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September 18, 2019

How Northwell created a 'culture of inquiry' among its nurses

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    The health care industry is "awash in a sea of change," and at Northwell Health leaders saw an opportunity to advance both the nursing profession and patient care through bedside research, Jennifer Thew reports for HealthLeaders Media.

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    Thew recently spoke with Kerri Scanlon, deputy chief nurse executive at Northwell Health and chief nurse executive at North Shore University Hospital, and Lily Thomas, VP of system nursing research at Northwell Health Institute for Nursing, about the health system's initiative to create a "culture of inquiry" among the nurses.

    Promoting a culture of inquiry

    "In a culture of inquiry, we want to remain open to multiple ways of knowing the answer (to questions about improving care delivery and patient outcomes)," Thomas said.

    "A culture of inquiry meant nurses would constantly be questioning things regarding practice, with the goal of improving care delivery and patient outcomes," Thomas said. "So, it's a culture where we promote questioning." She added, "We don't just accept things because it's the way we've always done it."  

    How a culture of inquiry improved bedside nursing

    When creating this culture, Thomas said Northwell leaders began "at the bedside" where nurses spend much of their time. They encouraged their nurses to be inquisitive and champion real-time research.

    For example, Thomas recalled a palliative care unit nurse who noticed a pressure injury on the a patient's skin. The nurse informed her manager and after sifting through some research, they found the symptoms were in line with a Kennedy terminal ulcer. They called Thomas and the wound care nurse and decided to study the situation "systematically," Thomas said.

    Together, the team came across a "phenomenal finding," Thomas said. "We found a correlation between appearance of these skin changes and the time of death. We named the phenomenon Trombley Brennan-Terminal Tissue Injury," Thomas said. The condition is now considered "a prognosticator of death," with research showing that 75% of Northwell patients with the condition died in 72 hours, according to Thomas.

    The culture inquiry has produced other benefits for patients and staff alike, according to Thomas.  "We've had improvement in terms of patient outcomes, but also, whenever evidence-based practice is implemented … it improves nurse autonomy, nurse satisfaction, and nurse engagement," Thomas said.

    The culture of inquiry, according to Scanlon, allows research "champions" to support frontline staff with evidence and research, which has helped RN engagement improve each year. "That's when you start to really move things to where people see nursing as a profession, not as a job."

    Who to hire, according to Northwell

    According to Scanlon, "Bringing in the right people [at the bedside and in leadership] is key" to making the shift to a culture of inquiry.

    The "right people" are usually inquisitive and innovative graduates with a lot of research experience and a firm understanding evidence-based practice, Scanlon said.

    "They are coming into this profession … wanting to be involved and they are always asking the questions, 'Why am I doing this? Why am I doing that?' That's the type of nurse you want," Scanlon explained. "We are looking for individuals that are not happy with the status quo [and have the attitude]: 'There's got to be a better way to do something'" (Thew, HealthLeaders Media, 9/13).

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