'Nursing is not a primary business resource - it is the primary business resource," said Janet M. Bingle, MS, RN, chief nursing executive for Indianapolis-based Community Health Network. Bingle delivered the keynote speech last month at the National Association of Clinical Nurse Specialists' 2009 conference, held in St. Louis.

She urged clinical nurse specialists help solidify that role. "Competent staff is ever more important, as we have to do more with less. The challenge [for clinical nurse specialists] is to make sure you're practicing in evidence-based ways."

Rocky Landscape

The challenge becomes especially difficult in a healthcare industry where financial issues compete with concerns over quality and patient safety, Bingle said.

Healthcare delivery systems across the country are postponing expansions and other projects such as clinical and information technology, or updating and replacing equipment.

Industry leaders fear further revenue losses from a rise in under- and uninsured patients, Bingle said, which often equals uncompensated care.

She urged attendees to find ways to demonstrate nursing care as a fixed cost and illustrate its value. Such expenses are "tolerated if there is a benefit for them," Bingle said.

In the midst of economic turmoil, Bingle noted, the care delivery model is changing significantly. She predicted a shift to preventive medicine and disease management, where - through telemedicine - nurses remotely monitor and communicate with patients in the home.

Not 'Just a Nurse'

Nurse-sensitive outcomes comprise a "significant" part of healthcare initiatives, guidelines and regulations. Of 43 new quality measures hospitals must report in fiscal year 2009 to get full payment next year, four are nurse-sensitive (e.g., falls, pressure ulcer prevention and failure to rescue), Bingle noted. "The Joint Commission is testing 15 additional measures of nursing care," she said.

The economic value of nursing becomes especially evident in the age of pay for performance," when nurses can help prevent costly mistakes.

"Don't tell anyone you're 'just a nurse,'" Bingle told attendees. "Our job is to clearly articulate - in robust, evidence-based practice - what our contributions are and how they're felt. Convey the value nursing brings and articulate that value no matter what table you sit at."

Business Case

One savvy CEO looked to clinical nurse specialists to promote an organization-wide focus on improving care and outcomes.

"They helped me to elevate [the hospital's] focus on clinical improvement and taught me a ton about what it takes to improve patient safety and interpret [regulatory] data," Douglas Leonard, president of the Indiana Hospital Association, said of his experience at a Midwest hospital he once led.

Engaging All Disciplines

As clinical and teaching experts, the nursing professionals had already won the trust of physicians, nurses and other members of the healthcare team.

"They're excellent communicators, respectful of all disciplines, inclusive, humble and diplomatic," Leonard said.

The hospital's clinical nurse specialist team helped elevate the focus on clinical improvement, educated Leonard about improving patient safety, and drove improvements in CMS scores and implementing certain Institute for Healthcare Improvement initiatives.

The clinical nurse specialists also helped support departments feel like they had a stake in clinical priorities and accelerate the work on patient satisfaction.

In addition, Leonard created a patient safety council after the Institute of Medicine released its 2004 report "To Err is Human," and the clinical nurse specialist team was involved in planning and measurement strategies. He also brought them before the board of trustees.

"The board came away comfortable that we were focusing on the right issues. It was a powerful thing that helped support clinical priorities, make patient care safer and more efficient, and improve patient satisfaction."

Outward Focus

"Think outside your clinical sphere of influence" and help staff at all levels of the organization embrace clinical priorities - from housekeeping staff to the C-suite, Leonard said.

For example, clinical specialists might provide leadership in CMS measures and present to hospital board and physician leaders. "Invite the CEO to see some of your work," he said.

He encouraged attendees to work with physicians on improving patient safety, reducing costs, and driving up patient and family satisfaction.

Presenting at managers meetings also could help bridge the gap between clinical and administrative realms, he noted.

"Make a business case for quality. Get to know your CFOs and CEOs," Leonard told attendees. "Retaining cash is the order of the day. An enlightened CFO can be your best friend. Make sure [the C-suite] understands the work you do, the problems [you help to] avoid and the money you save."

Karin Lillis is senior regional editor at ADVANCE.