Staff nurses often report feeling powerless in a health care system that is continuously changing as we attempt to navigate through what seems to be an endless stream of new, and sometimes muddy waters. Changing reimbursement methods are forcing big changes in accountability for patient safety and satisfaction while systems adapt to policy reforms, new technologies, changing standards of care, and genetically guided therapies.  This leaves many bedside nurses struggling with maintaining a good standard of care for their patients,  meeting the goals of the facility and the endless paperwork required.


If you are passionate about quality patient care and you have the ability to emerge as a leader in facilitating change then don’t become a victim. You can seize the moment and engage in this process, to ultimately improve patient outcomes and get noticed as a top player.  There have been many studies on successful process improvement plans, and it has been discovered that most of the successful development comes, not from management, but from stakeholders in the processes being targeted for change.  After all, staff nurses are in the forefront and can offer many valuable suggestions to enlighten upper management and make positive changes.


Go online and check the hospital library service for ideas that promote better work flow and improve patient care.  Talk to other staff nurses on your unit to see if they have similar frustrations. Chances are, if you have a frustrating issue, many others are experiencing the same dilemma.  If you find examples of similar issues and how they have been dealt with, then use these ideas for your own institution.  If you can’t find any information for the particular issue you are facing, then be a leader and innovator and develop your own ideas.


Making Change


In one hospital in the U.S, staff nurses are leading the way in many areas. The nurses were spending an enormous amount of time looking for supplies for procedures and patient care.  Upon investigation, they discovered that it was the materials stock staff  that were making decisions about where to put supplies, not the nursing staff.  They implemented a plan to use the staff nurses on that unit to make the decisions about where items were placed and they managed to streamline their patient care and speed up the process of gathering supplies.  Seems pretty simple, but this is a perfect example of staff nurses making excellent decisions with positive outcomes, not only for time management, but for patient care. The less time we spend on searching for items that are placed in inconvenient and illogical places, the more time we can spend on patient care.


Staff nurses also initiated the “Ban the Basin” initiative, when Infection control officials reported the harmful effects of bath basins. Nurses used evidence-based practice to change the practice of using bath basins, which were also used for emesis.  They included a scripted patient and family communication as well as introducing an alternative product for emesis collection and disposal.


Bedside shift reporting is also becoming a popular trend. It is one that has caused a lot of anxiety with nurses initially, but is very effective  because it eliminates much of the “chit-chat” that occurs during traditional report and in many instances decreases report times substantially.  Patient satisfaction reports increase, due to the inclusion of the patient and family members.


Transforming Care at the Bedside

In 2003 the Robert Wood Johnson Foundation which funded the Transforming Care at the Bedside (TCAB) program, explains the unique ways in which the TCAB can empower nursing staff to be facilitators of great change within the nursing arena:

“TCAB takes a unique approach to addressing quality of care issues identified by supporting nurse and other frontline staff to develop their own interventions, design new processes, and adapt ideas from staff that improve care. This is a bottom-up, team-based approach to achieving quality rather than a top down approach. With TCAB, new ideas for transforming the way care is delivered do not come solely from hospital leaders of the quality improvement department, but from front-line nurses and other care team members – the people who spend the most time at the bedside.”


Take  Charge of Change

There are many resources available for taking charge of change. The Centers for Disease control and Prevention has excellent resources and patient education information.  The Agency for Healthcare Research and Quality also has an excellent handbook for nurses on patient safety.  The Institute for Healthcare Improvement is a leader in sharing the best practices for patient safety and quality improvement.  Your professional associations and state and regional hospital associations are also great resources to help you initiate positive changes.


Be a leader and make changes.  Remember you are the patients advocate and positive change impacts your patients. You can make a difference!