医疗保健质量和安全:首席护理官的主要职责

2022
02/22

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每个医疗保健机构的首席护理官 (CNO) 都有多个主要角色。


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全文翻译(仅供参考)

每个医疗保健机构的首席护理官 (CNO) 都有多个主要角色。CNO 的首要任务是展示在提高患者护理质量、安全性和价值方面的领导能力,尤其是通过优化运营,特别是在护理方面。为此,CNO 必须提高效率,促进与医生的良好工作关系,使护士的目标与医疗保健系统的长期战略计划保持良好的一致性,良好的沟通,并促进、授权和参与护士。1所有这些角色相互重叠,相互依赖,对 CNO 乃至医疗保健组织的成功至关重要。

优化护理操作

CNO 的角色之一是担任护理部门的运营主管。这是一项重大责任,因为在所有非医师中,护士是典型医疗保健组织中最大的专业,并且是非医师员工中成本最高的部分。2此外,关于床边护理,“护士提供绝大多数患者护理”。3 CNO 运营角色的某些部分是减少浪费和成本增加,提高效率,并负责护理部门的预算。2,4 CNO 的其他职责是招聘和/或培养在优秀结构内工作的一流管理人员,并提高护士的团队合作和绩效。2CNO 不仅是帮助医疗保健组织做出明智决策和计划的参与者,而且还实施了战略计划的护理目标。5

CNO 有责任升级患者护理、实现出色的患者治疗效果和满意度、改善人口健康,并遵循医学研究所的 6 个目标来改善医疗保健。2,4,6–9这 6 个目标是“医疗保健应该是安全、有效、以患者为中心、及时、高效和公平的。” 9实现这些目标在很大程度上是护理团队的责任,因为“护理部门通常在医疗机构内雇用最多的直接患者护理提供者。” 6CNO 在确保医疗机构满足与该医疗机构的护理相关的法律、认证和监管要求方面也负有主要责任。CNO 在改善运营和促进专业精神方面的作用都可以带来更好的患者护理。

让护士成为专业人士并赋予他们权力

法律和执照规定了护理实践的某些方面,包括普通注册护士和具有高级学位的护士的执业范围。实践的其他方面也受到专业协会的影响,例如他们推荐的指导方针和道德规范。然而,由 CNO 来激励护士在这些范围内作为训练有素、敬业的专业人员进行实践,并享受他们的工作。2

CNO 必须帮助为护士的角色和实践以及他们所服务的跨专业团队提供远见和战略思维。CNO 还必须激励和支持护士及其团队,并在组织和社区会议上代表他们的观点、需求和价值观。这可以通过适当的教育和沟通、有效的领导和领导结构、非常好的人员配备水平和工作流程、患者通过系统的高效流动以及质量监控来实现。4–6,10

CNO 的一个主要作用是充当“护理[作为一个专业] 的声音……[为了] 将文化转变为临床调查和专业参与的一种。” CNO 在促进护理领域作为一个职业方面的作用包括授权护士,允许护士尊重地发言,而不必担心受到指责,以改善对患者的护理并改善员工的工作条件,给予护士一定程度的患者自主权关心,并让他们在重要的行政事务上共同决策。2

事实上,CNO 的职责之一是帮助确定如何在护理部门的各个级别进行决策。7然而,为了领导,CNO 不仅必须赋予追随者权力,还必须成为优秀的榜样,并通过为组织、组织中的个人和服务对象提供鼓舞人心的信息和愿景来激励他人。6将这种通常抽象的愿景转化为符合医疗保健组织目标的有意义和有益的职业目标的能力是改变行为和文化的重要关键。2

促进护士的职业发展还意味着 CNO 在确保护理人员使用文献和组织指南中的最佳证据为护理实践提供信息方面负有主要责任。2,6这也是 CNO 在提高质量和安全方面的关键作用的一部分。

提高质量和安全性

鉴于护士在提供护理方面发挥的重要作用,有人说“CNO 是监督患者质量和安全的哨兵”。4尽管医疗保健系统可能有首席质量和安全官或质量和安全副总裁,但 CNO 是提高质量和安全的重要力量。6此外,64% 的优质专业人员是护士,只有 3.2% 是医生。11 CNO 和首席医疗官应保持良好的关系,最好每周会面几次,以优化患者护理和效率。6,12,13 CNO 还必须与质量和安全负责人良好合作,6首席体验官、首席运营官、首席执行官和其他高管通过成本控制和更高的质量(包括安全性)来提升价值。13

