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News Special: The nurse contribution to the next stage review - Research unit calls for metrics to demonstrate nursing outcomes

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Adopting metrics that measure nurses’ contributions to care could lead to them earning money for attending courses or developing new ideas, NT has learnt.

Nurses at five hospital trusts within the North West Strategic Health Authority are already winning monthly cash prizes
if they follow seven quality indicators being piloted to improve patient care.

Three of the SHA’s indicators – healthcare-associated infections, pressure ulcers and falls – have been recommended as potential ‘front runners’ for a national metrics programme in State of the Art Metrics for Nursing: A Rapid Appraisal, a report published by England’s National Nursing Research Unit.

The SHA’s initiative was also singled out in a second NNRU report, Nurses in Society, which reviewed the evidence for developing benchmarks for the nursing contribution to patient care and called for the profession to embrace metrics as a ‘tangible measure’ of this.

Jane Cummings, NHS North West director of nursing, performance and quality, told NT: ‘We have incentivised the initiative, but it has been hugely motivational and had a positive impact on morale because the nurses are able
to see the impact the care they deliver on has on patient care.’

The report calls on the RCN to establish a coalition of organisations to share best practice and standardise data collection in order to help England establish a coherent metrics system for nursing.

It recommends the California Nursing Outcomes Coalition (CalNOC) as a model for this.CalNOC was established in 1996 to bring together the key work being undertaken across the US state on nursing care and patient outcomes.

It aims to maintain a database of indicator evidence, conduct research, and provide healthcare organisations with information to shape policy and practice.

‘We enable members to understand how nurse staffing impacts outcomes at the unit level,’ said Nancy Donaldson, CalNOC research coordinator and director of the Center for Nursing Research & Innovation at the University of California, San Francisco.

‘We have learned what it takes to capture valid, reliable measures and how challenging it is to sustain and spread this effort, yet how vital it is.’

Moving to metrics

  • Nurses should embrace metrics in areas such as pressure ulcers and failure to rescue, overseen by a National Quality Board.

  • The Department of Health should ensure that the Connecting for Health initiative provides a suitable infrastructure.

  • The RCN and other key stakeholders should create a national coalition to share best practice.

  • Professional bodies and senior members of the profession should reinforce and reiterate the significance of nursing contribution in all settings.

  • Healthcare providers must identify mechanisms to ensure timely feedback of indicators to nursing units.

  • Healthcare commissioners and regulators should use nursing metrics as part of their assessment of quality and the commissioning process, and publish indicators.


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