Nurses working directly with patients at the bedside are faced with not only patient and family demands, but also the regulatory requirements of care and the precise documentation of all tasks being provided. With the availability of information being recorded in the electronic health record, most organizations hire quality nurses to remotely view the information and provide feedback to the departments and nurses caring for the patients. The role of these specialized nurses is not to harass the bedside nurses with a "gotcha" notification; the quality nurse's role is to provide background support to ensure the nurse is capturing the excellent care he or she is providing.

For well over a decade, the Centers for Medicare and Medicaid Services (CMS) has set reimbursement values geared toward improving patient outcomes. Decreased hospital stays, readmission rates and hospital-acquired infections are a few of the measurements that CMS uses to incentivize organizations to improve processes in order to receive maximum payment. With the enactment of the Affordable Care Act (ACA), quality measures and outcomes of individual hospitals are readily available for patients and insurance companies to view on the Hospital Compare website. Where patients and physicians have a choice of which hospital to use, this data is golden.

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As the quality departments of hospitals embraced Value-Based Purchasing Programs from CMS, it became apparent that a specialty nurse was needed to monitor many of the outcomes and provide bedside nurses with feedback and strategies to meet the rigid targets. Quality nurses, when given a wide scope of employment and support, can easily be embedded into hospital units to address patient outcomes such as:

  • Catheter-Associated Urinary Tract Infections (CAUTI)
  • Central Line-Associated Blood Stream Infection (CLABSI)
  • Clostridium Difficile Infection (CDI)
  • Methicillin-Resistant Staphylococcus aureus Bacteremia (MRSA)
  • Surgical Site Infection (SSI)

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By working with the nurses and leaders on each hospital unit, the quality nurse can review documentation and provide near-time feedback to the nurses providing the care in order to meet the quality indicators. For example, a quality measure related to reducing CAUTI would be to review the need for the urinary catheter each day, as recommended by the Institute for Healthcare Improvement. The quality nurse could see that, based on the documentation, the bedside nurse has not documented the reason for the continued catheter for over 24 hours. He or she could contact or connect with the nurse to check on the status of the catheter and remind the nurse of the necessary documentation.

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Another area of assistance to the bedside nurse is having the quality nurse round with the nurses on their assigned patients to review the associated quality measures. This not only helps to improve patient outcomes but can also build strong collaborative relationships between the bedside nurses and the quality nurse when presented as a partnership. An example of rounding would be where both the quality and bedside nurses view the patient's central line dressing to ensure it is clean, dry, intact, and has been changed in the past 7 days. Also, the nurses can ensure the tubing of the urinary catheter is not kinked and the bag is not touching the floor; all contributors to infections.

The role of the quality nurse is to aid and support the bedside nurses in meeting regulatory measures to improve patient outcomes. When presented as a collaborative partnership, quality nurses are more "got your back" than "gotcha" when identifying areas where the bedside nurse can improve.

Amanda Bucceri Androus, RN, BSN

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