Introduction
Nurses play an integral, challenging, and complex role in the healthcare system. Nurses are considered as the backbone of the complex and diverse system that comprises patients and a multidisciplinary team of experts. Nurses are educated and trained to cater to a large group of patients and often seek continuing education and upgrade their skills and knowledge. It is only through clinical exposure that nurses learn and implement new strategies and techniques. Nurses are known to transform the healthcare system by acting as mediators between the patient population and the medical team (physicians and other allied healthcare members). Through evidence-based practice nurses implement new strategies/interventions that not only benefit patients but also helps the organization. Most patients rely on nurses to assist them during their hospital stay. It is empirical for nurses to have a diversified role and act as game changers in a healthcare organization (Smolowitz, et al. 2015). Nurses play a key role in the diagnosis, treatment, and management of patients. Their role is not limited to manage but help in preventative healthcare and community awareness (Fooladi 2015). Nurses act as an advocate in palliative or end-of-life care. They have a special role in managing special populations such as geriatric, paediatric, disabled, and pregnant women (Premji & Hatfield 2016).
Success of healthcare organizations and Nurses role
Nurses form an integral part of a healthcare organization since they aim in improving health outcomes, patient satisfaction, and reducing overall burden and expenses. Nurses achieve key milestones in the healthcare organization with respect to improvement in patient outcomes, patient readmission, and improvement in overall job motivation and workplace environment. Nurses act as team players and strive to serve patients with an aim in uplifting the reputation of the organization by implementing promising strategies. This paper provides an overview of how nurses are integral to the overall success of healthcare organization.
Improvement of patient outcomes
Nurses collaborate with interdisciplinary teams to help improve patient outcomes. In a large healthcare organization achieving improved patient outcomes is a challenge but at the same time a reflection of higher standards of quality care and practice. Based on current evidence, focusing on the diagnosis, treatment, care, and management of patients right from admission to discharge and continuum of care would help in improving the overall quality of care (Bridges, et al. 2011).
Improving diagnosis
It is important for nurses to assist physicians and patients on a timely and accurate basis. Nurses can verbally discuss with the patient on current symptoms and medical history. They can review medical records and co-ordinate with the reporting physician on the patient’s current health status (Kourkouta, & Papathanasiou, 2014). Most nurses would assist physicians with documentation and record keeping of patient’s records which not only fastens the diagnosis process but also reduces the risk of errors and saves time. A collaborative approach with the physician and multidisciplinary team is a key to improved diagnosis and patient outcomes (Håkans 2012).
Evidence-based practice
Most healthcare organizations often have lower patient outcomes and higher rates of distress and low quality care. The root cause of low patient outcomes lies within the use or practice of sacred cows or conventional practices. In most cases, nurses only follow protocols and guidelines without understanding the patient needs and assessing patient feedback on implemented interventions (Ammouri, et al. 2014). Nurses are trained to think beyond their scope of practice and identify new areas and strategies that would promote quality of care and patient outcomes. Evidence-based practice (EBP) helps nurses develop and implement strategies that are not only benefit patients but improve overall outcomes (Majid, et al. 2011).
Better care transitions: Nurses have been reported to be an integral part of care transition. Patients and their family members rely on nurses to assist, care, and manage patient during the entire transition phase. In a recent study, the role of the nurse was considered a key success to better patient outcomes while transition to palliative care among elderly patients (Kirby, Broom, & Good, 2014). Skilled nurses have been reported to enhance the overall quality of care and improve overall health outcomes during transition of care (Toles, et al. 2016).
Continuum of care among patients: Nurses play a key role right from diagnosis, hospitalization, discharge planning, and home healthcare (Goldberg 2014). In a recent systematic review, a team of researchers have identified that providing continuum of care to the aging population, specifically at discharge and follow-up was associated with improved patient outcomes (Fleming & Haney 2013).
