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    What Would Florence Do?: A Guide for New Nurse Managers
    What Would Florence Do?: A Guide for New Nurse Managers
    What Would Florence Do?: A Guide for New Nurse Managers
    Ebook133 pages2 hours

    What Would Florence Do?: A Guide for New Nurse Managers

    By Sue Johnson

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    About this ebook

    ANA’s What Would Florence Do? A Guide for New Nurse Managers, is designed to help nurses excel in their management roles, regardless of tenure. This publication is an excellent resource that all CNOs or health care HR professionals can provide to their new and existing nurse management staff as an essential training guide.
    Being a nurse manager is a tremendous responsibility and an exciting opportunity. You are accountable for the success or failure of your unit, your team and even your organization. In order to be successful, you are going to need a mentor to guide you in what to do; someone whose influence on modern nursing is respected and has transcended time.
    You are going to need Florence Nightingale!
    Since we can’t travel back in time, we’ve developed the next-best thing to talking to Florence in person — an essential guide designed to mentor you in all aspects of being a great nurse manager as you navigate this phase in your career.
    This guide details Florence’s ideals and how using them can make you a phenomenal nurse manager in the 21st century. What Would Florence Do? A Guide for New Nurse Managers will give you actionable tips on:
    • Care coordination.
    • Community partnerships.
    • Developing others.
    • Ethical practice.
    • Safety and quality improvement.
    • Strategic planning.
    • And more!
    With this handbook, you don’t have to steer through the current regulatory, quality and reimbursement issues in the era of health care reform without practical real-world guidance.
    eBook features and functionality: Links from each header in the Table of Contents to its in-text occurrence; Active URLs; Next page/Previous page navigation; Home page is Table of Contents; Fully searchable.
    LanguageEnglish
    PublisherNursesbooks
    Release dateNov 1, 2014
    ISBN9781558105850
    What Would Florence Do?: A Guide for New Nurse Managers

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      Book preview

      What Would Florence Do? - Sue Johnson

      Regulatory, quality, and reimbursement issues reflect the complexity of our current healthcare environment. Hospitals’ ability to manage their bottom line is affected by all these forces. The Affordable Care Act established the Hospital Value-Based Purchasing Program (Centers for Medicare and Medicaid Services, 2013b), which began providing incentive payments to hospitals based on quality, not quantity, of care provided to Medicare patients beginning at the start of Fiscal Year (FY) 2013. This potential for additional reimbursement puts hospitals at risk for reimbursement reduction (1.0% of base operating Diagnosis Related Group amounts in Fiscal Year (FY) 2013 and 2.0% by Fiscal Year (FY) 2017) if they fail to meet clinical process of care measures (70%) and patient experience of care measures (30%). The impact of empowered nurses on the hospital’s bottom line is as great today as the impact of Florence Nightingale on healthcare reform in the formative years of our profession. Let’s take a closer look at the parallels between the two as we get acquainted with Florence and her achievements.

      Florence and the Nurse Manager

      Florence’s contributions to health care included emphasis on quality patient-centered care based on the best available evidence. To achieve this quality patient care, she knew that nurses had to be educated and observant to make wise judgments that promoted the health of their patients (Nightingale, 1992). The 2011 Institute of Medicine Report echoes Florence’s message that nurses should practice fully based on their training and education and should be full partners with physicians and other healthcare professionals in healthcare redesign (Institute of Medicine, 2011). Staff nurses, in their daily work, influence many of the clinical processes of care and patient experience of care measures in the Value-Based Purchasing (VBP) Program. Perioperative and Surgical unit nurses are experts on clinical SCIP measures, such as prophylactic antibiotic use, Beta Blocker administration, controlled postoperative serum glucose in cardiac patients, and Venous Thromboembolism (VTE) prophylaxis. In FY 2014, the Value-Based Purchasing Program will also require postoperative urinary catheter removal on post-operative day 1 or 2 (Centers for Medicare and Medicaid Services, 2013b). Staff nurses will play an integral role in the success or failure of this additional clinical process of care measure and sound leadership, but nurse managers must support staff nurses in achieving the goals of the Value-Based Purchasing Program and Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS). HCAHPS is a national survey that asks recent patients about their experience during their hospital stay. These results are posted nationally to compare hospitals based on ten important hospital quality topics (Centers for Medicare and Medicaid Services, 2013a).

      Since 30% of Value-Based Purchasing reimbursement is based on patient experience of care measures, HCAHPS scores gauge how well, or poorly, the patient rates his or her experience (Centers for Medicare and Medicaid Services, 2013a). Florence understood how important it is for staff nurses to spend time getting to know their patients and communicating with them. In her Notes on Nursing, she emphasized the importance of informing the patient when the nurse will be returning, listening to the patient’s concerns, observing the patient for condition changes, reducing unnecessary noise, ensuring confidentiality and privacy, and using appropriate infection control measures, especially hand hygiene (Nightingale, 1992). These measures are as important in today’s hospitals as they were in Florence’s time, and leadership by nurse managers and staff nurses in each of these measures can result in higher patient ratings of their hospital experience. These higher ratings can positively influence the hospitals’ Value-Based Purchasing reimbursement. Providing the opportunity for nurses to interact and know their patients beyond just the disease process is priceless.

