Developing a nursing management practice atlas: Part 1, Methodological approaches to ensure data consistency

Report cards: relevance for nursing and patient care safety

The emergence of health care report cards in the North American environment is outlined. While it is evident that substantial activity has emerged, the majority of these initiatives excluded nursing, or use a broad indicator for nursing that may not provide meaningful representations of the quality of nursing care provided in the system and the relevance of this care to patient care safety. Given that nurses are the primary care provider in health care settings, this represents a significant gap in health care report cards. The pioneering work of the American Nurses Association (ANA) Nursing Report Card in the development and validation of report card indicators for nursing is discussed. Challenges related to data availability and data quality are identified. Potential opportunities for linking nursing practice outcomes to patient care quality and patient safety through a report card process are outlined.

Defining and measuring nursing productivity: a concept analysis and pilot study

AIMS

The purpose of this article is fourfold. First we report a concept analysis of nursing productivity to show the complexity of the concept and its measurement. We then show how the concept analysis was used to design a method for measuring nursing productivity. Third, we describe how we used this measure in a pilot study of the impact of a differentiated Registered Nurse (RN) practice model on productivity. Finally, we identify the challenges encountered and present recommendations for nurse executives and researchers based on our findings.

RATIONALE

We believe our experience can be useful to nurse executives and researchers who are interested in studying the impact of care delivery models on nursing productivity.

DESIGN

We defined productivity as the ratio of output (patient care hours per patient day) to input (paid salary and benefit dollars). We conducted a pilot test using the productivity measure developed from the concept analysis to determine the effects of a differentiated RN practice model on patient, staff, and organizational outcomes. The purpose of the pilot study was to determine whether the data needed to measure productivity could be obtained from administrative databases and to develop the steps and process for the analysis. We analysed data by 2-week pay periods for two quarters prior to implementation of the differentiated nursing practice model and for two quarters after implementation to assess for changes in nursing productivity.

RESULTS

Pilot testing showed that we could detect changes in productivity using this measurement approach. It also revealed several challenges in using administrative databases to measure productivity.

CONCLUSIONS

We discuss these challenges with recommendations for both nurse executives and researchers. The most reasonable approach for operational decision-making is longitudinal monitoring of productivity by organizational units combined with indicators of quality of patient care.

Performance management data systems for nursing service organizations

Increasing demands are being placed on nursing administrators to manage the cost-efficiency and quality-effectiveness of the nursing service organization. One effective administrative tool that can be used for both internal management and external reporting of a nursing service organization performance is the performance management data system described in this article. While efforts are underway to build essential elements of a performance management data system, including the structure and content of nursing-sensitive databases and data management methods, no consensus has been reached. The author reviews the relevant literature and offers guidelines to take the nursing administrator through the process of developing a performance management data system. Beginning with a conceptualization of the nursing service organization as a system, the 5-phased process moves through data variable selection, data variable measurement, and data analysis to the final internal and external reporting of the organization's performance.