Clinical Leadership: Growing Nurses, Elevating Practice

By Fiona Winterbottom, DNP, APRN, ACNS-BC, ACHPN, CCRN Sep 08, 2020

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In my roles as critical care APRN and evidence-based practice facilitator, I am a champion of nurse-led change and quality improvement.

Photos accompanying this blog were taken at Ochsner Health System's CSI Innovation Conference, prior to the COVID-19 pandemic.

In my roles as critical care APRN and evidence-based practice facilitator, I am a champion of nurse-led change and quality improvement. Over the past year, I have been delighted to watch nurses grow, innovate and elevate their practice through their participation in AACN Clinical Scene Investigator (CSI) Academy, a nurse leadership and innovation program. I have long held that direct care nurses understand the problems and barriers associated with providing excellent patient care and can offer creative solutions to the challenges of complex healthcare delivery. Now I have the evidence to prove it!

Earlier this year, teams of nurses from Ochsner Health System completed the CSI Academy program, sharing the results of their quality initiatives with nurse leaders and colleagues. One of these teams — a cardiac medical unit — launched a project titled "Blow Out Burnout: Decreasing Turnover, Increasing Self-Care." This CSI team implemented targeted interventions to reduce nurse burnout, increase staff engagement and decrease turnover. They created staff resources, including handouts, a serenity room and an end-of-life toolkit offering fingerprinting, EKG strips, locks of hair and an armband for patients' families.

The team measured the influence of their interventions using the Maslach Burnout Inventory and AACN's Healthy Work Environments (HWE) Assessment Tool. Results demonstrated an overall increase in the HWE score, a 13% decrease in depersonalization, a 17% increase in employee engagement and a 20% decrease in turnover with a positive cost avoidance of $117,000. Their end-of-life toolkit has been shared throughout our health system during the COVID-19 pandemic as a resource for patients' families.

The work of this team reminded me of the CSI Academy sessions I experienced at AACN's annual National Teaching Institute & Critical Care Exposition (NTI). These sessions inspired my staff and me to consider the possibilities of empowering direct care nurses to take charge and lead change. Clearly, the CSI alumni nurses who presented at the sessions made a significant difference in their hospitals' patient outcomes.

I was so impressed. I quickly got to work collaborating with our hospital's philanthropy department to obtain funding for 10 teams of Ochsner Health nurses to participate in CSI Academy. Our system's chief nursing officers fully supported participation, and we launched the program in February 2019. Direct care nurses from nine intensive care units (ICUs) and one acute care medical-surgical unit participated, with a handful of nurse leaders serving as coaches. I participated as Ochsner's overall project lead, assisting teams and coaches in progressing through the program and providing general support.

I can't tell you how thrilled I was at the conclusion of the program. The nurses from all of our CSI Academy teams were so innovative! From project selection, data collection and implementation to logo creation, marketing and presenting their work, the CSI teams' efforts reflected tremendous growth and inspired others. These nurses and their projects demonstrated positive outcomes on three fronts:

  • 1Nurse Impact

    • Increased clinical ladder program participation (over half of CSI nurses enrolled)
    • Increased the number of certified nurses
    • Decreased burnout
  • 2Patient Impact (clinical outcomes)

    • Reduced average length of stay
    • Decreased adverse events, such as hospital-acquired infections and in-house cardiac arrests
  • 3Fiscal Impact

    • Achieved cost avoidance of more than $1.0 million
    • Enhanced patient outcomes and experiences = PRICELESS

These measurable results validated my belief that direct care nurses are natural innovators who can positively impact patient care — and more — when given the knowledge, skills and opportunity to do so. For Ochsner, our next steps are to spread and scale the CSI Academy program across our health system. Our goals are to make the program available to all nurses who want to participate and to continue fostering nurse-led innovation.

As for myself, after 30 years of ICU nursing, CSI Academy has given me the tools to harness all my clinical nurse specialist skills while doing what I love best: developing nurses by engaging their spirit of inquiry and passion for their profession.

How are nurses in your facility solving problems and introducing innovation that enhances outcomes?