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For years, the nursing profession’s most respected authorities have aimed to define what, exactly, constitutes effective nursing—and what can be done to improve standards across the healthcare system. This practice’s origins can be seen in Florence Nightingale’s reliance on statistical methods to link environmental concerns with patient outcomes.

In the past few decades, the nursing field has made significant strides in standardizing quality evaluations. These days, nurses and patients alike rely on nursing sensitive indicators to provide a much-needed blueprint for effective care. Still, the concept of the nursing sensitive indicator remains a point of confusion and, sometimes, contention.

To provide clarity for this oft-misunderstood practice, here’s an explanation of nursing sensitive indicators to help you understand how these evaluation procedures work and why they are so vital to the modern healthcare system:

What are Nursing Sensitive Indicators?

In 1998, the American Nursing Association (ANA) established the National Database of Nursing Quality Indicators (NDNQI). This national database provides both quarterly and annual reports about the effects of nursing at the unit level.

The overarching goal of the NDNQI? To build on a quickly growing body of knowledge referencing what, exactly, impacts the quality of nursing care. This effort is important in part because, as a profession, “nursing has a responsibility to measure, evaluate, and improve practice.”

At the most basic level, nursing sensitive indicators aim to determine whether nurses have an impact on their patients. Just as importantly, however, these indicators determine what that impact looks like and whether it delivers a net positive or negative for both individual patients and the community at large.

How Do Nursing Sensitive Indicators Measure Nursing’s Impact?

The range of currently approved nursing sensitive indicators falls under a few key classifications first identified years ago by Avedis Donabedian, MD, MPH that remain relevant today. These categories make it easier to understand how, exactly, specific concerns play into patient care:

  • This emphasizes the context under which nursing care is delivered. Key considerations include facilities, equipment, staffing, and financing.
  • Any interaction between patients and nurses—within the context of delivering healthcare services—can be classified as part of the process portion of Donabedian’s model.
  • Several elements can be defined as outcomes, including changes in health status, increased knowledge, or improved patient satisfaction.

How Are Nursing Sensitive Indicators Developed?

Nursing sensitive indicator selection is far from haphazard. The original indicators selected for the NDNQI database passed extensive feasibility tests before they were approved. Since then, indicators have evolved to some extent to take a growing range of concerns into account. In 2001, for example, pilot testing revealed that RN job satisfaction would be a viable addition to the original indicators. Any time a nursing sensitive indicator is added, it must first pass a rigorous inspection to ensure it sufficiently impacts patient outcomes and is truly effective across the spectrum of modern healthcare.

Types of Nursing Sensitive Indicators

No one nursing sensitive indicator is sufficient on its own for measuring the profession’s impact on patient care and outcomes. Rather, several elements must be considered together to provide a comprehensive view of nursing practices and results.

In addition to falling under the scope of the structure, process, and outcome classifications referenced earlier, the NDNQI database gets specific by collecting statistics for and analyzing these important indicators:

  • Patient falls with and without injuries. Without proper assistance or effective treatments, patients are vulnerable to falls. These can delay recovery and prompt considerable suffering above and beyond what the patient might have otherwise experienced.
  • RN satisfaction survey. As mentioned above, measures of RN satisfaction were not originally included among nursing sensitive indicators. These were added, however, because they were deemed essential for understanding work environments and promoting effective solutions for nurse recruitment and retention.
  • Nosocomial infections.Often referred to as hospital-acquired infections (HAI), nosocomial transmission can sometimes reveal a lack of proper sanitary protocol within a particular unit or facility. In addition to examining general rates of HAI, indicators may delve into specific subsets, such as those involving urinary catheters, central line catheters, and ventilators.
  • Nursing hours per patient day. A key measure of staffing procedures, this was among the earliest and most important indicators approved by ANA. Nurse-to-patient ratios can hold huge implications for diagnoses, patient satisfaction, and more. This metric can be classified based on patient time spent with RNs or other nursing staff members, such as LPNs.

Indicators not included in the NDNQI database statistics, but which professional nurses should consider, nonetheless:

  • Patient satisfaction with pain management. Assessment and treatment of pain is complex, and optimal pain care remains elusive. Only 63-74% of patients report that their pain was well-controlled. Personal biases may interfere with healthcare’s ability to accurately assess pain management needs, but nurses who keep in mind the ethical principles of autonomy, beneficence, nonmaleficence, and justice will be better equipped to make sound judgments.
  • Patient satisfaction with nursing care. Despite the many challenges inherent in determining patient satisfaction, it has become a metric to measure payment systems for quality. The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey lists nine categories of factors contributing to patient satisfaction: communication with doctors, communication with nurses, responsiveness of hospital staff, pain management, communication about medicines, discharge information, cleanliness of the hospital environment, quietness of the hospital environment, and transition of care.

Success in nursing and across the healthcare industry lies in the ongoing collection and analysis of staffing and patient data. A range of considerations can provide insight into whether nurses deliver the level of care that patients deserve—and whether they receive the support and training they need to abide by elevated standards of care. Guided by nursing sensitive indicators, today’s nurses can feel confident that they have the tools, knowledge, and assistance required to make a discernible difference in a challenging but rewarding field.


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