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Department: Ask an Expert

Nurse-driven protocols

Lockhart, Lisa MHA, MSN, RN, NE-BC

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doi: 10.1097/01.NME.0000694200.09075.69
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Q: What are the benefits of nurse-driven protocols?

A: Nurse-driven protocols allow qualified nursing professionals to have autonomy in their specific area. These protocols improve safety, increase staff satisfaction, and foster efficiency in care delivery. The development and use of nurse-driven protocols also promotes a healthy work environment. Shared and effective decision-making at all levels is vital to patient safety, care quality, communication, collaboration, and a sense of empowerment among staff.

Nurse-driven protocols are evidence-based, vetted collaboratively with physician leaders, and targeted to an established need in particular settings. After the need is identified, leaders work together to look at data-driven indicators, such as core measures, rapid response team use, and internal and external benchmarks, to guide the team in problem-solving. Protocols at other organizations that have demonstrated improvement in care outcomes are reviewed and evidence-based clinical practices are researched to compare best practices and develop an action group to plot out what future practice should look like based on these findings. The team must be multidisciplinary, including nursing, healthcare providers, and education and development colleagues, to demonstrate the benefit to the organization in terms of clinical outcomes and financial considerations. Bedside caregivers are crucial to developing a protocol that actually works and can be implemented.

The next step is to establish buy-in from organizational leaders, healthcare providers, and frontline staff. The organization must provide support for the new protocol, such as compensating staff members for the time to research the protocol and educate colleagues about it, making meeting spaces available, and giving staff members access to technology that can assist with the process. Organizational support is key to the success of any protocol development and demonstrates that the required collaboration and support are in place from the highest level.

Success of nurse-driven protocols depends on proper use and a clear understanding of expectations, rationale, and need. Excellent examples of successful protocols include those for catheter-associated urinary tract infection prevention and catheter removal, ventilator weaning, critical care blood glucose management, chest pain, stroke activation, heparin infusion, alcohol withdrawal, and hypothermia. Making an investment in this aspect of shared decision-making and care responsibilities pays off in many ways, not the least of which is more satisfied patients and staff.

REFERENCES

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