© 2009 On the CUSP: STOP BSI Nurse Empowerment Christine A. Goeschel RN MPA MPS ScD (candidate) Tennessee Center for Patient Safety December 2, 2009

© 2009 Learning Objectives To understand the importance of nurse empowerment To consider the regulatory and accreditation mandates for nursing leadership To learn strategies to help empower nurses

© 2009 CUSP/CLABSI: What We Know Change involves technical challenges – Evidence – Measurement – Analysis Change involves adaptive challenges – How to Engage nurses, physicians, executives – Competing priorities – Organization hierarchies – How to hardwire practice changes

© 2009 Improve Patient Safety Culture: Create Trust Improve Patient Safety Culture: Create Trust Caring – Keep Patients your North Star – Commit that preventable harm is not tenable – Tell your own Josie Story Competent – Learn from mistakes – Implement teamwork tools (CUSP)

© 2009 Ensure Patients Reliably Receive Evidence Pronovost: Health Services Research 2006 SeniorTeam Staff leaders Engage How does this make the world a better place? Educate What do we need to do? Execute What keeps me from doing it? How can we do it with my resources and culture? Evaluate How do we know we improved safety?

© 2009 Nurse Empowerment Keep patient as north star ~ Harm is not tenable Decision to speak up – Must feel competent – Must feel it is safe – Must feel it will work Transparency when harm occurs – At patient level – At provider level – At organization level

© 2009 Strategies for Nurse Empowerment Policy Level – Code of conduct – Require nurses to assist with central line placement – Require adherence to checklist – Policy to deal with disruptive behavior – Require that bedside nurse attend rounds

© 2009 Strategies for Nurse Empowerment Practice Level – Licensure – Nurse Practice Act – Magnet Nursing – Collaborative Practice Models Infection Preventionists Attending Physicians

© 2009 Strategies for Nurse Empowerment Performance Level – Orientation /Skill Building – Annual Competency Assessment – Clinical ladder ~ leadership recognition

© 2009 Use tools to practice nurse empowerment in safe space – Nurse participates in patient rounds – Daily Goals with nurse read back – Learn from Defects – Participate in M&M Address disruptive behavior quickly Strategies for Nurse Empowerment

© 2009 In conflict, keep focus on patient as north star Remind staff that teams make wise decisions with diverse and independent input – Do not play man down Strategies for Nurse Empowerment

© 2009 Action Plan Project leaders meet with CUSP/CLABSI team Discuss what policies can be put in place to enhance nurse empowerment Create strategy to involve beside nurses in this project : use the 4Es Discuss what tools you can use to enhance nurse empowerment