Outcome Evaluation: An Essential Component for CNS Practice

Outcomes, lengths of stay, and variances—oh my! Outcomes—what a wonderful word. It sounds so simple yet can be so very complex. This word has a different meaning to every discipline and individual in healthcare. How do you define it? What source or sources do you use to delineate it? How do you quantify it? What is a CNS to do? In my endeavor to answer those questions for my institution and myself, I found this wonderful article by Linda Urden. Her writings were not unfamiliar to me, and I admired her style and the useful information she always provided. I knew this would be a quality article—and it was! I must tell you the little story of how I met the author, as well as describe how useful the article has been to me in my practice. In June 2000, I attended an outcomes measurement seminar at University of North Carolina Chapel Hill. Like the good CNS I was, I headed to the seminar with my clinical pathway project and numerous articles ready for an intense week of education. I was 1 of about 16 participants. The attendants to this particular seminar consisted mostly of doctorally prepared nurse researchers. I was 1 of 2 master’s-prepared nurses who had come to learn as much as possible about outcome measurements and to seek advice from the experts. On the first day of the seminar, we introduced ourselves and conveyed to the group our goals for the week. Mid-week, each participant presented his or her own specific project and asked the group for help with the project’s structure. In presenting my project, I mentioned this article as the primary article I was using in the development of a new clinical pathway and variance analysis tool for my hospital. To my surprise, Linda Urden spoke up and said, “Oh, that’s me, that’s my article!” I couldn’t believe it! To her surprise, someone was actually using and quoting her article. To my surprise, sitting in the same room with me, was the author of my favorite article, and I didn’t even realize it! What a wonderful thing to happen! At first introduction, I had not made the connection between Linda Urden, the seminar participant, and Linda Urden, the author. Making a personal face-to-face connection with one of your favorite authors is something one doesn’t expect to happen. Until that moment of discovery, authors of articles seemed so untouchable and far away, but now I know they are not. They are real people, people with a passion for their practice, and people who enjoy sharing information with others. Linda and I laughed over my surprise, and I still cannot get over it. It was wonderful getting to meet her and talk with her. She was able to give me more useful information for my project. In the chaotic environment of today’s healthcare market, downsizing, rightsizing, budget cuts, vacancy rates, and even the “kitchen sink” make it difficult for the CNS to survive. Therefore, it is imperative that the CNS use articles such as this one to guide his or her practice and convey his or her worth to an organization. Through the use of this article, I was able to put headings and subheadings to a clinical pathway variance analysis tool. In addition, we were able to establish outcomes, other than length of stay and cost, that our institution could use to monitor patient progress and determine a pathway’s effectiveness. It also assisted to standardize language between disciples. By defining certain categories of outcomes and their variances, the statistical reporting process was enhanced. Interpretation of the numerical values became easier and more understandable; not only to administration, but also to our nursing staff at the bedside. The information led to data-driven changes in practice, changes that might not have been considered. Although we were not quite ready for some of the outcomes measurement tools listed in the text, the information could be retrieved for use at a later point in the process. The CNS is in a unique position to use all of his or her critical thinking skills, training, and advanced knowledge base to affect outcomes, both clinical and non-clinical. As a CNS, I believe I have the ability to affect change, not only in clinical practice at the bedside, but also in the inherent culture of my institution. I believe I am a valued and respected member of the healthcare team. My knowledge and my legitimacy as a clinical expert come both from practical experience and the literature I chose to use. Although I am not as directly involved in the clinical pathway process as I was in 2000, I still search for articles like this one to both build education programs and promote research-based nursing practice. The writing of such quality articles as this one, by authors who give concise information, only augments the CNS database. Thank you for the opportunity to write about this author’s impact on my practice. Kim Blount, MSN, RN, CCRN Tumultuous changes in healthcare costs, delivery, and service are requiring revolutionary new approaches by healthcare professionals to meet current and future needs. Multidisciplinary teams are creating many innovative care delivery models. It is essential that healthcare professionals evaluate the cost effectiveness and impact of their care and service on both patient and system outcomes. Clinical nurse specialists (CNSs) are an integral component in these models and are uniquely qualified both to implement and to evaluate care delivery and systems changes. The purpose of this article is to describe the role of the CNS in outcomes evaluation. Specifically, various types of outcomes are delineated, with a differentiation between nurse-sensitive and medical and collaborative care outcomes. Examples of valid and reliable measurement tools that are easy to use and have wide comparability are described, and implications for CNS practice are posed.