12 minute read
Discover Nurse-Led Innovation
BY JEBRA TURNER
Nurses have always applied their expertise and ingenuity to improve the workplace and patient care. Nurse innovation is now its own specialty, as well as a soughtafter skill that every nurse must develop.
As we face global health threats, such as COVID-19, it is time to empower front-line nurses and innovation specialists to solve our most pressing problems. After all, nurses bring a unique perspective that physicians, researchers, and administrators can’t offer.
In these profiles, innovation nurse leaders describe their work, and show how nurses—in and out of hospital settings—can transform health care in this brave new world.
HIGH-TECH, LOWTECH, NO-TECH
“Even as a nursing student I was inventing workarounds for my patients,” says Hiyam Nadel, MBA, CGC, RN, director of the Center for Innovations in Care Delivery at Massachusetts General Hospital. “Most nurses are natural innovators—innovation is a sexy term right now, but it's really about solving problems.”
For example, while ambulating patients with foley catheters during an internship, Nadel devised a taping solution to keep the catheter from pulling and causing pain. When several years later the solution was commercially available, other nurses thought it was her invention. But it wasn’t—someone else beat her to market.
Disappointed by that missed opportunity, she wondered, ‘What am I missing?’ and decided to pursue an MBA in innovation to find out. She later became a founding member of the Society of Nurse Scientists, Innovators, Entrepreneurs, and Leaders (SONSIEL).
Why are nurses poised to be such an influential force in health care innovation? “Nurses are on the frontline, they understand human needs and dignity at a very deep level, they touch the equipment and can recognize when it’s not working well,” says Nadel. “We have to get them around the table, contributing to problem solving and identifying solutions.”
By providing training on entrepreneurship and the legal implications of innovation, some nurses are taking their workarounds and turning them into products and devices. “Innovation shouldn’t be intimidating. It doesn’t have to include technology. In fact, we encourage solutions that are high-tech, low-tech, and no-tech,” she says.
Nadel leads “mini-hackathons” at the hospital to problem solve in a new way on important issues. “I teach them the ideation process. As we break things down, people can generate ideas, then innovations spread from
unit to unit, so we’re not so siloed,” she adds.
One example of an innovation in development is an adaptive feeding kit for ALS patients so that they can feed themselves. Otherwise, these patients would have to prematurely go into a long-term care setting, or wait to eat until caregivers employed outside the home are present, explains Nadel.
Recently, outside organizations have requested innovation consultation from nurses at the hospital, recognizing their unique perspectives. “Startup companies are coming to us for nurse pilot programs. They’re aware that nurses are the end users so they should be the ones to test new products before commercialization,” she says. The center is also involved in product prototyping.
REBEL NURSE
Rebecca Love, MSN, RN, president and cofounder of SONSIEL, has been on the vanguard of pushing the boundaries of the nursing profession to include a pivotal role in health care innovation. The Boston-based innovator is also one of the authors of The Rebel Nurse Handbook: Inspirational Stories by Shift Disruptors, which covers over 40 stories of innovation and entrepreneurship.
“People think innovation is a buzzword or a fad but across history, the nursing profession was founded on innovation,” Love says. When Florence Nightingale led the charge for sanitation in military hospitals during the Crimean War, she challenged conventional thinking. The doctors of that time didn’t accept the new germ theory and her insistence on sanitation in patient care. “They believed that ‘if you could not see it, it does not exist.’ So nursing was always the ability to think differently.”
Love points out that the current state of health care asks nurses to do more with less but doesn’t provide a way to venture into other arenas. “There are no opportunities to not live a Groundhog’s Day life,” she explains. “The traditional path for nurses is to pursue their degrees, up to a PhD, then join academia, and publish research. Innovation and entrepreneurship are not highlighted as viable options. When we deny nurses the right to innovate, they leave the bedside.”
Years ago, when Love was a struggling entrepreneur, someone suggested she attend a hackathon, a multi-day event where people work together to innovate. “There were administrators and physicians and PTs there, but no nurses,” she recalls. “I thought I was in the wrong room—that these were the decision makers, and I didn’t belong there.” Later, Love learned that though few nurses participated in Bostonarea hackathons, a high percentage of the winning teams included a nurse member.
