A groundbreaking paper was released in the November-December 2024 issue of Nursing Outlook. The paper, “Call to Action: Blueprint for Change in Acute and Critical Care Nursing,” calls for a new framework highlighting their nursing practice, their practice environment and nursing outcomes. It also called out the need for more CNSs because of their essential role in supporting nursing practice.
The paper was written as a response to the many challenges with articulating the work of nursing that were always there, but came to a crisis point during COVID-19 when healthcare teams were under unprecedented stress.
An expert panel representing clinical practice, academia, and administration decided to give voice to hospital-based nurses in focusing on what nursing care provides to patients and their families, and developed this Call to Action and Blueprint for change. Not surprisingly given their expertise and mandate, many of the authors of the paper are CNSs. Two of these, Maureen Seckel and Kathleen Vollman, kindly took some time to speak to us about the Blueprint.
Maureen Seckel has been a critical care nurse since 1980 and a critical care CNS for about 30 years at Christiana Care, Newark DE. Now retired, she is a consultant in both critical care and sepsis. She has also been a long-time member of NACNS and is a past chair of the Clinical Nurse Specialist Institute.
Kathleen Vollman has been a critical care nurse since 1980 and spent a decade as a clinical nurse specialist in the ICU at Henry Ford Hospital in Detroit. She later founded Advancing Nursing, a company dedicated to empowering nursing environments through enhanced knowledge, skills, and processes. Vollman also played a pivotal role in establishing the NACNS, serving as both a founding director and a charter member.
Why Change is Needed Now
Nursing policy needs urgent reform because of a projected workforce gap, estimated to be 10% by 2027. There are several causes of this gap, including the retirement of baby boomers, with over 25% of nurses expected to retire within five years. Additionally, high levels of burnout during the COVID-19 pandemic led many nurses to leave their roles, highlighting a need for better support structures.
The result is a much younger nursing workforce where nurses with just a year or two of experience must mentor incoming graduates. This high turnover and rapid influx of inexperienced staff creates a cycle of limited mentorship and a potentially unstable care environment.
Vollman says, “From a patient and family perspective, nurses are very important because we’re a large part of their care and support experience. In almost every annual Gallup poll about the most respected profession in this country, nurses have been number one.”
Seckel added, “There’s a common expression used by my bedside colleagues, particularly post-COVID, about getting back to basics and improving critical thinking and having nurses describing nurses. A lot of what we have now was created without any input from us.”
The second reason for reform lies in the difficulty in proving return on investment for nursing care. In financial analyses, nursing salaries are lumped in with the cost of hospital beds and supplies. Metrics are focused on measuring the absence of nursing care with the goal of reducing costs as much as possible, instead of investigating the presence of quality nursing care and its impact.
Noted Vollman, “We’ve always had to create ROI metrics that show, ‘when this prevention isn’t given, here’s the harm that takes place.’ But these preventative measures are considered soft costs because if you prevent it, the harm doesn’t occur.”
She added, “Devin Carr, one of the authors of the paper and the CNO of Maine Medical, brought up an example in which his system has been measuring the number of patient falls, and falls with injury, for many years. Now, they’re flipping the narrative, measuring the quality of patient mobility and the difference that nursing care has on patient ambulation, hospital stay length, and how much assistance they need when they go home — which all impact quality of life. Falls just happen to be going down as well.”
A Prescription for Better Care
The Blueprint outlines a complete structure including nine domains of nursing practice and determining metrics that will allow healthcare systems to measure the true value of nursing care.
“The practice of acute and critical care nurses will thrive when the outcomes of their day-to-day practice are made visible to everybody touched by the work of nurses,” said Seckel. “These outcomes should be viewed and measured from the return on investment perspective as the ROI of nursing human capital development in terms of improved consumer, nurse and organizational outcomes. There’s an additional paper recently published titled ‘The Nursing Human Capital Value Model’ that I think does a great job of showing organizations how to measure better outcomes, and getting away from simple cost reduction-oriented models.”
Vollman added, “Instead of focusing on failures, such as ‘failure to rescue,’ hospitals could flip the narrative and describe the “number of lives saved”. For example, achieving early intervention prevents longer hospital stays 90-98% of the time. By linking these positive outcomes to shorter hospital stays, a stronger case for prevention-focused investments could be made.”
The paper also calls for the establishment of a federally-funded National Nursing Workforce Commission to support nursing research and ensure nursing input in healthcare policy decisions.
Seckel noted, “If you’re not at the table, you’re on the menu. Nursing professionals must be integral to policy development to ensure healthcare evolves to meet patient and family needs effectively.”
Next Steps
The Blueprint is aimed at everyone in the healthcare system, including the educational institutions that train nurses. NACNS has committed to creating a Think Tank to explore the outcomes that CNSs contribute to the Blueprint for Change.
Seckel commented, “It’s open access, so everybody can read and share it. You can drop a copy on your leadership’s desk, or review it at your CNS meetings. It needs to be talked about now because change takes time and action.”
“In my perfect world,” said Vollman, “we get seed funding for an operational person to work with us to put a plan together that would target patients and families, nurses, and healthcare systems, and getting work groups together and moving on this mission.”
Summing up, Seckel said, “We’re all very willing to take this forward, but this is not just ours. It needs to be shared and everybody needs to be a part of it.”