Demonstrating the Return on Investment for Nursing: Elevating Nursing Practice Through Engagement

Saturday, 21 July 2018: 1:50 PM

Rani Hajela Srivastava, PhD, MScN, RN
School of Nursing, York University, Toronto, ON, Canada
Gillian Strudwick, PhD, RN
Centre for Addiction and Mental Health, toronto, ON, Canada
Kristin Cleverley, PhD, MSc, BScN, RN, CPMHN
Lawrence Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
Margaret Gehrs, MScN, BScN, BSc (HK), BScN, MScN, CPMHN (C), RN
Professional Practice, Centre for Addiction and Mental Health, Toronto, ON, Canada
Ann Pottinger, MScN, MN, RN
Nursing Practice and Professional Services, Centre for Addiction and Mental Health, Toronto, ON, Canada

“There is a common, global understanding that nursing is relevant to care for the sick, and much of the work of nurses, and their impact, lies within the hospital environment. Unfortunately, this perception is based on the current reality of where most nurses work. The brutal truth is that if there is a desire to build and maintain healthy and productive societies, there is a need to understand how nursing can increase their contribution, that is, not only in caring for the sick but also in contributing to the social and economic agenda. Furthermore, nurse leaders have a professional, moral, and scientific obligation to be aware of the evidence and both to introduce it and integrate it into all levels of system” (Shamian & Ellen, 2016, p.99)

The above is the opening paragraph in an article by Shamian & Ellen (2016), where they present evidence showing the clinical, social, and economic returns on investment in nursing, and call for action by nurse leaders to “invest the time, energy, and effort to make the changes that are needed and keep an eye on engagement opportunities outside of the nursing bubble” (p 99). Although Shamian & Ellen (2016) are asking leaders to think beyond the world of hospital nursing , the reality is that even within the world of hospital nursing often opportunities for nursing engagement are limited and the impact of nursing knowledge and contribution remains unrecognized and untapped.

Given that nursing engagement and impact is determined both by nurses and the organizational context in which they practice (Keyko et al., 2016), and that to achieve sustainable success, changes are needed in both, our goal was to create a movement with short term wins and a longer term vision, strategy, and plan.

The purpose of this presentation is to share highlights from our journey of nursing engagement. The objective of this work was to engage nurses, leaders, and other collaborators across the organization in creating a shared vision for optimizing nursing leadership for high quality patient care, education, and knowledge development. In addition, we wanted to change the organizational narrative on how nursing is treated, viewed, and looked to for leadership. In short, our objective was to create a movement for, and with, nurses to show how nurses were the “key ingredient” or the “secret sauce” to achieve the organization’s goal of transforming lives.

Our context is one of a mental health specialty hospital with a strong history of interprofessional practice and few nurses in formal leadership positions until recently. Our approach therefore needed to engage nurses but also other collaborators and leaders throughout the organization. Previously, the organizational narrative on nursing was one of gaps: in knowledge, in consistent adherence to high standards of practice, and in nurses themselves feeling empowered. However, there is increasing recognition that the deficit approach has not been successful for sustainable change and thus leaders are encouraged to adopt a strengths based approach (Gotlieb et al. 2012).

Positive Organizational Scholarship (POS) is a growing discipline, rooted in positive psychology frameworks, that focuses on enhancing capabilities rather than dwelling on the deficits (Havens, 2011). The initiative labelled ‘BEST of [organization’s name] Nursing’, was formally launched in February 2017 and framed in the positive with respect to both the current and future promise of nursing at the organization. The 8 month process consisted of 4 steps: (a) engagement of a core team of 40 -50 nurses to become change agents; who (b) engaged colleagues (nurses, leaders, and interprofessoinal colleagues) in dialogue on Best of Nursing; that led to (c) a large summit for synthesizing the dialogue and creating strategies and (d) finalizing the strategy and developing workplans for focused work over the next 18-24 months. The final strategy is one that is aligned with organizational goals, leverages organizational priorities, and honors what we heard from nurses. The recurrent themes were to: enable, engage, and invest. Thus we’ve chosen to focus on three big goals: 1) clinical excellence; 2) nurses as specialty practitioners and leaders; and 3) nurses as partners for organizational initiatives. The presentation will outline the POS approach, share highlights and lessons learned, and discuss the strategy as well as outcomes obtained to date.