Love then sought to organize the first nurse hackathon, but “got shot down at university after university” until Northeastern University hosted the summit in June of 2016. “Two weeks before the event, it sold out and it was a big success. The weekend of the hackathon changed my life. There’s a sense of empowerment, and for many nurses, when they leave the event they feel they can change the world.”
NURSE PERFORMANCE IMPROVEMENT
Innovation is the new
required nurse skillset, according to Uniqua Smith, PhD, RN, NE-BC, associate director of innovation and performance improvement at MD Anderson Cancer Center in Houston, Texas.
Nurses have always been innovative but “they don’t toot their own horns,” she says. “Many do not call it innovation; this is just what we do. But nurses don’t realize just how spectacular their innovation skills are.”
It is Smith’s mission to help hospital staff to come up with better ideas, improve their practice, and then to share those innovations with other units and hospital systems.
An example of a nurse-led innovation at MD Anderson involves hospital compression stockings, which for years have been required for surgery. But some nurses noticed that they caused skin integrity issues. “Those stockings had been part of traditional practice, to reduce the risk of DVT, but if a device is causing harm to our patients, we need to assess it,” explains Smith.
“The literature says the results are just the same using sequential compression devices, without the stockings. So the nurses launched a pilot program on their unit, and the results basically changed the policy for the entire institution.” The nurses are also in the final stages of publishing their findings in an academic journal.
“Nurses are trained in the clinical aspects of nursing, but not so much in sharing the great things that they’re doing,” says Smith, which is something that she assists them with in her abstract writing class and other interventions.
Another crucial innovation focus is nurse well-being and resilience. “We’re looking at nurse wellness, to make sure our staff members do not burn out, especially in oncology.” The nurses in one of the units decided to create an “escape room,” and received a grant from the wellness department to outfit the room with a massage chair, aromatherapy scents, and healthy snacks.
Their next innovation opportunity is ensuring that nurses make use of the
room—without apology or guilt. “When I was a bedside nurse I didn’t even want to take a restroom break or a full lunch break,” says Smith. “My manager decided to allocate an extra nurse who could serve as ‘lunch relief’ and relieve people to go to lunch,” a system that’s still in use a decade later, she adds.
Smith notes that younger nurses are comfortable asking, “Why do we do it this way?”— and not just going along with generally accepted practices. “They open the door for all of us to do the same,” she says. “Do the research, read the literature, and see for yourself why we do it like that. We encourage evidence-based practice, but if there is no evidence then you need to put on your thinking cap and figure out a way to improve it.”
INNOVATE FOR NURSE RESILIENCY
Some hospitals have innovation labs while others take a unit-based approach, says
Nicole Lincoln, MS, RN, CCNS-BC, FNP-BC, CCRN, senior manager of nursing innovation at Boston Medical Center and a SONSIEL founding member. All are committed to innovation as part of the magnet model, which emphasizes shared governance and giving voice to nurses at the bedside.
“I was a nurse educator so it was natural for me to go to the nurses in the units,” she explains. “Some hospitals are more involved with innovating products but my nurses in unit-based councils are more about workflow.”
Why are bedside nurses benefited by nurse-led innovation initiatives?
“Innovation builds resiliency in nurses. Otherwise you can feel like it’s a hopeless situation—but if they can see that they have power to address inefficient workflows, that can be very motivating because it makes it a better workplace for them,” she says. “If something is broken nurses don’t feel they can fix it, but can just come up with workarounds, that only causes burnout.”
One of the broken areas in need of improvement is electronic recordkeeping, which has been a boon in some ways, “but for nurses, it’s also terrible,” Lincoln says. Where before nurses could quickly flip through a chart, now they have to navigate through an endless labyrinth of information.
“The people who created the electronic records technology are not nurses. So, we’ve formed a nurse informatics council that comes together for one whole day every month to make changes. Our group is all nurses working at the bedside because they’re closest to the work. That’s part of the shared governance piece,” she says.
