify program strategies, and evaluate outcomes, they aren’t being nonproductive.

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. Never, in any regard, has Nightingale been referred to as nonproductive; 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 whenever 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 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.

Nurses have the potential to be leaders throughout their work communitiesfrom the bedside to the boardroom and from professional organizations to policy and advocacy forums.5 The challenge is 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 support their vital role in the transformation of healthcare. The program was designed specifically for clinical nurses because they’re astutely aware of the clinical obstacles impeding the achievement of optimal patient outcomes. However, they often lack the leadership, advocacy, and financial skills to drive effective solutions.

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 entrepreneurship, quality improvement, data and financial analysis, and stakeholder engagement, as well as education regarding how healthcare policy impacts the nursing profession and how nursing care affects a hospital’s bottom line. The program helps participants guide their peers in creating unit-based change that’s easily scaled across the entire hospital, expanding opportunities for nurses to lead and diffuse collaborative improvement efforts.

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 data, develop and implement a unit-based project, and calculate the fiscal impact of their project on their units and institutions, thus reframing these activities as productive.

The impact of the AACN CSI Academy projects to date has resulted in more than $28 million of estimated savings for participating hospitals. Outcomes include, but aren’t limited to, increased early mobility; prevention of delirium; and decreased pressure ulcers, catheter-associated urinary tract infections, central line-associated bloodstream infections, and ventilator-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 hospital, and adopting additional projects initiated by neighbor hospitals.

The AACN CSI Academy 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 practical beginning, however small, for it is wonderful how often in such matters the mustard-seed germinates and roots itself.7 In other words, innovate by every means possible. The current healthcare system as we know it is transforming, providing numerous opportunities 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.