For a safer patient world, we need empowered nurses to lead innovation
15 September 2022
By Robert Nieves, JD, MBA, MPA, BSN, RN
With the rapid adoption of digital health technologies and patient-centered care, nurses can play a pivotal role in the transformation of healthcare
Caption: © istock.com
The COVID-19 pandemic has impacted all aspects of clinical practice, compelling professionals to take on numerous challenges in record time and rethink many of their usual processes. It has resulted in the rapid adoption of digital technologies and significant changes in the delivery of services, and provided important lessons(opens in new tab/window) that are defining the trends that will mark how clinical care is delivered by interdisciplinary healthcare teams
We have realized that we have to take advantage of everything we have learned throughout the pandemic and utilize that knowledge and those experiences to improve the way we work, mitigate errors, redirect the care we provide to patients and focus on achieving a safer patient world.
The pandemic has exacerbated the challenges(opens in new tab/window) that we have experienced in healthcare over the years. As of today, it is estimated that 6.3 million individuals worldwide have died from the COVID-19 virus(opens in new tab/window). Furthermore, 2.6 million deaths occur every year due to adverse events in low- and middle-income countries alone, such as medical errors, according to a 2018 study by the National Academies of Sciences, Engineering, and Medicine(opens in new tab/window). This total is truly staggering, and healthcare professionals must galvanize efforts to put safer practices into place to mitigate the number of preventable errors.
To create a safer patient world, we must put into place a variety of interventions focused on people, systems and processes. Within this framework, one of the most “innovative” aspects required is that of the empowered nurse leader. Fundamentally, every nurse must assume the role of a leader, and every healthcare organization should foster a culture to empower nurse leaders. Due to the nature of COVID-19, the world has come to realize that nursing plays a pivotal role in the care and wellbeing of our patients. For us to achieve a safer patient world, we need nursing to actively participate and lead in this effort.
New coordinates imposed by technology and post-pandemic care
I’ve reviewed the data published in the Clinician of the Future report, carried out by Elsevier Health, to contextualize the new circumstances in which the nursing role must develop. The data from this global study help identify the changing needs and evolving roles, and the necessary tools that will develop and respond to this new model, and define the role of the nurse through their leadership in the implementation of this innovation.
Among the most notable conclusions of this research, a large majority of clinicians (71%) recognize that their roles have changed in the last decade. There is an expectation that their roles will continue to change in the next decade, with clinicians highlighting the importance to acquire “Technology Intelligence.”
The changes in roles, how we work, the technologies we use, and the overall movement towards digitalization are especially evident to clinicians in three specific areas:
Big data and digital health
An increasingly empowered patient population
The implementation of a blended clinical environment
In the report, 80% of clinicians believe that big data will be an integral part of population health management, and 70% agree that the general use of digital health technologies will enable a positive transformation of care. Among the innovations that are expected to be developed in this framework are the continued adoption and optimization of electronic medical records with the integration of multiple data sources; increasingly personalized treatment approaches, in which the analysis of clinical data in real-time will be key; and the increasing use of artificial intelligence (AI) tools for clinical decision support.
To leverage this innovation, the role of nursing is critical. With personalized patient care, nurses are the professionals who spend the most time with patients, getting to know their individual preferences and using the information to treat them holistically. Nurses must fully understand the importance of capturing this type of patient information and making it actionable. They must also consider documentation as a valuable source of high-quality data which has a direct impact on real-time analytics and clinical decision-making. However, for patient knowledge to have an impact, the clinical decision support tools must be adopted and incorporated into many of the daily processes that nurses carry out. Knowledge must be actionable to truly make a difference.
The challenge of reinforcing digital training
The transition from the traditional healthcare model to digital has two needs that must be addressed: digital literacy and the transformation of the interdisciplinary team.
There is a widespread acceptance that digital health will only be useful if clinicians are supported through context-relevant education and training. Education that is focused on keeping clinicians updated with the latest digital health technologies, data and data security will be key. However, education must go beyond the “point, click and fill out the field” training. That is the norm for the actual use and application of the information in practice. The use of the information must be as important as the collection of the information. Likewise, clinical profiles, roles and teams will change because new skills will be required, such as expertise in the use of these technological innovations. For clinicians to be successful, the support of larger and better-equipped teams will be needed to manage data and information technology properly. In line with this, everything indicates that interdisciplinary teams will be expanded to include analysts, data scientists and experts in data security.
Two-way empowerment in a changing clinical environment
The empowered patient will continue to push the evolution of care models and how care is provided and decided(opens in new tab/window). The Clinician of the Future report highlights that 66% of clinicians say patients are increasingly able to make more informed decisions regarding their health. In turn, this empowerment represents an opportunity; the expectation is that it will reduce the burden of clinician workload, result in a shift towards preventative care (largely facilitated by monitoring tools), and put a greater emphasis on public health thanks to the widespread use of AI and big data.
