Health care is growing increasingly complex. Everyone from hospitals and insurance companies to health care providers are looking for ways to improve the process and, more importantly, outcomes for patients and their families.

Leading-edge hospitals know the most direct route to enhancing patient outcomes is to invest in those closest to the patients — nurses. With an average 12-hour shift, nurses spend more time at the bedside than most other health care team members and personally experience the challenges — and the joys — of providing quality patient care.

Recognizing a problem

Cathie Manning, critical care staff nurse at the Baystate Medical Center in Springfield, Massachusetts, witnesses the detrimental effects of delirium on patients all too frequently.

“I saw, firsthand, patients who came into the intensive care unit and, within a day or so, became confused, restless and agitated,” said Manning. She also referenced the more serious potential consequences of delirium, including longer ICU stays, increased mortality and long-term cognitive impairment: “It was like their mind drifted off.”

“Leading-edge hospitals know the most direct route to enhancing patient outcomes is to invest in those closest to the patients — nurses.”

“We know that certain medications, lack of sleep and immobility can contribute to delirium,” she continued. “I noticed our staff didn’t talk much about our patients’ sleep patterns and, at times, we were interrupting patients’ sleep to perform interventions that, with thoughtful consideration, could be rescheduled.”

Effecting change

Through a nurse empowerment program, Manning and a small team of nurses from her unit decided to do something about it. With their leader’s support, the group introduced an initiative to change the unit’s approach to patient sleep. The initiative included educating the multidisciplinary team about sleep and delirium; regularly measuring noise levels inside and outside patient rooms; implementing a new sleep protocol for naps, nighttime sleep and medication administration; and teaching families about the importance of rest.

“Assessing patients for delirium decreased rates in our unit considerably, helping our hospital avoid costs of nearly $900,000 and significantly improving the quality of life for patients and families,” Manning said. “Because of this work, we’ve had the opportunity to collaborate with colleagues from several Boston-area hospitals to form a groundbreaking nursing consortium focused on improving recognition and treatment of delirium across the state.”

Every day, staff nurses like Manning step forward and lead the charge for improved patient care. Health care organizations that foster a supportive environment that empowers the expertise of nurses will enhance outcomes in the process. As a first step, consider taking advantage of the American Association of Critical-Care Nurses’ free Healthy Work Environment Assessment Tool, available at www.aacn.org/HWEUSA.