CNO 必须强调持续学习和质量改进是成功的关键。6正如一位护士所说,“CNE(首席护理执行官)越能胜任,组织中的每个人都会越能胜任。” 14

关于质量和安全举措,CNO 不仅应参与护理人员,还应参与整个组织中的一些人。CNO 还应该与参与质量和安全改进委员会的人员进行一些巡视,以与楼内护士建立融洽关系并激励他们。例如,在一个质量改进过程中,调查人员未能扫描条码,发现最常见的原因是附近没有合适的设备。纠正这一点后,无法扫描条形码的比率在 6 个月内下降了四分之三。6

CNO 还应该能够利用信息技术来提高质量和安全性,并解决与设备或培训相关的任何缺陷。CNO 应要求对工作的多个方面进行质量评分,并强调与来自不同学科的专业人士合作以改进结构和流程并从而改善结果的重要性。所有质量和安全结果都必须透明。CNO 还必须能够向其他高管展示由 CNO 领导的质量和安全工作如何为组织节省成本。6

尽管一线“护士代表了医疗保健领域最大的专业劳动力”,但他们在重要决策中往往没有很强的发言权。尽管护士对如何提高患者护理的质量和安全性有很多了解。例如,护士非常了解如何预防跌倒和用药错误。护士非常了解在跨专业团队中合作、预防和治疗感染以及良好沟通和领导的重要性。护士还知道许多最好的用品,以及各个单位的适当护士人员配置水平。15

为了改变这种情况并赋予护士权力,护士主管有责任与医生、专业协会、监管机构、大学健康中心、政府和公司建立各种伙伴关系。护理界需要在尽可能多的具有真正决策权的委员会和董事会中有代表。建议根据最佳证据进行实践教育,采取行动实现“四重目标” 15,并遵循加拿大患者安全研究所提供的质量和安全专家建议。15,16护士主管还需要强调所有团队成员遵循最佳实践并承认错误的重要性。15

护士与患者、家庭和社区建立联盟以促进更好的护理也很重要。此外,护士使命的核心是,他们不仅要关注成本控制、质量和安全方面的统计数据,还要记住一些对患者友好和关怀的语言和手势的重要性。15

加拿大患者安全研究所列出了 6 个安全领域:“促进患者安全文化、团队合作、……有效沟通、……管理……风险、……优化人类和环境因素……以优化患者安全,……[和] 识别、响应和披露不良事件。” 16该组织还拥有大量工具和其他资源,例如他们的患者安全文化捆绑包,其中包含有关如何创建和维护安全文化的详细清单。16

教学、指导、辅导和建议

CNO 应该是某些护理领导者的老师、导师和教练。CNO 还应促进领导力发展和临床护理技能方面的正式教育活动。这些可能包括讲座、模拟、团队项目和大回合。大查房是护士推广最佳实践和分享经验以提高患者满意度和结果的一种方式。17

CNO 的重要作用是传达护理部门正在发生的事情,并向众多个人提供报告和建议。这不仅包括最高管理层的其他高管、董事会成员、经理和护士长,还包括一线护士和护理学院的学生。沟通可以通过正式会议、讨论组、问答环节、讲座、通讯、印刷文章或医院网站、电子邮件等方式进行。18

对于护理专业的学生,CNO 可以提出建议,当护士找工作时,重要的是要注意面试官正在寻找准雇员在多大程度上能够适应护理部门,他/她的深度渴望提供出色的患者护理,以及个人对护理专业的热情。受访者应考虑分享有关他/她的个人护理经历以及他/她的特殊技能和价值观的感人故事。申请人应展示有关循证实践和质量改进重要性的知识。受访者还应该对医疗保健组织进行研究,例如从互联网上和与组织中的人交谈。19

更新或扩大责任领域

CNO 的新职责包括在重大变化期间帮助领导,例如医疗保健的报销方式或设施关闭或合并期间。此外,人们越来越关注团队、人口健康、门诊医疗和心理医疗服务中的跨专业合作。20 CNO 应具备护理临床方面的专业知识,了解影响护理的法规和法律,并充分了解医疗保健知识和趋势的新发展。7

结论

CNO 需要满足医疗机构、医疗团队成员(尤其是护士)和社区的多重期望。其中一些作用是提高患者的满意度、质量和安全性;改善护理业务;作为护理专业的倡导者;打击欺凌;赋予护士权力并让他们参与其中,以发挥他们的潜力。在所有这些事情中,CNO 必须表现出明智的领导能力。

Full text

The chief nursing officer (CNO) in each healthcare organization has multiple major roles. The first priority of the CNO is demonstrating leadership in improving the quality, safety, and value of patient care, especially by optimizing operations, particularly in nursing. To do this, the CNO must increase efficiency, promote good working relationships with physicians, craft a good alignment between the goals of the nurses and the long-term strategic plan of the healthcare system, communicate well, and promote, empower, and engage the nurses.1 All of these roles overlap, depend on one another, and are critical to the success of the CNO and indeed the healthcare organization.