However, having an empowered patient is not enough. For future healthcare models to be successful, they must be based on two synergistic dynamics: the empowered patient and the empowered clinician. An empowered clinician with the right knowledge, clinical decision support tools and ability to act is needed to deliver high-quality and safe patient care. To achieve the aspirational vision of a safer patient world, healthcare organizations must foster a culture of empowered patients and clinicians.
Another paradigm shift that is anticipated is that healthcare will be provided in the patient's home rather than in traditional healthcare settings, such as hospitals and clinics. This new model offers benefits to both clinicians and patients in terms of flexibility and time efficiency while reflecting a change in the professional skills required in this new scenario. The data shows that the most valuable skills in 2031 will be:
Technological competence (51%)
Clinical knowledge (42%)
Communication skills (40%)
Critical thinking (39%)
Data analysis and knowledge of statistics (37%)
Clear purpose and assumption of responsibilities
A key starting point for achieving the vision defined by these future trends is for nurses to assume leadership status. However, to implement a culture of leadership, it is very important to first adopt a definition of what leadership means for the organization. Once a definition is adopted, every member of the healthcare organization must be able to articulate and demonstrate an understanding of its application and what it consists of. There are many definitions, but I particularly like the one by Ledlow and Coppols(opens in new tab/window):
The ability to assess, develop, maintain and change the organizational culture and strategic system to optimally meet the needs and expectations of the external environment. Leadership is primarily about developing a vision and allowing people to work toward change. It implies creating a shared mission; address political, organizational and resource barriers; and inspire and motivate others.
Leadership in nursing does not imply doing what everyone wants; being a leader means assuming important responsibilities, such as keeping up to date with the latest health research. On top of this, it means providing evidence-based care, supporting the team with the knowledge and tools necessary to deliver the highest quality of care, developing treatment plans to improve care and outcomes, and advocating for and educating patients to help them empower themselves.
Healthcare organizations must also promote and develop the key characteristics of leadership in each member of their nursing team. These attributes include the ability to communicate and motivate staff, think creatively and critically, innovate with new workflows, delegate tasks, and advise and teach others. Assuming those responsibilities and strengthening those characteristics is what will lead us to a true transformation.
From theory to the patient’s bedside
Clinicians have also described their perceptions of the emerging healthcare world, defining the challenges and opportunities that professionals are likely to face in the near future. From these findings, the next logical question is how do we operationalize and put this leadership into practice through technology, a key driver of this change, to advance nursing practice and achieve the vision of a safer patient world?
The answer comes from two key strategies:
Nursing informatics and
The implementation of new standardized care models based on best practices
Informatics in nursing is a newer discipline to operationalize the four key tenets of informatics theory in practice. That includes identifying, defining, managing, communicating, and making actionable data, information, knowledge and wisdom in professional practice.(opens in new tab/window) It focuses on the use of the data derived from the care provided to deliver information within context, achieve knowledge, and apply that knowledge through clinical reasoning and decision making. Nursing informaticists consider the content, workflows, culture and technology used to bring to life the theory of informatics. These actions are carried out via structures, processes and information technologies to provide support to nurses, interdisciplinary allied health team members and patients. This discipline implies the appearance of new roles and offers important opportunities for the nursing profession.
The other strategy that allows nursing to conduct transformation through its leadership role is the incorporation of the latest clinical evidence into care models. Clinicians tell us that they are not ready, that they need more knowledge, more education and more training. The solution lies in developing and defining new models and applying them.
Evidence-based practice as its starting point, followed by the adoption of the model by all the clinicians involved in the process, capturing and analyzing patient data, producing empirical results, and in turn providing either new evidence or validating the existing practices. This process is circular and continues.
Tools to optimize processes and results
Directly related to this new model is the challenge of improving the tools that help manage workflows. As an example, the patient care planning process that nurses use daily for every patient must, by definition, be a written reflection of the care provided to the patient. This documentation requirement can be much more valuable if it is optimized and designed as a clinical decision support tool and supportive of an interdisciplinary care model.
An evidence-based interdisciplinary care plan that establishes the relationship between the clinical objective/outcome (what the patient needs to demonstrate) with the intervention plan (what we need to do) and the interventions (what we do to work towards achieving) provides the clinicians with the necessary reminders as to what we need to think about, what we can do and why it is important. It is necessary to think about care planning, not just by documenting a care plan, but by incorporating knowledge and best practices and using them from within the workflow. In short, what is sought is to achieve a better process and results through decision-making support tools.
Nursing leaders must be well equipped and trained to make the right decisions at the right time as an essential condition to play this key role in the innovation and transformation process.
We have to do the right thing individually, but also as a group, since it’s the way to make a great impact within our organizations for our patients. It does not matter if the nursing profession has a formal or informal role that officially identifies their leadership, if they are caring for the patient at the bedside, or if they are a leader. It is as leaders and with the help and management of innovation that we are going to advance our profession to implement the necessary changes in this new scenario and achieve a safer patient world.