Nurses and patients know that nursing care makes a difference. During a session at the 42nd Annual Congress in Denver, CO, David Rice, PhD, RN, NP, director of professional practice and education at the City of Hope National Medical Center, encouraged nurses to take strides to prove it by using benchmarks and data.
Rice defined a benchmark as “a standard, or a set of standards, used as a point of reference for evaluating performance or level of quality. Benchmarks may be drawn from a firm’s own experience, from the experience of other firms in the industry, or from legal requirements.”
“We use benchmarks in every aspect of our industry,” he said. “How do we use them to demonstrate the benefit of nursing? How do we demonstrate the value of the care we provide?”
With benchmarking, nurses can improve their performance and patient outcomes by “continually identifying, understanding, and adapting outstanding practices and processes found inside and outside the organization,” Rice said.
He suggested the Agency for Healthcare Research and Quality’s six domains of healthcare quality as broad areas where nurses can focus and make measurable differences:
- Safe: Avoiding harm to patients from the care that is intended to help them
- Effective: Providing services based on scientific knowledge to all who could benefit and refraining from providing services to those not likely to benefit
- Patient-centered: Providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions
- Timely: Reducing waits and sometimes harmful delays for those who receive and those who give care
- Efficient: Avoiding waste (e.g., equipment, supplies, ideas, energy)
- Equitable: Providing care that does not vary in quality because of personal characteristics, such as gender, ethnicity, geographic location, and socioeconomic status.
Regarding equitable care, Rice reviewed specific patient subpopulations for whom nurses can make a particular impact. He stressed the importance of being mindful of diversity, in not only the visible ways people are diverse (e.g., age, gender, gender expression, race, class, physical ability), but also invisible factors (e.g., ethnicity or national origin, gender identity, politics, religion, relationship status, employment status, personal habits, communication style, educational background, work experience, socioeconomic status).
He especially encouraged nurses to impact the care of patients who do not have health insurance; those living in poverty; the lesbian, gay, bisexual, and transgender population who have multiple high-risk factors, including tobacco and alcohol use, eating disorders, psychological distress, poverty, medical debt, higher cancer risks, and lower screening rates; and patients in the South and Appalachia areas of the United States, areas that have the highest mortality rates, are lowest-ranked in overall health care, and reduce or restrict the advanced practice nurse role.
Throughout the presentation, Rice offered very specific examples of nursing-sensitive indicators, or areas where oncology nurses can demonstrate the impact and value of the care they provide:
- Central line–associated bloodstream infections
- Hospital-acquired pressure injury
- Falls and injury
- Catheter-associated urinary tract infection
- Ventilator-associated events
- Preventable hospital readmission
- Vesicant chemotherapy extravasation
- End-of-life metrics.
Rice quoted Kristen Swanson, creator of the Swanson Theory of Caring and Healing: “When ‘doing for’ is done well, it often goes unnoticed.” But Rice encouraged the audience start benchmarking what they can to continue to measure and demonstrate the value of nursing. “You impact the care quality and safety of patients with cancer in measurable and immeasurable ways,” he said. “Be compassionate. Be self-, patient-, and population-aware. Be data driven.”