Editor's note: This popular story from the Daily Briefing's archives was republished on Sept. 10, 2019.

Three hospitals and health systems have collectively saved millions of dollars and improved staff morale by embracing nurse-led innovations.

Oct. 7 webinar: 4 ways nurse leaders can help save millions

Nurses typically represent a major portion of the hospital workforce. At SSM Health, for example, nurses make up 50% to 60% of the system's workforce. HealthLeaders Media spoke with three nurse leaders who explained why health care leaders should not overlook nurses in their efforts to "fix the hospital."

How SSM Health nurses reduced patient falls—and saved $2.5M annually

Maggie Fowler, VP and chief nursing officer at SSM Health, said when most of the care team leaves for the day, "nurses are still the ones there who are assessing the plan of care"—maintaining almost constant contact with patients.

The 4 foundational cracks that are undermining your nurses’ resilience

As such, nurses are positioned to recognize the challenges patients experience and develop solutions, HealthLeaders Media reports. For example, Fowler said the nursing practice councils at SSM Health developed a risk assessment tool to reduce patient falls. At facilities where the tool has been in place for nearly a year, falls have declined by 30% per 1,000 patient days. According to HealthLeaders Media, the reduction in falls will save SSM an estimated $2.5 million annually.

Fowler said, "We're dealing in an environment with reduced reimbursement, so anything that we do, in turn, should have a positive outcome to lower the overall cost of care. We need to be advocates to help connect the dots for executives and other employees in the organization."

How Union Hospital empowers nurse leaders

HealthLeaders Media reports that strong nurse leadership in executive ranks can ease a health system's transition to value-based payment models.

Katie Boston-Leary, CNO at University of Maryland Capital Region Health and former SVP of patient services at Union Hospital, noted the industry-wide transition presents a challenge for nurse leaders because they must manage both the old fee-for-service model and the new value-based payment models. 

"We have a lot of people in nurse leadership roles that are still using the approach of yesteryear where it is the top-down approach," Boston-Leary said, adding, "It's a little bit of managing what was and what should be versus what is."

But Boston-Leary said success can be achieved by having nurse leaders who "can stand with their finance person, with their CEO, and work to get proper data analytics or IT resources to better utilize and manage nursing resources."

Moreover, Boston-Leary noted that nurses have the ability to devise innovation solutions—but they must be empowered by leadership to do so.

Union Hospital emphasizes empowerment in its nurse residency program, HealthLeaders Media reports. Under the program, every nurse residency cohort develops a research-based idea for the hospital to implement. That way nurses who are new to the practice, learn they are "leader[s] at the bedside … [who] have a voice," Boston-Leary said.  

As a result of one project, Union Hospital created a tranquility room for staff to use to de-stress during a shift. Boston-Leary said, "We saw marked improvement with our RN satisfaction scores in almost every domain in comparison to two previous years, as nursing felt that they were being listened to."

How University of Virginia Health System nurses helped create 'The Pause'

Jonathan Bartels, a palliative care liaison nurse at the University of Virginia Health System, called nurses "the eyes and ears of health care."

Bartels was instrumental in developing a practice called "The Pause," wherein health care professionals take about a minute after a patient dies to stop and honor the patient's life.

The practice garnered national and international attention and anecdotally led to positive responses among health care providers, HealthLeaders Media reports. "EMS [staff] and health care providers tell me [The Pause] shows that you really care. It's not just enough to try and save a life; it's that extra demonstrative of compassion," Bartels said.

Bartels said executives should see nurses as "informal leaders" to facilitate changes. He said, "Leaders are not just the leaders who are identified by the institutions. These are leaders who are identified by their peers. Use them as change agents" (Thew, HealthLeaders Media, 4/1).

Oct. 7 webinar: 4 ways nurse leaders can help save millions

Margin management is a top priority for most health system executives. The default strategy is to focus disproportionately on labor budgets—specifically nursing labor budgets. This isn't surprising, given that approximately half of hospital expenses are from labor, and nursing represents the largest segment of the labor workforce.

Yet nurse executives have other, larger cost savings opportunities. This webconference will address the cost opportunities associated with care variation reduction, and then turn to a lingering area of concern to nurse executives: premium labor.

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