Creating a Culture of Nursing Innovation

By Nancy M. Albert, PhD, CCNS, CHFN, CCRN, NE-BC, FAHA, FCCM, FHFSA, FAAN, Associate Chief Nursing Officer of Nursing Research and Innovation

Nursing innovation has always been important, but it has gained heightened attention in recent years. The COVID-19 pandemic brewed the perfect storm, exacerbating the nursing shortage and shining a light on how hospitals deliver care. The changes that occurred during COVID-19 linger even though the pandemic subsided, and challenges within nursing – and unavailability of service workers in general – are not going to disappear quickly.

It’s imperative for nursing leaders to thoughtfully consider how we deliver care. Innovations can foster efficiencies in the day-to-day work of clinical nurses and promote effectiveness in meeting patient outcomes.

Nursing trends necessitate innovation

When I first became a nurse, we delivered care using a team model, with groups of healthcare professionals working together to assess patient needs, plan and implement care and then, evaluate patient outcomes. During the mid-1980s, hospital-based nursing care shifted to the primary care model, which emphasizes continuity of care by assigning one nurse as the point of contact and primary caregiver. Initially, the primary nurse was meant to lead care for a patient’s entire unit/hospital stay; but as nursing shifts became longer in hours and shorter in days per week, primary care became less focused on the entire unit/hospital stay.

Primary nursing care remains the dominant model today, but its efficacy is thwarted by several trends. Among them are the nursing and service worker shortage and also, retention of nurses and service workers at one site for long periods of time. Most healthcare systems simply don’t have enough nurses. Even when we increase our pool of registered nurses, the second trend – transience of clinical nurses and services workers – will most likely persist.

Previously, nurses joined a hospital, and many stayed on their units or within their hospital site for many years. Now, nurses have numerous job opportunities, and it is common to have turnover to a different organization or to a new role within the same organization. Early career turnover is higher than ever before, whether it’s to try a new care environment, take advantage of different resources and job rewards or receive a salary boost. The loyalty that Baby Boomers and other generations had to hospitals has waned, and we need to acknowledge and accept our new reality.

From an innovation standpoint, we need to ask ourselves, “How might we use our nurses to their fullest potential – even if they are with us for a shorter length of time?” Innovation ideation by a variety of personnel – clinical nurses, nursing leaders and service workers from many departments (environmental, dietary, transport, etc.) – can help answer the question so that nurses and service workers who regularly interact with nursing are satisfied with their jobs and their healthcare systems.

Within hospital settings, clinical nurses are visible 24/7, while other healthcare professionals may only spend a fraction of their time on units and directly with patients. Thus, nurses recognize problems and unmet patient and/or clinical caregiving needs. Nurses understand what needs to be done differently to enhance efficiency and effectiveness; they understand how to work smarter – and with less effort – to get more done in a day.

Creating an environment that supports sharing of innovative ideas and bringing innovations to life is the first step in using nurses’ ideas, based on their knowledge and experiences. Why should we work the same way we have been for years if there are easier, more effective ways to deliver high-quality care?

Five tips for cultivating innovation

Innovations within nursing are all-encompassing, from new devices and tools to streamlined processes and workflows. While the results can be game-changing, the path to innovation is not easy. It takes time and effort, as well as a certain mindset. Some leaders – from nursing managers to directors and CNOs – may be reluctant to consider innovation because it requires change. And change can be uncomfortable.

That’s why innovation leadership is so important. Nursing leaders must buy into the notion that nurses can change the world. If you are that leader and want to foster innovation, here are a few pointers:

• Define what innovation means to your organization. Many leaders think of innovation as using the latest equipment and technology. However, that’s a purchasing decision, not the result of nurses being innovative. Developing a definition of innovation is critical so that everyone has the same meaning and are working in synchronization toward common goals.
• Include innovation in your annual strategic planning. Innovation needs to be part of higher level thinking, and not just one time a year. What is going on at your hospital that is innovative? What are the outcomes of those innovations? Are you making progress?
• Create an innovation infrastructure. Is the infrastructure in place to support clinical nurses in any hospital role when they verbalize an innovative idea and want to bring it to life? Can nursing leadership support provision of time and resources to develop prototypes or meet with experts who can share knowledge that moves ideas forward. If you don’t have the necessary infrastructure within nursing, consider partnering with a local university, another hospital department or even a single expert employee who can champion innovation and is willing to mentor novice innovators.
• Start small. If you don’t have the resources to support a comprehensive innovation program, then narrow your focus. For instance, you might prioritize information technology or staffing model innovations. Once you’ve gained momentum and increased resources, you can expand into other areas.
• Reward innovators. It’s disincentivizing for ideas to come forward, but then to not be shared or acted on. Promote nursing ideas and innovations, even if it’s in a newsletter or an intranet note format. Create a reward system to recognize nursing innovations. Keep nurses engaged with simple words of support, such as “keep at it” or “you’re on the right track.” Since failure is part of innovation, words of support can also focus on getting past a failure; for example, “It’s OK that this idea did not work; that is common. What’s next? Let’s move forward!” Collectively, words of encouragement and support show that you value the innovation process.

The hospital healthcare landscape is vastly different than it was pre COVID-19; nursing is more complex because of a reduction in nurse and service-worker workforces. At the same time, new medical discoveries mean there are more devices, technologies and gadgets available to serve patients. Nurse leaders need to encourage nursing innovations to ensure that nurses have a voice in hospital healthcare transformation.