Strategic Plan in Place

Excellent care to patients and families with the best staff in the safest environment.

The vision statement for the Department of Nursing was created two years ago with input from staff nurses, NICs, managers and directors throughout Brigham and Women’s Hospital. “It describes how we see ourselves and where we want to go,” said Mairead Hickey, PhD, RN, chief nursing officer and senior vice president for Patient Care Services. “Now, with a strategic plan in place for the Department of Nursing, we have a roadmap to operationalize this vision to get us where we want to be in two years, three years and five years.”

The Department of Nursing’s strategic plan is focused on fostering an environment at BWH that ensures ongoing development of nursing practice, optimizes patient outcomes and incorporates the voice of nurses in decisions that influence patient care. The strategic plan, which Hickey presented to staff nurses, educators, managers and directors in several forums, was developed during the summer of 2007. Some priority elements, such as the revised committee structure, were implemented within the following months.

The strategic plan has four main components: development of a professional practice model; enhancements to the department’s infrastructure; implementation of new initiatives to bring fresh ideas into the department; and strengthening ongoing programs that are central to the department’s operations.

“We need to ask ourselves what we are doing well and what we can do better,” Hickey said. “And, most importantly, we’re working hard to ensure that all BWH nurses have a voice in shaping the solutions.”

Professional Practice Model

Nurse leaders and clinical nurses are hard at work to create the design principles for BWH’s nursing practice model.

“Knowing the patient and his or her family is one cornerstone of our nursing practice,” Hickey said. The practice model will ensure that those elements necessary to sustain the nurse-patient relationship are in place. The practice model will also define nurses’ relationships and accountability to patients, families and other members of the care team.

“Our practice model will serve as a vehicle to strengthen nursing practice and patient care at BWH through evidence-based practice, education and research,” Hickey said. “Once our practice model is in place, we will know more about the clinical and administrative support, tools, technology and resources that nurses need to deliver excellent care.”

Infrastructure

The infrastructure of the Department of Nursing refers to the basic architecture that determines how the department functions and provides critical support to day-to-day operations. Infrastructure also determines how flexible the department is in meeting unexpected challenges and future requirements. The infrastructure includes such things as position descriptions that define roles, responsibilities and accountabilities; decision making processes; the committee structure and generation of certain kinds of data and information.

The strategic plan details ways to ensure clinical nurses have the appropriate support, resources and materials in place to deliver high quality, evidence-based care in a safe environment. An example of improving the department’s infrastructure occurred in the fall when the committee structure was expanded to enable nurses in varying roles and from different practice areas to engage in open dialogue and share in decision making while learning about their colleagues and different practice specialties.

Processes are in place to review descriptions of various roles within the department beginning with nurse managers and directors. Financial management systems and personnel databases will be enhanced to generate data that will facilitate decision making for operations, education, training and benchmarking with other institutions.

“Data on acuity, staffing levels and quality outcomes allows our department to demonstrate and quantify what we do well and helps us identify areas for improvement,” Hickey said.

Initiatives

Initiatives are focused and coordinated activities that address specific needs and issues of the Department of Nursing. Initiatives are time limited, and, once plans to address a particular problem or concern are determined, these plans may move into a program or role for ongoing oversight.

There are many ongoing initiatives within the Department of Nursing and some that include other BWH departments. The strategic plan calls for developing an inventory of these initiatives and evaluating each of them for reliability and sustainability. Examples of ongoing initiatives include improving recruitment and retention efforts and aligning the many recognition activities and scholarship opportunities that currently exist. There is an ongoing initiative to improve consistency among the roles of directors and managers within the department.

There are also several unit-based initiatives underway throughout BWH. Staff, operations supervisors and nursing managers are working with other BWH departments to improve service and systems through a number of process improvement initiatives. “The goal is to identify initiatives that demonstrate success, reliability and sustainability in hopes of expanding them throughout the department” said Hickey.

Programs

Ongoing programs of education and research are necessary to support development of clinical knowledge, nursing practice and nursing staff. The wide array of programs within the Center for Nursing Excellence demonstrates the interdependence of nursing practice, education, research, professional development and technology innovation to advance clinical practice and improve care delivery to patients and families.

Examples of these programs include the quality and safety program that extends throughout the department and the newly launched simulation program. In addition, there are efforts underway to develop a nurse scientist program, enhance partnerships with schools of nursing, create diversity mentorship and culturally competent care programs and a global health nursing program.