Why is NDNQI important to nurses?

“Nurses have to be full partners with physicians and other health care providers in redesigning the health care system,” - former Secretary of the US Department of Health and Human Services, Donna E. Shalala

(Kuehn, 2010, p. 2345)

• In October of 2010, a report was released, “The Future of Nursing: Leading Change, Advancing Health,” and it is shaking up healthcare as we know it. 
• The American Medical Association (AMA) is not happy with the outcome of the report.
  

• Nurses are featured and acknowledged, by the IOM, as the leaders and agents who will transform the health care system
  
• Nurses ensure care is patient centered, effective, safe, and affordable

• Nursing community to embrace this report as a blueprint for action

• Nurses use evidence-based research and collaboration to improve health care
• Nurses have the proven solutions, but they cannot do it alone

(Carlson, 2010)

• Remove scope-of-practice barriers.

• Expand opportunities for nurses to lead and diffuse collaborative improvement efforts.

• Implement nurse residency programs.

•  Increase the proportion of nurses with baccalaureate degrees to 80% by 2020.

• Double the number of nurses with a doctorate by 2020.

• Ensure nurses engage in lifelong learning.

• Prepare and enable nurses to lead change to advance health.

• Build an infrastructure for the collection and analysis of inter-professional health care workforce data.

• Nurses should practice to the full extent of their education and training.

• Nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression.

• Nurses should be full partners, with physicians and other health care professionals, in redesigning health care in the United States.

• Effective workforce planning and policymaking require better data collection and an improved information infrastructure.

                                                                                        = NDNQI
The NDNQI is one way to document what we as nurses do.  It is also a way to document what effect changes in staffing have on patient care.
(Nickitas, 2010, p.385)

• Total nursing hours per patient day

• Percent of total nursing hours supplied by RNs, LPNs/LVNs, and unlicensed assistive nursing personnel

• Percent of nursing hours supplied by contract or agency staff

• Nurse turnover: controllable/uncontrollable (adapted from National Quality Forum) or voluntary/involuntary (Magnet)

• Years of RN experience (survey) in the unit and in nursing

• RN certification (by a national body)

• RN intention to stay in the unit, in the hospital, and in nursing

• Quality improvement - Unit-level comparisons of staffing data and patient outcomes with units in like hospitals

• Satisfy reporting requirements, e.g. for Joint Commission or the Magnet Hospital program
  
• RN retention efforts

• Nursing administration (budget planning, resource allocation)

• Staff education (Expanding evidence-based practices.)

    (Anderson, Manno, O'Connor, & Gallagher, 2010)

Nursing leaders at participating facilities have used the information obtained from the NDNQI to advocate for more staff (Montalvo, 2007).

High RN Job Satisfaction:

• Higher commitment to the organization

• Higher intent to stay in the job

• Lower rates of needlestick injuries to nurses

• Higher patient satisfaction

• Lower risk adjusted Medicare mortality

Higher Patient-to-Nurse Ratios:

• Higher emotional exhaustion

• Higher patient risk-adjusted mortality

(Boyle, Miller, Gajewski, Hart, & Dunton, 2006)

Researchers will also continue to benefit from these NDNQI enhancements. These developments will enable researchers to fine-tune their research questions and identify additional associations between nursing workforce characteristics and processes and the observed patient outcomes.

According to Sachs (2010), NDNQI is the richest database of nursing performance in the country. Hospitals can compare performance and job satisfaction levels of individual nursing units to similar units locally, regionally and nationally.

The data reported in NDNQI are nurse sensitive indicators. NDNQI data are used to show the impact nurses have on quality of care. These indicators are nursing sensitive, so they show how nursing care, such as good oral care, or skin care or the interventions that prevent patient falls, are so important to patient outcomes (Trossman, 2006).

 IPFW Hospital
Total Falls per 1000 Patient Days
IPFW Hospital Medical Unit

During the 3rd quarter in 2009, the hospital implemented new bed alarms.

NDNQI data would be posted on the unit as a dashboard. A dashboard is a one page print out that graphically represents whether a unit met, exceeded, or fell short of target goals for each indicator and how the unit compared against unit based national benchmarks (Trossman, 2006).

Trossman (2006) stated that NDNQI data help nursing administrators and RN staff plan quality improvement activities, such as designing interventions that test nursing protocols and practices.

On the medical and surgical units at Parkview Hospital, NDNQI data is reported to the TCAB committee. TCAB stands for:

        T: Transforming
        C: Care
        A: At
        B: Bedside

TCAB is a committee meets once a month to discuss progress made on improving the quality patient care as noted through NDNQI data. TCAB pays special attention to many nursing sensitive indicators such as:

• Safety and Reliability: Amount of falls

• Patient Centered: Patients perception of care and discharge calls

• Efficiency: Productivity and Controllable Cost Per Unit Service

Just like NDNQI, TCAB produces graphs and diagrams for medical and surgical units to show progress. Benchmarks are noted on each graph to illustrate goals. These easy references show the staff where they stand and how much they need to improve.

To learn more about TCAB please visit this website.

NDNQI data is used to help improve the care of patients and the work environment of nurses to avoid costly complications.  

According to the Agency of Healthcare Research and Quality (2000), preventable health care-related injuries (such as falls, pressure ulcers, medication errors, ect.) cost the economy from $17 to $29 billion annually.

It is estimated that 44,000 to 98,000 people each year die from medical errors. This is higher than annual mortality rates from:

• Motor vehicle accidents (43,458)

This makes medical errors the eighth leading cause of death in the United States (AHRQ, 2000).

Trossman (2006) informs us that NDNQI data also can be used for other budget requests. For example, if there is a high incidence of pressure ulcers on some units, nurse administrators can request specific equipment, such as pressure redistribution mattresses.