OPTIMIZES NURSING OPERATIONS

One role of the CNO is being head of operations for the division of nursing. This is a major responsibility because, of all the nonphysicians, the nurses comprise the largest specialty in the typical healthcare organization and is the costliest section of the nonphysician employees.2 Furthermore, regarding bedside care, “nurses provide the vast majority of patient care.”3 Some parts of the CNO operational role are diminishing waste and cost increases, improving efficiency, and being responsible for the budget for the nursing section.2,4 Other responsibilities of the CNO are recruiting and/or developing topnotch managers who work within an excellent structure and improving the teamwork and performance of nurses.2 The CNO not only is a participant in helping the healthcare organization make wise decisions and plans, but also operationalizes the nursing objectives of the strategic plan.5

The CNO has responsibilities for upgrading patient care, achieving excellent patient outcomes and satisfaction, improving population health, and following the 6 aims of the Institute of Medicine to improve health care.2,4,6–9 Those 6 aims are that “health care should be safe, effective, patient centered, timely, efficient, and equitable.”9 Achieving these aims are largely the responsibility of nursing teams, because “the nursing department typically employs the highest volume of direct-patient care providers within a healthcare facility.”6 The CNO also has a major responsibility in making sure that the healthcare facility satisfies the legal, accreditation, and regulatory requirements relevant to nursing in that healthcare organization. The CNO’s roles in improving operations and promoting professionalism both result in better patient care.

ENGAGES AND EMPOWERS NURSES AS PROFESSIONALS

There are certain aspects of nursing practice that are defined by laws and licensure including the scope of practice for general registered nurses and those with advanced degrees. There are other aspects of practice that are affected by professional societies such as their recommended guidelines and codes of ethics. However, it is up to the CNO to inspire the nurses to practice within these boundaries as highly trained and engaged professionals who enjoy their work.2

The CNO must help provide vision and strategic thinking for the roles and practices of nurses and the interprofessional teams they serve on. The CNO must also inspire and support the nurses and their teams and represent their perspectives, needs, and values at organizational and community meetings. This can be achieved with appropriate education and communication, effective leaders and leadership structure, very good staffing levels and work processes, an efficient flow of patients through the system, and quality monitoring.4–6,10

A major role of the CNO is to serve as “the voice of nursing [as a profession]… [in order to] transform the culture to one of clinical inquiry and professional engagement.” This role of the CNO in promoting the field of nursing as a profession includes empowering nurses by allowing nurses to speak up respectfully without fear of recrimination to improve care for the patient and improve working conditions for the employees, giving nurses a measure of autonomy in patient care, and giving them shared decision making in important administrative matters.2

Indeed, one of the responsibilities of the CNO is to help establish how decision making is done at each level of the department of nursing.7 However, in order to lead, the CNO must not only empower the followers, but must also be an excellent role model and motivate others partly by having an inspiring message and vision for the organization, the individuals in it, and those it serves.6 The ability to translate this often abstract vision into meaningful and rewarding professional goals that fit with the healthcare organization’s objectives is an important key to change behavior and culture.2

Promoting the profession of nurses also means the CNO has major responsibility in making sure that the nursing staff is using the best evidence from the literature and organizational guidelines to inform nursing practice.2,6 This is also part of the critical role of the CNO in improving quality and safety.

IMPROVES QUALITY AND SAFETY

In view of the large role that nurses have in providing care, it has been stated that “CNOs are the sentinels who oversee patient quality and safety.”4 Although the healthcare system likely has a chief quality and safety officer or vice president of quality and safety, the CNO is an important force in improving quality and safety.6 Furthermore, 64% of quality professionals are nurses, and only 3.2% are physicians.11 The CNO and the chief medical officer should have a good relationship and preferably meet several times a week to optimize patient care and efficiency.6,12,13 The CNO must also work well with the chief of quality and safety,6 the chief experience officer, the chief operating officer, the chief executive officer, and other executives to drive value up by cost control and greater quality, including safety.13

The CNO must emphasize continuous learning and quality improvement as keys to success.6 As one nurse indicated, “the more competent the CNE (chief nursing executive) is, the more competent everyone in the organization is going to be.”14

