Direct Care Nurses Leading Innovation

Marian Altman, PhD, RN, CNS-BC, CCRN-K

I am a nurse. However, the word nurse doesn’t adequately describe everything I do. I am a care giver, an advocate, a teacher, a hand holder, a negotiator, a cheerleader, a problem solver, an influencer, a solution seeker – and an innovator. Nurses, the largest group of healthcare professionals who care for patients 24/7, are ideally positioned to understand patient needs and identify, create and sustain innovation that leads to positive patient and unit outcomes. However, most nurses do not see themselves as innovators or feel empowered to use their expert knowledge to create innovative solutions.

The Institute of Medicine's 2010 Future of Nursing report confirmed the vital role nurses must take to become change leaders in healthcare. This report, along with the untapped power of direct care nurses and the challenges of the current healthcare environment, led the American Association of Critical-Care Nurses (AACN) to develop AACN Clinical Scene Investigator (CSI) Academy in 2012. I was a faculty member for one of the initial cohorts and continue working with the teams today.

What is AACN CSI Academy?

AACN CSI Academy is a 12-month, hospital-based nurse leadership and innovation program that is based upon the concept of implementation science to educate and empower direct care nurses to effect positive change. AACN CSI Academy’s goal is to leverage nurses’ expertise to enhance patient care, building on that expertise with additional leadership skills gained through team education, coaching and mentoring. Participants are given the knowledge and support to guide and partner with their peers and interdisciplinary team members to create unit-based change that is sustainable and scalable.

Who participates in AACN CSI Academy?

Teams of two to four nurses work together. The team identifies a patient-care challenge in their unit within the nursing sphere of influence. Some of the challenges focus on:

• Hospital-acquired infections and conditions such as pressure injuries, falls, mobility issues, sepsis, surgical site infection and delirium
• Communication issues during handoffs and nurse-led rounds
• Work environment problems such as staffing, turnover, moral distress and burnout

What does AACN CSI Academy teach participants?

CSI faculty deliver content in an experiential learning environment, including on-site workshops, virtual meetings and regular consultations. Curriculum topics include:

• Creativity and innovation
• Change management
• Project development and measurement
• Implementation science concepts and sustainability

The AACN CSI Academy curriculum specifically focuses on the "how to" of creating change, applying John Kotter's eight-step change model for transforming ideas into an impactful project.

AACN CSI Academy Outcomes

To date, CSI teams from 95 hospitals in 15 regions have significantly improved patient outcomes, all while having a positive fiscal impact estimated at $84.2 million with a median return on investment of 605%. Examples of clinical outcomes include the following:

• A North Carolina team reduced length of stay 14%.
• An Alaska team decreased hospital-acquired pressure injuries 56%.
• A Washington team reduced catheter-associated urinary tract infections 92%.
• A California team decreased patient falls 50%.
• A Massachusetts team reduced nurse turnover 27%.

The CSI teams' change initiatives often result in positive clinical outcomes beyond the original objectives. For example:

• 11 CSI teams increased patient mobility, reduced hospital-acquired conditions and improved patient/family satisfaction
• 10 CSI teams focused on communication-related issues – such as bedside report and patient handoffs – not only decreasing errors in those areas, but decreasing length of stay and improving patient and staff satisfaction as well
• Many CSI teams Improved the unit's morale and work environment, although that wasn't the project focus

CSI Academy participants also report experiencing significant personal and professional growth. For example:

• Obtaining new leadership-focused jobs
• Acquiring advanced education
• Challenging the clinical ladder
• Earning specialty certification
• Publishing in peer-reviewed journals
• Presenting educational webinars about their project
• Giving podium and poster presentations at conferences
• Receiving a patent and working with a company to mass produce a product

Summary

Teams share their outcomes at an Innovation Conference in month 12 that is attended by hospital leadership and their peers. The teams describe the problem, their project's purpose and goals, key activities, fiscal outcomes, lessons learned and their sustainability plan. The presentation is vital to help attendees understand the important work that nurses do and the positive impact nurses can make when given the opportunity to unleash their creativity and innovation — and the time and support to do so. As author Margaret Mead said, "Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it is the only thing that ever has."

Innovation is key to maintaining and improving the quality of patient care. As faculty for AACN CSI Academy it is my honor and privilege to help nurses express their creativity and innovation, and then support them while acting as a change agent for their projects.