Toward a National Report Card for Nursing
As nurse leaders, we are held clinically and fiscally responsible for the care of patients and clients in our organizations. A significant portion of care provision in our organizations is executed by nursing staff. The literature has clearly delineated the outcome variables that are sensitive to nursing care. The relationship between specific input variables, such as RN skill mix and nursing hours per patient-day, and nurse-sensitive outcomes has also been demonstrated. In September 2010, the Academy of Canadian Executive Nurses (ACEN) Policy Committee made nurse-sensitive indicators its specific focus and resolved to initiate collaborations with the right stakeholders to pursue a vision for a national report card for nursing. The initiative was chosen to highlight and make explicit the contribution of nursing to healthcare outcomes and to develop a report card that could formulate and drive policy platforms in the future.
The policy committee contacted researchers in the field, as well as key stakeholders involved in outcome measurement, including the Canadian Nurses Association (CNA), Canada Health Infoway (CHI) and the Canadian Institute for Health Information (CIHI). The idea for a national nursing report card was solidified, and an invitational Think Tank was configured to launch this work. ACEN and CNA agreed to co-chair a planning committee for the Think Tank meeting to select and define nurse-sensitive structure, process and outcome indicators. The work of this committee evolved into the February 13 event: Think Tank: Toward a National Report Card for Nursing.
In preparation for the Think Tank, the planning committee engaged Diane Doran, RN, PhD, FCAHS, scientific director, Nursing Health Services Research Unit (Toronto site); Barb Mildon, RN, PhD, CHE; and Sean Clarke, RN, PhD, FAAN from the Lawrence S. Bloomberg Faculty of Nursing, to write a synthesis entitled Toward A National Report Card in Nursing: A Knowledge Synthesis. This synthesis identified "what is currently known about outcomes/performance monitoring initiatives in nursing, including specific indicators and reporting systems and what is known about the development, implementation and utilization of nursing report cards" (Doran et al. 2011).
The objectives of the Think Tank were:
- to develop a shared vision and critical path for a national report card on nursing,
- to generate support for the work among the nursing leadership community,
- to outline the concrete steps to make this happen and
- to achieve this through collaboration with other national and quality system initiatives for health information in Canada.
Representatives from ACEN, provincial nursing officers, provincial nursing associations, the federation of nursing unions, universities, and national and international researchers who are experts in the field of nurse-sensitive outcomes gathered in Montreal on February 13 to hear about the current status of the research regarding nurse-sensitive outcomes, the work of Canada Infoway and CIHI, and a number of specific collaborations that are creating general healthcare indicators. In addition, Dr. Norma Lang (University of Wisconsin regent distinguished professor and the Aurora distinguished professor of healthcare quality and informatics at the University of Wisconsin–Milwaukee College of Nursing) spoke on the important development of nurse-sensitive indicators, including the analytical approach taken to define the best-practice processes that have been linked to outcome indicators.
Discussion took place throughout the conference over how the excellent work done thus far can be used as a national set of nurse-sensitive indicators. In addition, the group had an opportunity to provide input to a "straw dog" set of structure, process and outcome indicators, representing a composite of the most frequently used indicators from the research, CIHI, HOBIC and a number of other sources. To be selected, an indicator had to be "meaningful, feasible and actionable."
The deliverables that were set out prior to the Think Tank were successfully achieved – beginning consensus on a minimum number of indicators to track in a nursing report card, and a draft critical path of milestones to move this initiative forward.
The planning committee will participate in a post–Think Tank meeting to discuss terms of reference and to finalize the draft documents. Committee members will also work at establishing linkages and determine partnership roles. The hope is to disseminate the draft template broadly (possibly through a survey format) to a clearly defined audience. Feedback would be collected and would potentially provide further refinement of the initiative. The plan is to launch the report card in the first quarter of 2012.
ACEN would like to thank its partners: the Canadian Nurses Association, Canada Health Infoway and Health Canada.
The Think Tank Planning Committee:
Think Tank Co-Chairs
Dr. Karima Velji, Chair, Leadership/Policy Committee, ACEN
Nora Hammell, Director, Nursing Policy, CNA
Planning Committee Members
Maureen Charlebois, Canada Health Infoway
Barbara Foster, Office of Nursing Policy, Health Canada
Dr. Kathryn Hannah, CNA Health Informatics Advisor
Sandra MacDonald-Rencz, Office of Nursing Policy, Health Canada
Patricia O'Connor, Academy of Canadian Executive Nurses
Dr. Susan VanDeVelde-Coke, Academy of Canadian Executive Nurses
A previous issue of Nursing Leadership [23(4) 2011] inadvertently included misinformation in the ACEN column on page 13. To clarify, the Registered Nurses Association of British Columbia (RNABC) did not implement reforms through a new health provision professions act to become the College of Registered Nurses of British Columbia (CRNBC). Rather the RNABC was dissolved and the CRNBC was created under the Health Professions Act. The new Association of Registered Nurses of British Columbia (ARNBC) takes on advocacy and other issues. The College is responsible for professional matters including the establishment and enforcement of Standards of Practice, the establishment of entry-level competencies for registered nurses and nurse practitioners, and the recognition of schools of nursing. ARNBC is not a member of the Canadian Nurses Association, rather CRNBC is the jurisdictional member for British Columbia.
About the Author(s)
Susan VanDeVelde-Coke, Executive Vice-President, Programs/Chief Health Professions and Nursing Executive, Sunnybrook Health Sciences Centre, President, ACEN, Toronto, ON
Karima Velji, Vice President, Clinical and Residential Programs & CNE, Baycrest, Executive Committee Member, ACEN, Toronto, On
Doran, D., B. Mildon and S. Clarke. 2011 (February 13). Toward a National Report Card in Nursing: Knowledge Synthesis, Ottawa: Academy of Canadian Executive Nurses.
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