A Nurse’s Wish for National Nurses Week (and no, it’s not a pizza party)

I love having lunch with my nurse colleagues. Whenever we fuel our minds over salads and sandwiches, we also solve problems in healthcare, identifying what we believe is the true source of the problem and which solution would make the biggest difference for patients.

I was thrilled when the Innovation team selected one of my friend’s ideas for implementation. They received a cash prize and publicity for their innovation, but when they asked when they could plan and test the idea on the unit that needed it most, they were told that there was no budget and no real process for implementing such novel ideas. They were advised to spend their own funds if they wanted to do something, but there would be no administrative support.

But administrative support makes or breaks most projects. They only required a pack of stickers and permission to spend staff hours on a 20-minute training session to reduce the most common adverse event for patient safety at their facility. But the answer was “no.”

Instead, the idea became copyrighted by an organization that seemed more interested in a quick public relations piece than patient safety. They could not reproduce the idea elsewhere, but it would remain impotent in the hands of disinterested owners.

The problem? The idea was cheap. Any facility in the world could implement the change with only a few dollars a month. Worse, if it was effective there would be no need for several other interventions that had failed to produce real results for patients.

No one really wants to admit that the old interventions appear to be fruitless; at least when we put an expensive machine in the room, people felt like we were doing something serious about patient safety.

When profit is the priority, affordable solutions are often left by the wayside. If Corporate cannot develop the product into a mega-profit high-tech piece of equipment, then it is of little interest.

Another time, a nurse discovered an error and came up with a solution to identify and prevent the error from happening. Reducing the error events would result in millions of dollars of revenue recovery. Corporate was suddenly interested, so they developed a project to implement the idea across the multi-facility organization.

The nurse innovator who created the solution was excluded from the project. Unfortunately, this is common practice. The “experts” take over, though they do not understand the work, and the idea is often botched without the input of frontline workers.

Meanwhile, the frontline nurse with a passion for innovation and patient safety became disillusioned as patient care remained unchanged.

I remember being shocked when managers asked nurses to come once a month to a committee meeting and provide their input. Administration wanted to achieve Magnet recognition, and these committees were a prerequisite. The nurses rolled their eyes and said, “Been there, done that. You don’t want our input; you want us to do your work on the solution you’ve already selected. I’ve got better things to do.”

But the model for Magnet recognition requires servant leadership that presents a problem, not a prefabricated solution, and allows the frontline employees to innovate and find a solution. To practice servant leadership, “you need to give [employees] a longer leash and let them try to solve problems themselves.”[1]

It appears there is a mismatch between theory and practice.

Servant leadership focuses on sharing knowledge and decision-making “by placing the needs of others first an creating and environment for followers’ growth.”[2] Yet, it is too common for exhausted leaders to prioritize their own survival and immediate needs to secure their position before attending to the needs of patients and staff.

The difficulty is that nurses are burned out on the bait-and-switch virtue signaling used by healthcare leaders who are focused on climbing the ladder while claiming to help the sick.

Why does this happen? Despite the availability of cost data related to adverse events, healthcare leaders are often unaware of the Return on Investment (ROI) for implementing process improvements and patient safety solutions. They see a lack of profit and forget about the cost of lawsuits and unexpected deaths.

Is it possible to build trust and bridge that gap, or has the chasm become too wide?

It is still possible. There are still morally conscious administrators and nurses across the healthcare field. Our industry is bustling with dedicated individuals ready to champion creative solutions to improve care and reduce costs.

So how can these nurse innovators and good-hearted administrators become engaged in healthcare improvement together?

I’m glad you asked because I’ve got a wish-list to share:

1. Solutions need a place to go: Create an avenue to communicate innovative ideas to administration, such as an email inbox (innovation@facility.com) and review them in the nursing committees quarterly.
2. Don’t tell nurses what to think: Present problems without solutions to the nurse committees and be willing to model servant leadership by facilitating discussion and listening to feedback from these frontline staff members.
3. The nurse with the idea participates in the project: Permit innovative authors to spend up to 2 hours per week for a 6-month period in paid collaboration to plan and implement their ideas, if selected. Their input will make the project effective, and their enthusiasm might change your company culture for the better.
4. Innovative ideas that save lives should not be parked in intellectual property jail: Partner with the publicity arm of the company, or with another respected organization, to publish the results of these pilot programs.
5. Embrace failure as a learning experience: Even null results will inspire others to try to innovate and discuss what worked, what did not work, and what could work better next time.
6. Help administration understand the Return on Investment (ROI) for risk management and process improvement. The data on the cost of patient safety errors and adverse events is available through government and advocacy organizations and the cost savings from preventing such events and lawsuits should be calculated into the ROI for innovative solutions. Include this value in the ROI estimate for innovation projects.

This wish-list is my request for Nurse’s Week. It’s time to be honest about what we really want as a profession, and I don’t want another pizza party. I don’t need a gift card or flowers. I want to see my patients get better and I want to go home at the end of the day knowing that I made a difference.

I am a proud member of the nursing profession, and we want the opportunity to improve patient care.

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[1] Milano, Steve (Jan. 12, 2022). Four Elements of Servant Leadership. Chron (an affiliate of the Houston Chronicle). https://work.chron.com/four-elements-servant-leadership-4919.html.

[2] Maglione, J L; Neville, K (June 20, 2021). Servant Leadership and Spirituality Among Undergraduate and Graduate Nursing Students. J Relig Health, 60(6). 4435-4450. 10.1007/s10943-021-01311-9.