Initiative on the Future of Nursing Explores Improving Quality across Acute Care Settings

More than 300 nurses, public policy experts and health care professionals attended an acute care forum organized by the Initiative on the Future of Nursing in October that featured leading experts from around the country.

    • November 24, 2009

“The acute care environment will be shaped by the intersection of technology, business models and human needs. New acute care models will emerge haphazardly, by default, or by design,” Marilyn Chow, D.N.Sc., R.N., FAAN, said at the Initiative on the Future of Nursing forum on acute care, held in October at Cedars-Sinai Medical Center in Los Angeles. “Nursing cannot transform a care delivery system alone. The future is already here. It’s just not everywhere.”

“Nurses are the primary hospital caregivers. The efficient use of their time and energy is critical to the future of hospitals and acute care,” added Chow, vice president, patient care services at Kaiser Permanente.

The Initiative on the Future of Nursing is a two-year, joint effort of the Robert Wood Johnson Foundation and the Institute of Medicine to examine issues that face the nursing profession and develop recommendations to ensure that the nursing workforce can meet the demands of a reformed health care and public health system. More than 300 nurses, public policy experts and health care professionals attended its acute care forum—the first of three such events the Initiative is hosting.

Quality and Safety Challenges

The forum featured leading experts from around the country. “We have made cumbersome, difficult, almost impossible work systems for nurses,” warned Tami Minnier, R.N., M.S.N., FACHE, chief quality officer for the University of Pittsburgh Medical Center, adding that nursing care delivery systems must be reliable and should be led by nurses.

The interruptions and work system failures that nurses encounter can suppress their ability to provide the best possible care, agreed Maureen Bisognano, B.S.N., M.S.N., executive vice president and chief operating officer at the Institute for Healthcare Improvement. “Nurses’ performance is intimately tied to the system in which they work.”

Insufficient problem identification and error reduction are system failures, not incompetence, Bisognano noted. For acute care to be truly patient-centered, work systems must be redesigned to ensure that nurses can use their professional expertise to provide safe and reliable care. “We need a national learning system to make all models and prototypes accessible to nurses, at all levels, everywhere in the country,” she urged.

Technology-Based Solutions

Wireless communication, remote location systems, point of care testing, and telemedicine are being integrated into acute care settings, said Steve DeMello, M.B.A., research program director at the Public Health Institute. Technology is aiding ergonomics, facilitating education and training, improving nurse productivity and efficiency, and changing basic models of care. Although new technologies have been tested and implemented, they have not been replicated consistently and appropriately across organizations, he said.

New technologies can help eliminate non-value added work, said Pam Cipriano, Ph.D., R.N., FAAN, noting that doing so can return valuable time to patients. Cipriano chairs the American Academy of Nursing’s Workforce Commission. Used correctly, she said, technology reduces errors, provides access to important resources, and improves safety, qualify and efficiency.

Nurses should not be passive consumers, Cipriano said. They should also be on the design end of technology and health care delivery systems.

Interdisciplinary Collaboration Critical

Before a nurse can collaborate successfully, he or she must be competent in his or her own discipline, understand the complexity of population health, and be skilled in conflict resolution and communication, said Pamela Mitchell, Ph.D., F.N., FAHA, professor and founding director of the Center for Health Sciences Interprofessional Education and Research at the University of Washington. Inter-professional collaboration is important to workplace satisfaction and retention of nurses, she added, and health care organizations and academic institutions should work together to teach collaboration skills.

Communications and collaboration are often hindered by “disruptive physician behavior,” said Alan Rosenstein, M.D., M.B.A., Vice President and Medical Director for VHA West Coast and Medical Director for Physician Wellness Services. Disruptive behavior affects nurse satisfaction and retention, and patient safety.

Rosenstein urged organizations to recognize disruptive behavior, and commit to eliminating it with consistently applied policies and procedures. General education and advanced training at all levels, and clear means of reporting incidents and providing intervention and feedback are essential, he said.

The next Initiative on the Future of Nursing forum, addressing primary care, community health, and public health, will be held December 3 in Philadelphia. To register for the webcast, or to learn more about the Initiative on the Future of Nursing, visit