In an introspective conversation last week, a close friend who is a hospital CEO shared a story that reflects the real struggles most healthcare leaders experience today as they balance the significant – and often competing – demands of reducing cost, increasing quality and improving patient experience. As he was leaving the hospital on a Sunday evening after several hours of catching up on paperwork and emails, he ran into a nurse walking out at the end of her 12-hour shift. “Hi, how are you?” he asked as they walked toward the employee parking lot.
She started to reply with the expected, “Just fine.” But instead she paused. Perhaps it was because it was the weekend or the fact that the CEO was wearing a polo shirt instead of his typical suit and tie. Whatever the reason, she felt safe opening up.
“You know, I’m tired,” she admitted in a frank but respectful way. “Working shifts with a six- or seven-patient assignment seems to be happening way too often. It’s just really hard to take care of the patients and families in the way I know they deserve to be cared for.”
He couldn’t disagree with her heartfelt concerns. Sincerely, he listened and reverently replied, “I understand.”
For healthcare organizations to stand any chance of truly transforming the way that care is managed,realizing aggressive goals for lower cost, increasing quality, and improving patient experiences, candid conversations like the one between this nurse and CEO must happen more often. In many ways, the quality of our engagement with frontline nurses and how we incorporate their critical input into the difficult work of redesigning care will determine how successful, and sustainable, our change efforts will be.
In countless ways, nurses indisputably have earned the right to play a leading role in care redesign efforts at all levels. While we are sometimes reluctant to admit it, the fact is that the lion’s share of the burden of many of the necessary – but difficult – changes we are making today fall squarely on the shoulders of frontline nurses. These include, but certainly are not limited to, reductions in labor costs that affect staffing ratios, the introduction of complex electronic medical records, and increasing requirements from regulatory agencies. In addition to these challenges, research confirms that interactions with bedside nurses are among the greatest influences on a patient’s positive perception of their overall experience during a hospital stay.
The good news? The ranks of nurses are filled with compassionate, talented, dedicated individuals who were called to the profession because of their deep commitment to caring for individuals at some of the most vulnerable times in their lives. Is it any surprise that in Gallup’s annual poll of the most trusted professions in the country nursing again came out on top? The profession has held that top spot for 12 out of the past 13 years, displaced only once in 2001 by firefighters in the wake of the 9-11 tragedy.
Our patients trust their nurses to provide exceptional care. Similarly, healthcare organizations that seek meaningful change in the value and quality of care must trust their wisdom, insights, and commitment to finding solutions that will best meet the needs of our institutions and the patients we serve.