QUERI – Quality Enhancement Research Initiative

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VA Nursing: Effectiveness and Entry

Ann Arbor, MI

Overview:

While high-quality nursing care is essential to delivering safe, effective care to patients, there remain consistent challenges to its delivery, experienced by all healthcare delivery systems. These challenges include cycles of severe nursing shortages, lack of continuity between care settings, and lack of the use of best evidence in providing care. The VA healthcare system has a strong history of assessing quality of care and responding to quality challenges through program and policy initiatives, and has been widely recognized for its major transformation through ongoing, consistent attention to patient and system data. Recently, the Office of Nursing Services (ONS) has undertaken several initiatives affecting nursing care and patient safety. Two initiatives that we are evaluating - Staffing Methodology and the RN Transition-to-Practice Program - were mandated throughout VA in 2010 and 2011. In addition, this Partnered Evaluation Initiative is responsive to requests for additional evaluations from ONS as they arise.

Objectives:

The long-term objective is to support the work of the ONS by evaluating initiatives they have designated as key to supporting their mission. These include Staffing Methodology and RN Transition-to-Practice, both of which focus on supporting effective nurse staffing and retaining new graduate nurses in practice. The evaluation team looks at both the way the initiatives are being put into place and the effect they are having on patients, staff, and the VA healthcare system. Specific aims include:

  • Assess the degree of implementation and current status of the Staffing Methodology initiative across VHA.
    • Using developmental evaluation approaches, examine the extent to which the defined elements of the Staffing Methodology initiative have been implemented across all VA healthcare facilities; and
    • Using a summative approach, assess the effect of the implementation of the Staffing Methodology initiative to date by analyzing available nurse staffing and patient outcome data across all VA healthcare facilities.
  • Assess the degree of implementation and outcomes of the RN Transition-to-Practice initiative across VHA.
    • Using process evaluation approaches, examine the extent to which defined elements of the RN Transition-to-Practice initiative have been implemented across all VA healthcare facilities; and<
    • Using a summative approach, assess outcomes of the RN Transition-to-Practice initiative, including competency, job satisfaction, and turnover.

Methodology:

We are using mixed methods approaches in all evaluations, coupling interviews with key informants, surveys, and quantitative approaches that focus on interrupted time-series analysis for summative outcome evaluation for both initiatives.

Operations Partner:

This Initiative coordinates closely with key stakeholders in the Office of Nursing Services (ONS). The mission of ONS is to "provide leadership, guidance and strategic direction on all issues related to nursing practice and nursing workforce for clinical programs across the continuum of care and across the spectrum of care delivery sites that impact our Veterans."

Principal Investigator:

Anne Sales, PhD, RN; contact at Anne.Sales@va.gov or Salesann@umich.edu .