      The Nurse Manager’s Role

      Florence described the role of the charge nurse as not only carrying out nursing skills and duties, but also ensuring that everyone else follows proper procedures in patient care in the charge nurse’s absence (Nightingale, 1992). Substitute ‘nurse manager’ for ‘charge nurse’ and her statement is applicable to today’s nursing culture. It is your responsibility to ensure that patients receive timely, efficient, effective, and patient-focused care. Florence was a lifelong proponent of healthcare reform. She used statistical data to support the reforms she advocated and was the first person to recognize the need for uniform hospital statistics throughout the world (Nightingale, 1992). As a nurse manager today, you need to pay careful attention to unit and hospital statistics that include nurse-sensitive indicators, i.e. processes and outcomes that are affected, provided, and/or influenced by nursing personnel, but for which nursing is not exclusively responsible (National Quality Forum, p. 2). These indicators include:

      ■ Nursing hours per patient day (NHPPD)

      ■ Nursing skill mix

      ■ Nurse turnover rate

      ■ RN education/certification

      ■ NDNQI RN satisfaction survey results

      ■ Catheter-associated urinary tract infection rates

      ■ Central line-associated blood stream infection rates

      ■ Fall/injury fall rates

      ■ Hospital/unit acquired pressure ulcer rates

      ■ Pain assessment/intervention/reassessment cycles

      ■ Peripheral IV infiltration rates

      ■ Physical restraint prevalence

      ■ Ventilator-associated pneumonia rates (American Nurses Association, 2013b).

      You must carefully evaluate these indicators for trends and note improvements resulting from the nurses’ roles in providing quality patient-centered care. You also must share this information with unit staff members and organization leaders. It is imperative for you to provide a therapeutic climate in the unit for unit staff members, other healthcare team members, and patients/families. You must also advocate for resources that will enable staff nurses to spend quality time interacting with patients and families and ensure that this interaction occurs consistently.

      Florence had significant influence on the British Empire in improving health and sanitation of hospitals as well as on the development of professional nursing. She collaborated with elected leaders, bureaucrats, and even Queen Victoria on healthcare issues of her day (Nightingale, 1992). Like Florence, you and other nurse managers are organization decision-makers and are in a unique position to promote the achievements of your staff nurses in nurse-sensitive indicators that impact the hospital’s bottom line. Nurses have an exceptional opportunity to influence their organizations as Value-Based Purchasing is implemented nationally. You and other nurse managers collaborate with leaders of many hospital departments on a daily basis. You must share the success stories of your nursing staff in meeting Value-Based Purchasing requirements, nurse-sensitive indicators, and the impact these successes have on the organization’s bottom line. You are responsible to advocate for unit-based resources that will advance the organization’s mission and the future of nursing in the organization.

      Just as Florence devoted her life to her mission, you must devote time and energy to the mission of the organization and the nursing department. As Florence encouraged nurses to collect empirical data about patients’ conditions to make wise judgments about care delivery (Nightingale, 1992), you must use empirical data for the same purpose. Since Florence aligned herself with influential leaders to facilitate healthcare changes (Nightingale, 1992), you must also align with influential organization leaders, such as the CFO, to meet the regulatory, quality, and reimbursement challenges of 2013 and beyond.

      The Future of Health Care

      This is a pivotal time for nurses to assume leadership roles in health care. As a nurse manager, you owe it to yourself, your patients, and your profession to stay educated and informed about changes in healthcare reform. Don’t hesitate to make your voice heard in decision-making that will impact your practice. Ask yourself What Would Florence Do? The answer will affect how well you navigate healthcare reform and influence the future of nursing. The future of health care will provide significant opportunities for nurses to validate Florence Nightingale’s statements about nursing in disease and wellness. [T]here is universal experience as to the extreme importance of careful nursing in determining the issue of the disease. The same laws of health or of nursing, for they are in reality the same, obtain among the well as among the sick (Nightingale 1992, p. 6). Although the wording is from a different era, Florence’s message echoes that of the 2011 Institute of Medicine’s vision of … a practice environment that is fundamentally transformed so that nurses are efficiently employed—whether in the hospital or in the community—to the full extent of their education, skills, and competencies (Institute of Medicine, p. 30). The future will require skilled, capable nurses who will lead their organizations and profession to the truly patient-focused care envisioned by Florence Nightingale in the 1800s.

      Florence’s Role

      Transformational leaders are experts at strategic planning (American Nurses Credentialing Center, 2008), and Florence Nightingale was a transformational nurse leader. This was evident in her first nursing leadership position. In 1851, Florence

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