Patient engagement: Most patients often feel uncomfortable and stressed in hospitals. There is limited interaction with the medical staff. Patients often feel insecure and distressed since most of the staff members are busy with their own workload. However, registered nurses are trained to communicate and engage with patients. They help understand patient needs and that overtime provide a comfortable and secure environment to patients. They help facilitate patient-centric care and management (Kourkouta, & Papathanasiou 2014).
Quality assessment and improvement: Nurses are trained to ensure that the quality of care meets international standards. The administrative nursing staff collaborates with the nursing staff in developing and implementing quality control and quality improvement programs. Self-reporting, peer review, and monthly rewards programs ensures that nurses participate in a smart and competitive environment that promotes quality care (Izumi 2012).
Reduction in number of patient readmissions
Hospital readmissions are a common and serious issues that most healthcare organizations face. Regulatory and health authorities view patient readmission as a quality parameter of organizations and that any flaws directly reflect the poor standards of care, incompetency, and lack of competent staff (Dharmarajan, et al. 2013). Nurses form an integral part of the multidisciplinary team that ensures patients are educated, trained, and look after without the need to return to the hospital (Kutney-Lee, et al. 2011).
Prevent surgical site infections
Surgical site infections are a leading cause of patient readmission. Nurses implement infection control practices such as hand hygiene, regular dressing, and use of antiseptics before and after patient handling. The risk of surgical infections is reduced when nurses implement effective strategies and safeguard patients (Anderson, et al. 2014). In a recent review, nurses ensure that patients receive optimal care and support post-surgery and have zero tolerance against infections which in turn improves patient outcomes (Gillespie, et al. 2014).
Nurse continuing education
Nurses need continuing education to improve their knowledge and clinical decision-making skills. Continuing education gives an edge to nurses who have a significant exposure to patient education. For example, a nurse learnt that spending 5-minutes to interact with a patient may reduce the rate of stress and anxiety among elderly patients (Bailey, et al. 2012).
Whiteboard based care plan
Unlike conventional educational programs, a whiteboard based care plan provides basic information of care and management plans to nurses. It not only motivates them but helps in developing comprehensive discharge plans and reduce risk of readmission (Bailey, et al. 2012).
Implementing electronic health records (EHRs): Paper-based records or hand written communication charts often lead to misinterpretation that could have serious consequences on the patient’s health. A physician may develop a comprehensive discharge plan that is followed by the nurse. The patient is educated and trained about self-care and home-based interventions. Most physicians would also submit a list of medications that should be used post-hospitalization and a care plan for faster recovery. However, written or paper-based plans are vulnerable to loss, theft, misrepresentation, and even misinterpretation. The use of EHRs would prevent such miscommunication and have a positive impact on self-care of patients (Baillie, et al. 2013).
Efficient and effective treatment: Nurses play a key role in not only proving patients with efficient treatment but an effective management service that helps reduce the risk of readmission. Nurses are involved in a continuous effort to provide the best medical intervention medical science can offer keeping in mind the patient’s comfort, health and well-being. The patient’s safety and quality of care with effective and on-time treatment is the key to better outcomes (Epstein & Street 2011).
Patient communication and education: Patient education, specifically during hospitalization and at discharge is a key success strategy to prevent readmissions. Patients who are trained and taught about self-care activities, medication adherence, home-based care, and emergency reporting are most likely to reap the benefits and unlikely to visit or be readmitted to the hospital (Epstein & Street 2011).
Preventing falls and encouraging mobility: Nurses train and encourage fragile or weak patients to be mobile by using effective walking aids or exercise. Nurse involvement prevents the risks of falls and improve overall health outcomes of patients at home. Although, patients with physical immobility are at risk for fall, nurse-based interventions reduce the risks.
