Problem: Nurses are often interrupted when administering medication and can make medical errors as a result. Time with patients can be limited when nurses have to search for medical equipment. New nurses can be overwhelmed, and some wind up leaving the organization in their first year. These are just some of the systemic problems that impede the practice of nursing—but many of them can be solved by visionary leaders.
Background: Suzanne Boyle, R.N., D.N.Sc., traces her interest in health care to a critical life event decades ago. As an adolescent she watched her father experience a life threatening heart attack and experienced firsthand the dramatic impact health crises can have on patients and their families. Through it all, she was inspired by the nurses—from the intensive care unit (ICU) to the recovery room—who skillfully provided care.
Boyle’s father’s heart attack motivated her family to make healthy lifestyle changes through diet and exercise long before public awareness campaigns about heart disease. Boyle’s father recovered and lived to be 84-years-old and never had another cardiac event.
Caring was a family value instilled by both her parents, prompting Boyle and her sister to choose nursing as a career and her brother to choose emergency medicine.
Boyle enrolled in the nursing baccalaureate degree program at Boston College School of Nursing and became an ICU staff nurse, nurse clinician and administrator. Then she decided to advance her education at Yale University, where she earned a master’s degree in nursing and a doctorate in health policy and health services research.
Since then, Boyle has worn many different nursing caps.
In addition to her clinical work, Boyle has been an educator, researcher, clinical nurse specialist and an administrator, leading nursing practice and programs in both hospital and community settings. She was the principal investigator for a maternal-child health grant to improve access to prenatal care and breast and cervical cancer screening.
In her research, Boyle has focused on the relationship between the nursing unit work environment, nursing practice and patient outcomes. She has presented her findings in multiple forums and won several awards, including the Nursing Economics Foundation Scholarship Award (2002) and the Grace Davidson Award from New York University College of Nursing (2006).
In 2004, Boyle was awarded a fellowship from the Robert Wood Johnson Foundation (RWJF) Executive Nurse Fellows program, which offers senior-level nurses a three-year leadership program to strengthen their ability to lead change that will improve the nation’s health care system.
The fellowship proved to be a good springboard for a position she got that same year as Vice President for Patient Care Services at the highly regarded New York Presbyterian Hospital Weill Cornell Medical Center in New York City. In her role at New York Presbyterian, as it is known, Boyle oversees the departments of nursing, patient admissions, care coordination, social work and respiratory therapy.
In addition to her work at New York Presbyterian, Boyle is a member of the Executive Nurse Fellows program Alumni Board of Directors and the Hunter School of Nursing Advisory Board. She also is an assistant professor of nursing at New York University.
Solution: With her eye on innovation and systems improvement at New York Presbyterian, Boyle took note of recent research concluding that interrupting nurses while they are administering medicine—which studies suggest is a fairly common practice—increases medical errors.
With input from staff nurses and a pharmacy partner, Boyle is using those findings to improve patient care at New York Presbyterian. Nurses, for example, now may use signs to create a “do-not-disturb” zone while they are administering medications. For their part, hospital pharmacists have completely revised drug distribution processes to prevent medical errors; they have changed stocking levels and modified labels on medications in an effort to improve safe administration.
“It’s not rocket science,” Boyle says. “Simple changes like these can make big differences in outcomes.”
Boyle is also exploring ways to ease nurses’ workloads so that they can spend more time with their patients. Nurses are constantly running around in search of the tools they need to do their jobs, Boyle says. “We’re looking at ways to help nurses spend less time on the hunt for medical equipment and more time in patient rooms.”
These efforts build on another innovation Boyle implemented at New York Presbyterian in 2006 that significantly reduced turnover among newly hired baccalaureate graduate nurses.
Under Boyle’s Nurse Residency Program, new nurses receive mentorship, job training, and opportunities to network with each other and communicate with administrators. “We give our new nurses survival skills,” she says. “The program helps new nurses move from being novices in a new city and in a new hospital to feeling competent and confident.”
The program—modeled after similar evidence-based programs at other health care organizations—has been a huge success. In just one year, turnover among new graduates plummeted from more than 50 percent to 3 percent. Those who do leave seek advanced education and/or relocation. The low turnover rate has been sustained over the past 5 years.
These efforts align with an Institute of Medicine report that recommended a radical overhaul of the nursing profession to improve health and health care, Boyle says. A strong advocate for the report (called The Future of Nursing: Leading Change, Advancing Health), Boyle participated in the initial development phase and is now engaged with a pilot initiative in New York to implement the recommendations.
Her efforts at New York Presbyterian generally fall under report’s second, sixth and seventh major recommendations, which urge health care decision-makers and others to prepare and enable nurses to take a leading role in transforming health care and to provide opportunities for nurses to continue their education and training.
One recommendation in particular says that nursing organizations should provide leadership development, mentoring programs and opportunities to lead for all members—key goals of Boyle’s nurse residency program.
Boyle herself is, in fact, a manifestation of another recommendation: that nurses hold positions of power in health care and other organizations so they can spearhead improvements to health care delivery and outcomes.
As a vice president at New York Presbyterian, she puts these and other Future of Nursing recommendations into practice to make system changes that can improve patient care.
“We’re beginning to really start to move toward innovation and to dismantle old—and sometimes bad—habits. Just because we’ve always done something in a certain way doesn’t mean we always have to do it that way.”
RWJF Perspective: The Robert Wood Johnson Foundation supported the Initiative on the Future of Nursing, which developed the report that calls for a radical overhaul of the nursing profession to improve health and health care. In the report are recommendations to put nurse-led innovations into practice to improve delivery of care and patient outcomes and to cultivate nurse leaders.