Quality improvement programs put strain on nursing shortage

A study released Thursday by the Center for Studying Health System Change (HSC) shows that hospital quality improvement programs increase strain on nurses, aggravating an already difficult nursing shortage.

Hospitals face growing tensions and trade-offs when allocating nurses to the competing priorities of direct patient care and quality improvement efforts, according to the HSC research brief, titled "The Role of Nurses in Hospital Quality Improvement."

John Lumpkin, MD, senior vice president and director of the Health Care Group at the Robert Wood Johnson Foundation, said RWJF commissioned the study to gain a better understanding of the role that nurses play in quality improvement and the challenges they face when balancing competing priorities.

"Nursing has the biggest impact on a patient's experience in the hospital, so involving nurses in quality improvement is critical," he said.

Quality improvement programs demand nurse participation and more data collecting for nurses who are already overloaded, the study found. Because reporting methods are not standardized, quality measurement and reporting often force nurses to duplicate efforts.

"The stakes for hospitals to demonstrate high quality are increasing at the same time that resources – especially nurses – are in short supply," said Debra Draper, HSC's associate director and co-author of the study. "While quality improvement isn't solely the domain of nurses, they are critical because of their day-to-day patient responsibilities, and hospitals will need to guard against diminishing nurses' involvement in quality improvement activities."

The study interviewed hospital leaders in Detroit, Memphis, Minneapolis-St. Paul and Seattle and found that a hospital's culture sets the stage for quality improvement, including nurses' involvement. Hospitals that support leadership and have a philosophy that quality is everyone's responsibility reported being more successful in involving and retaining nurses. Successful hospitals also said individual accountability, physician and nurse champions and effective feedback are important.

Hospitals reported frustration in balancing the use of their best nurses between patient care and quality leadership. Some respondents said nurse leaders sometimes feel they get mixed messages about what is most important.