Increasing job motivation of nurses
Nurses burnouts have become increasingly common due to stress, workload, and dispute between nurse managers/leaders and staff. Poor job satisfaction, limited benefits, lack of promotion, and poor workplace environment have contributed to a steady decline among young nurses to leave the profession. However, nurse managers and leaders are in a continuous endeavour to promote and provide best in-class services and facilities to increase job satisfaction and motivation among nurses (Negussie 2012).
Intention/anticipation to turnover
Healthcare organizations should provide programs that encourage nursing staff to progress and move ahead with respect to professional development and organizational growth. The growth of the organization should have direct benefits to the staff members. An anticipation or intent to a rapid turnover would encourage nurses to work hard and dedicate themselves towards organizational vision and mission (Lorber & Skela Savič 2012).
Job satisfaction
Poor job satisfaction is a key to higher drop-out rates among nurses. Nurse managers should assess their staff member’s attitudes, beliefs, and behaviour towards their job profile (Negussie 2012). A nurse who is not only satisfied with the job but also inclined to achieving better outcomes and improved healthcare recognition is known to improve patient outcomes (Papathanasiou, et al. 2014),
Benefit and salary
Limited benefits, low salary, and no scope of salary hike are most common reasons for nurses to drop out of healthcare organizations (Negussie 2012). It is empirical for nurse managers to provide benefits such as recreational activities, family health insurance, gym memberships, child education facilities, and mandatory annual salary hike would improve job satisfaction (Asegid, Belachew, & Yimam 2014).
Autonomy
Healthcare organizations should enable nurses to take independent decisions based on their clinical experience and skills. The ability to provide nurses independence at work is associated with greater job satisfaction and motivation. Better working conditions and positive motivations help nurses to provide quality care to patients (Asegid, Belachew, & Yimam 2014).
Recognition of nurse performance at work
Nurse manager should recognize the scope and ability of individual staff members. A nurse rewards program (monthly) can help boost morale and motivate nurses to work harder and provide their best in terms of clinical decision making (Papathanasiou, et al. 2014),
Leadership relationships
Most dropouts are associated with dispute between staff and nurse managers. The healthcare organization should implement weekly/monthly nurse-manager meetings to facilitate transparent and cohesive decision making. Disputes between staff and managers should be resolved at the earliest to inculcate a positive work environment (Negussie 2012).
Promotion, work environment and group cohesion
The lack of recognition and failure to promote nurses to a higher authorized role may often lead to poor job satisfaction and motivation. Nurse managers should regulate different schemes and proposal wherein staff members are awarded and granted incremental hierarchical positions which would facilitate job satisfaction. Healthcare organizations and nurse managers should provide an excellent workplace environment that recognizes professionalism and work ethics. The key to job satisfaction is a positive work environment (Negussie 2012).
Summary
Nurses play an integral, challenging, and complex role in the healthcare system. Nurses are considered as the backbone of the complex and diverse system that comprises patients and a multidisciplinary team of experts. Nurses are educated and trained to cater to a large group of patients and often seek continuing education and upgrade their skills and knowledge. It is only through clinical exposure that nurses learn and implement new strategies and techniques. Nurses achieve key milestones in the healthcare organization with respect to improvement in patient outcomes, patient readmission, and improvement in overall job motivation and workplace environment (Smolowitz, et al. 2015).
Conclusion
In order to improve patient outcomes, healthcare organizations should include improved diagnosis, evidence-based practice, continuum of care, patient engagement, quality assessment and improvement (Fooladi 2015). Hospital readmission is a key quality indicator for healthcare organizations. However, nurses can prevent surgical site infections, educate patient on self-care and home management services, provide efficient and effective treatment, use EHRs, and prevent falls while encouraging patient mobility. Nurses should also participate in continuing education to improve their clinical decision-making skills and services. Lastly, healthcare organizations should provide better workplace conditions and a range of services including promotion, salary hike, and workplace autonomy to improve overall job satisfaction and motivation. Thus, it is clearly evident that nurses are the backbone of and that they are an integral part to the success of the healthcare organization (Premji & Hatfield 2016).
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