Advanced practice nurses urged to showcase positive outcomes


Nursing practitioners and clinical nursing specialists should do more to publicise and spread awareness of the benefits of their work in terms of positive patient outcomes, according to Dr Ruth Kleinpell, Director of the Center for Clinical Research and Scholarship at Rush University Medical Center in Chicago.

by Fran Weaver

In her presentation at the Advanced Practice Nursing Conference in Helsinki, Kleinpell encouraged participants from some 40 countries around the world to systematically demonstrate the value of their work by finding ways to measure the consequent outcomes. 

“It’s particularly important for advanced practice nurses to do this today, due to rising expectations with regard to high quality health care, cost-effectiveness, and good outcomes,” she said.

But instead of focusing on classical negative outcome measures, such as the traditional “5 Ds” – rates of death, disease, disability, discomfort and dissatisfaction –  Kleinpell encourages nurses to also consider a wider range of positive health aspects that can result from nursing interventions. Such indicators may include satisfaction levels, quality of life and social functioning, as well as states of physical and emotional health.

Systematic ways to assess and demonstrate positive impacts
“It’s important first to reflect on your role, identify outcomes that are directly affected by your work, and then select a method to evaluate your impact,” she explained. “You can then assess options for collecting the relevant data, compile and analyse the data, and finally – most importantly disseminate your findings to relevant stakeholders, for example through publications and presentations.”

Kleinpell emphasised that nurses can often demonstrate outcomes by collecting and analysing data that is already collected within their health care organisations.  Health services are likely to have data available on such factors as waiting times, emergency room visits, infection rates, hospital stay durations, readmission rates, and even patient satisfaction rates.

Kleinpell strongly urged nursing practitioners and clinical nursing specialists to demonstrate the efficacy of their work in this way even if funding is not available for them to get involved in more formal research work. “It often doesn’t take too much time to collect data for “before and after” nursing interventions. Especially when you’re trying something new it’s important to be able to demonstrate impacts on clients, health care and costs,” she said. 

Blow your trumpet!
“The impacts of APN care should be increasingly demonstrated at institutional, national and even international level, to provide a rationale for why APN should be expanded,” she added. This is particularly important since APN is a relatively new concept in many health care systems, and decision-makers may not be fully aware of the potential benefits. 

Kleinpell feels that nurses are often too humble when it comes to sharing their success stories, whereas they should instead be proud to stake a claim to their positive achievements, and realise their professional responsibility to spread best practices by saying: “This positive result is because of my care!” She sees such messages as particularly vital in today’s competitive and cost-conscious health care environment.  

Research evidence available
Dr Kleinpell herself has a long track record studying and publicising the benefits of advanced practice nursing. She has earlier described APNs as “invisible champions” in acute and critical care contexts. Many formal studies of APN outcomes have nevertheless been published, particularly in the US. In Helsinki Kleinpell strongly encouraged nurses to review existing literature relating to their specialist areas when aiming to publicise the benefits of their work.

According to Kleinpell, more formal studies of APN outcomes typically show that quality levels are as high as for physician-led interventions, while satisfaction levels tend to be higher, and costs significantly lower. 

In an ongoing survey of more than 1,200 nursing practitioners in the US respondents have stated that APN-led solutions can have favourable impacts on factors such as patient access, control of chronic illness, waiting times, hospitalisation rates, emergency room visits, care continuity and coordination, patient satisfaction and costs.

With the potential for such improvements in mind, the participants in the Helsinki international APN conference warmly welcomed Dr Kleinpell’s call for nursing practitioners and clinical nursing specialists around the world to be more proactive about measuring and publicising the fruits of their work.

Dr Ruth Kleinpell, Director of the Center for Clinical Research and Scholarship at Rush University Medical Center in Chicago. Foto by Tuomo Antikainen
Dr Ruth Kleinpell, Director of the Center for Clinical Research and Scholarship at Rush University Medical Center in Chicago. Foto by Tuomo Antikainen