Information technology is one of the keys to closing the
Tradition of Supporting Nurses–With a New Twist
When Lynda Benton, senior director of corporate equity at Johnson & Johnson, took on the role of leading the J&J Nursing Campaign in 2017, she was tasked with evaluating the focus of the company’s 120-year commitment to advocating for the nursing profession.
“Many people know J&J from when we stepped in to help address the U.S. nursing shortage in 2001, when a severe U.S. nursing shortage of 500,000 nurses was forecasted to occur by 2020,” she explains. “By 2017, when we saw that 1.1 million people had indeed joined the profession, J&J leadership asked me to take a fresh look at the focus of our strategy.”
After conducting extensive research, Benton led a strategy shift as a way to do more to empower nurses and elevate their profile as innovative leaders on the global health care stage. “Championing Nurses as innovative leaders launched in 2018 with a TV commercial, which was very well-received,” she says. “But I knew we had a responsibility to do more. We needed to find a way to directly empower and support nurse-led innovation in health care so that nurses would be more visible, and more involved in shaping our complex, evolving health care system.
The J&J Nurse Innovation platform includes multiple initiatives, some with partner organizations, including J&J Nurses Innovate QuickFire Challenge Series; J&J Nurse Innovation Fellowship; SEE YOU NOW podcast; and SONSIEL Nurse Hackathon 2.0.
“The hackathon was a phenomenal experience for the nurses who attended, and for me personally. There were over 200 attendees there, from student nurses to people in their early 70’s with decades of experience,” Benton explains. “I kept hearing them say: ‘I didn’t know what to expect, but I feel like I found my tribe.’ It was a high-energy, warm, supportive weekend.” A second SONSIEL Hackathon is scheduled for September 2020.
Montalvo recommends that nurses approach innovation in an organic manner. Start reading and listening to podcasts about business and innovation, but know that “nursing sets you up for innovation,” she says. “Understand your vision, your North Star, and see our nursing skillset as the basis for innovation.”
Surprisingly, Montalvo’s main business has become life coaching and mentorship for nurses. “When I began sharing on LinkedIn about starting my initiative, nurses started reaching out to me,” she says. Now she coaches other nurses on how to innovate in their personal lives, careers, and in the wider community.
QUEST FOR DIVERSITY AND ETHICS
“Innovation is one of our priority initiatives and for organizational strategies, but it’s also core to who we are as a profession,” says Oriana Beaudet, DNP, RN, PHN, the vice president of nursing innovation at American Nurses Association (ANA).
“Nurses have always been innovators. They think like engineers—they’re always working to find the best solution for patients, families, and communities. And if it doesn’t work, they go back to the drawing board.”
Beaudet believes the “incredible spike in the cost of delivering care” could be reduced if nurses were empowered to bring their knowledge, ideas, and insights to the table.
ANA is one of the lead organizations driving nurse innovation today. Because it is a strategic priority, they are creating opportunities for funding of research around nurse-led innovation, the ANA Innovation Award powered by BD, a partnership with HIMSS around innovation and NursePitch™, they also have the podcast SEE YOU NOW with Johnson & Johnson.
Beaudet says diverse representation matters in innovation because it leads to more creativity. “Innovation requires radical inclusivity. When looking at the science of teams, the broader an individual’s background, it increases the likelihood of the group’s ability to come up with innovative solutions,” she explains.
Liz Stokes, JD, MA, RN, director of ANA’s Center for Ethics and Human Rights, believes it’s also critical for nurses to understand that innovation, and especially artificial intelligence (AI), carries an ethical dimension for nurses.
“Nursing is already involved in the use, implementation, and design of AI, and we continue to see technology in health care,” she says. “AI or any type of program or design that approximates the human mind, that searches data from algorithms and then predicts something—patients discharge, for instance—is an important justice issue for nurses and people of color.”
How is technology an ethical issue? Stokes explains that devices “may be marvelous gadgets, but deficient because they haven’t been designed for a minority population or people of color may not have access to them.”
Jebra Turner is a freelance writer located in Portland, Oregon. Visit
her at www.jebra.com.
