Nurses Are the Eyes and Ears of Health Care

Faculty Profile: Pat Stone, PhD, Centennial Professor in Health Policy

October 7, 2015

Pat Stone understands the role that real world comparative and economic research plays in forming public policy, helping prevent adverse events such as healthcare-associated infections (HAIs) and improving the quality of patient care overall.  Stone has a long history of conducting research in these areas, and her sustained scholarly efforts have been recognized for improving public health in a variety of ways.  She has served on a number of policymaking committees, including the National Quality Forum Technical Advisory Panel and the Massachusetts Expert Panel on Healthcare-Associated Infections. Additionally, her work on the costs of HAIs has been cited in numerous publications, including reports by the Centers for Disease Control and Prevention and the Department of Health and Human Services. Her efforts have contributed to numerous changes in health policy, including federal and state legislation mandating that hospitals collect and report data related to HAIs; her work has also influenced the types of data that hospitals collect.  Stone received a BSN from the University of the State of New York, an MS from Syracuse University, a PhD from University of Rochester and an MPH from Harvard University.

You recently published the most comprehensive survey of US hospital infection control efforts in more than three decades. The study found one in 10 hospitals lack checklists to prevent central–line associated bloodstream infection (CLABSI) and one in four lack checklists to prevent ventilator-associated pneumonia (VAP). What do US hospitals need to do to move the needle on infection control?

The good news is that we are making progress in infection prevention and we’ve seen central-line associated bloodstream infection rates decrease in ICUs. That’s partly attributable to policies implemented at national and state levels.  However, we need to look at infection prevention throughout the hospital beyond ICUs, and throughout the community. We need to address situations when health care providers break basic infection-prevention standards, such as not following isolation precautions or not washing hands between patients.  This can be hard to accomplish because of the power structure in some health care settings. That’s why it’s critical to establish prevention champions in different areas and at different levels. A strong culture of infection prevention needs to exist throughout all health care settings, on both a peer-to-peer level between colleagues, and top-down from the administration.

What specifically can nurses do to improve infection rates in health care settings?

Nurses play important prevention roles across all settings including inpatient, outpatient, and home health care. In hospitals, for example, we focus on basic procedures like appropriate hand washing, and aseptic techniques when inserting catheters.  We get patients moving as soon as possible so they don’t get wound ulcers or pneumonia.  In nursing homes, nurses focus on nutrition, because malnourished patients are more likely to get wound ulcers. In home health care, nurses must be vigilant to cleanse items brought into patient homes such as equipment, and medical bags.

A study you published last year found that longer nurse tenure is linked to shorter hospital stays. With this is mind, what policies should hospital executives implement to retain experienced nurses?

The study showed that more effective care is delivered by a team that’s been working together longer. On a personal level, this became obvious to me 10 years ago, when my mother was dying in a California hospital.  At the time, the state was dealing with a severe nursing shortage. Mandatory staffing ratios had forced the hospital to use traveling nurses as staff. The nursing unit appeared chaotic. These nurses were good, but they did not function as a team – and this affected the overall quality of care.   I asked a nurse where mom was, and she responded that she didn’t know, and apologized, explaining that she was a traveler.

That scenario can be avoided when administrators work to build and encourage healthy work cultures. An administrator could offer a tenured nurse an opportunity to work on a quality improvement project, for example. Although, monetary compensation is important, it’s not the only factor in improving nurse tenure. Creating environments where all team members feel free to contribute and do their best work is a key factor in successful team building.

What do you believe is the role of nurses and the nursing profession in shaping health policy and how do you see the role evolving in the future?

Nurses have a huge role to play in influencing policy. Health policy develops in a living, working environment, such as in a clinic or hospital. Nurses are the eyes and ears of health care. We observe first-hand what works and what doesn’t. We are well-positioned to advise people in authority about changes to make and policies to pursue.

I was the only nurse in a Harvard health policy class dominated by MDs and public health specialists.  They often talked about coalition building, and I realized nurses’ voice should be louder because we comprise the largest health care profession.   Nurses can affect national policy by joining professional societies and building coalitions. They can also affect policy in their own work environment by  understanding data examining trends and suggesting solutions. We all should be focused on the “triple aim” of offering high quality, less costly, more patient-centered care. This can be accomplished in part by eliminating waste and improving efficiencies.  Nurses are the front line of this effort, so we must determine what needs to be done and then communicate this information to policymakers, both in the hospital or in elected office.  

What advice do you have for nurses and nursing students who want to become more involved in the public policy arena?

For students, policy courses are a good place to start. Some Columbia Nursing graduates work in policy institutes advocating and influencing public policy. Get involved in some way. Go to a community board meeting or open meeting of the local health department. Nurses can visit their legislatures to discuss relevant issues like staffing ratios.

Getting involved with professional organizations is also important. You can be a lone voice or you can join professional groups and have three million nurses behind you.  Being active in a nursing organization or in a clinical specialty group or interdisciplinary group magnifies your voice and your influence.  Build coalitions within clinical specialties like geriatrics or oncology and with groups outside of nursing such as foundations or physicians.

Working with others is integral to great nursing, and it’s also how health policy gets influenced and implemented.