Regarding quality and safety initiatives, the CNO should not only participate in those in nursing but also in some in the organization as a whole. The CNO should also make some rounds with those involved in quality and safety improvement committees to build rapport with and inspire floor nurses. For example, in a quality improvement process investigating failure by personnel to scan bar codes, it was found that the most frequent reason was not having the appropriate equipment nearby. When that was corrected, the rate of failure to scan the bar code declined by three-quarters in 6 months.6

The CNO should also be able to leverage information technology to increase quality and safety and address any deficiencies related to equipment or training. The CNO should require quality scoring regarding multiple aspects of the work and emphasize the importance of working with professionals from various disciplines to improve both structure and processes and thus results. There must be transparency in all quality and safety results. The CNO also must be able to show other executives how the quality and safety efforts led by the CNO results in savings for the organization.6

Although frontline “nurses represent the largest professional working force in health care,” they often do not have a strong say in important decision making. This is despite the fact that nurses have much knowledge about how to improve the quality and safety of patient care. For example, nurses know a lot about how to prevent falls and medication errors. Nurses are well-informed about working together in interprofessional teams, preventing and treating infections, and the importance of good communication and leadership. Nurses also know many of the supplies that are best and what are the appropriate levels of nurse staffing for various units.15

In order to change this situation and empower the nurses, it is incumbent on nurse executives to build a variety of partnerships with physicians, professional societies, regulatory bodies, university health centers, governments, and corporations. The nursing community needs to have representation on as many committees and boards that have real decision-making power as possible. Education in practicing according to the best evidence, taking actions to achieve the “quadruple aim,”15 and following expert advice on quality and safety such as that provided by the Canadian Patient Safety Institute are recommended.15,16 Nurse executives also need to emphasize the importance of all team members following best practices and acknowledging their mistakes.15

It is also important that nurses build alliances with patients, families, and the community to promote better care. Furthermore, it is central to the mission of nurses that they not only focus on statistics regarding cost control, quality, and safety, but also remember the importance of some friendly and caring words and gestures to the patients.15

The Canadian Patient Safety Institute lists 6 domains for safety: “contribute to a culture of patient safety, work in teams,… communicate effectively,… manage… risks,… optimize human and environmental factors… in order to optimize patient safety,… [and] recognize, respond to, and disclose adverse events.”16 This organization also has numerous tools and other resources such as their patient safety culture bundle, which goes into a checklist of details on how to create and maintain a culture of safety.16

TEACHING, MENTORING, COACHING, AND ADVISING

The CNO should be a teacher, mentor, and coach to certain nursing leaders. The CNO should also promote educational formal activities in leadership development and clinical nursing skills. These could include lectures, simulations, team projects, and grand rounds. Grand rounds are one way for nurses to promote best practices and share experiences to improve patient satisfaction and outcomes.17

Important roles of the CNO are to communicate what is happening in the division of nursing and to give reports and advice to numerous individuals. This includes not only other executives in the C-suite, members of the board, managers, and charge nurses, but also to frontline nurses and students in nursing colleges. Communication may be done in formal meetings, discussion groups, question-and-answer sessions, lectures, newsletters, printed articles or those on the hospital website, emails, and so on.18

In regard to nursing students, the CNO could give advice that when a nurse looks for a job it is important to note that the interviewer is looking for how well the prospective employee appears to be able to fit into the nursing unit, his/her deep desire to provide excellent patient care, and the individual’s passion for nursing as a profession. The interviewee should consider sharing moving stories about his/her personal experiences with nursing and his/her special skills and values. The applicant should show knowledge about the importance of evidence-based practice and quality improvement. The interviewee should also do research about the healthcare organization such as from the internet and speaking to those in the organization.19

NEWER OR ENLARGING AREAS OF RESPONSIBILITY

Newer responsibilities of the CNO include helping to lead during major changes such as in how healthcare is reimbursed or during a facility closure or a merger. Furthermore, there is increasing attention to interprofessional collaboration in teams, population health, outpatient healthcare, and mental healthcare services.20 The CNO should have expertise in the clinical aspects of nursing, understand the regulations and laws affecting nursing, and be well-informed about new developments in knowledge and trends in healthcare.7

CONCLUSIONS

The CNO needs to fulfill the expectation of the healthcare organization, the members of the healthcare team—especially the nurses, and the community in multiple roles. Some of those roles are in improving the satisfaction, quality, and safety of patients; improving nursing operations; being an advocate for nursing as a profession; combating bullying; and empowering and engaging nurses to fulfill their potential. In all of these things, the CNO must demonstrate wise leadership


原文链接:

https://journals.lww.com/nuclearmed/Fulltext/2022/03000/Quality_and_Safety_in_Healthcare,_Part_LXXVII_.32.aspx

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关键词:
首席,保健,医疗,职责,护理

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