A Bold Call for Change in Acute and Critical Care Nursing

Clinical nurse specialists (CNSs) are skilled and essential in transformational leadership. The article, “Call to Action: Blueprint for Change in Acute and Critical Care Nursing,” calls out the need for CNSs as part of a visionary framework reshaping the nursing landscape to address today’s acute and critical care nursing challenges. Although many of these challenges were laid bare during the COVID-19 pandemic, they have existed far longer. CNSs influence healthcare delivery by providing expertise and support to nurses, driving practice changes, and ensuring best practice and evidence-based care for optimal outcomes. CNS expertise, particularly in navigating complex patient needs and supporting nursing teams, was highlighted during the pandemic and is invaluable. CNSs are instrumental in combating the growing gaps in the nursing workforce by supporting the transition to practice of newly licensed nurses and serving as a resource to seasoned nurses. They improve the care that patients and families want and deserve. There is a pressing need for reform in nursing and why now, more than ever, it is the time for bold action. REDEFINING WHAT NURSES DO The Call to Action introduces 9 domains of acute and critical care practice1 that define the essence of nursing engagement with patients and families in their health, recovery, and healing. These 9 domains outline what nurses do every day: Create safe healing environments Build caring relationships with patients and families Assess and manage patient symptoms Administer physical, therapeutic, preventative, and end-of-life care Provide surveillance, are vigilant of patient risks, and are ready to intervene Teach patients and families what they need to know to actively participate in their own care and decision-making and manage their own care after hospital discharge Collaborate with, and coordinate care within the interprofessional team Advocate for the patient and family ensuring that their needs and preferences are known and respected within the interprofessional care team Navigate patient transitions in care across and out of the healthcare system Nurses should communicate the value they bring to patients and families through their actions, beyond just numbers or metrics. Nursing metrics should reflect nurses’ actual work, rather than focusing solely on harm or process measures that often go undocumented. In fact, patients and their families are more eloquent in expressing the impact of nursing care. For instance, a recent social media post shared a story of a nurse washing a trauma patient’s hair so the family could see her as their daughter, spouse, or sister, rather than a victim. This simple act created a compassionate, healing bond between the nurse and the patient and her family. Often, the stories shared by patients and families highlight the work of nursing in making them feel valued and safe. The DAISY Award program provides many exemplars of nurses not only giving excellent clinical care but also demonstrating extraordinary compassion. HOW SHOULD NURSING BE MEASURED? Two critical points should be considered when measuring nursing care. First, avoid burdening nurses with extra documentation whenever possible and instead use data routinely collected through their regular work. Healthcare systems gather data for various accrediting bodies and government agencies, using electronic health records and other databases. These datasets can be leveraged with artificial intelligence and other machine learning strategies to provide information about nurses’ work. Second, focus on recognizing the value nurses bring by providing care rather than measuring absence of care. See the Table for several examples of how measurement can be improved to better capture nurses’ contributions. Table - Selected Examples of Proposed Measurements Practice Domain Measurement Example Safe and healing environments Quantification of patient and family feelings of being safe Symptom management Number of times patients were at their preferred pain level or described as being comfortable Physical, therapeutic, preventative, and end-of-life care Number of patients at high risk for skin injury who do not have a pressure injury on skin prevalence dayNumber of patients with a central line or urinary catheter who had CLABSI or CAUTI preventedUse of mobilization strategies with impact on length of stay Surveillance Number of patients at risk of deterioration not needing rescue Abbreviations: CLABSI, central line–associated bloodstream infection; CAUTI, catheter-associated urinary tract infection. WHAT CAN CNSS DO NOW? Although it may not be possible to move from some current harm metrics, CNSs need to initiate discussions within their employment settings about flipping the narrative on measurement. Instead of reporting how many days since the last harmful event on a unit, start reporting how many events were prevented with nursing care. Start a conversation at the local National Association of Clinical Nurse Specialists affiliate level or with other CNS groups about ways to better describe and measure nursing’s work. Review the aforementioned publication and previous National Association of Clinical Nurse Specialist blog.2 To help support the Call to Action, take part in the national study “What Nurses Do” by completing the survey below and by sharing it with other nurses. Any registered nurse working in any setting or role in a hospital environment may participate by clicking on this link: https://redcap.nursing.upenn.edu/surveys/?s=XYEE7WP9J4MFK8T4, or scanning the QR code:It is time for the nursing community and particularly CNSs to rise to the occasion and ensure that the acute and critical care nursing practices defined by our healthcare system are nurse-driven, recognized, valued, and supported at every level. “Acute and critical care nursing should be measured by its presence, not by its absence.”1 CNSs have a long history of supporting nurses in acute care environments. Let’s be bold in using CNS expertise to demonstrate the value of nursing.