It’s time to get back to the basics.
Last month’s editorial made clear that the future of healthcare delivery hinges on our ability to optimize the work of nurses and enable them to practice the essence of nursing. This editorial explains how.
It’s not easy to define basic nursing care in terms relevant to all settings. Yet ensuring the delivery of basic care has never been more important. Pipe and colleagues noted the increasing complexity of nursing, which can potentially leave good nursing care behind.
Articulating instances of lapsed basic care (“missed” care) has advanced research in this area. Studies over the past 10 years indicate significant amounts of missed care in acute care hospitals. Missed care holds importance not just from a patient safety and quality-of-care perspective, but also from a business perspective. Missed or delayed care can result in reduced or eliminated reimbursement for acute care services.
To avoid missed care, staff nurses and nurse leaders must collaborate to create an environment that prioritizes basic nursing care. The following evidence-based strategies can help guide your work.
Make basic care a priority for staff and patients. The National Patient Safety Foundation report Through the Eyes of the Workforce notes the inextricable link between workplace safety and patient safety. Failure to provide caregivers with appropriate protection, respect, and support may result in more errors, compromised ability to follow safe practices, and difficulty working as part of a team.
Improve collaboration. Collaboration must occur at all levels. Traditional centralized command-and-control management structures can’t address today’s transparent and demanding healthcare market. We must create structures that support rapid, multidirectional collaboration and also include patients.
Implement shared governance. The shared decision-making that comes with shared governance is vital not just to patient safety but also to nursing’s future. Opportunities to engage frontline staff include appointing unit-based champions for specific issues and establishing unit, departmental, and organizational practice councils, which enhance staff communication networks and accountability.
Articulate the business case for nursing. Many researchers have made the business case for nursing through effective nurse staffing. For example, studies associate better nurse staffing with shorter stays and fewer complications, which result in lower costs. Such results highlight why hospitals should focus on nursing care to improve clinical quality and patient safety, use research that links nursing care with clinical outcomes, and ensure nurses have time at the bedside to care for patients.
Stop wasting nurses’ time. Nurses are the primary hospital caregivers. Increasing the efficiency and effectiveness of nursing care is essential to hospital function and delivery of safe patient care. However, evidence indicates the ubiquity of inefficiency in nursing practice. Studies note excessive walking and documentation as prime examples of what’s called “type 1 waste” in Lean process improvement terms. Redesigning work to eliminate wasteful effort puts more time back at the bedside, which can positively impact retention.
With healthcare reform, new technology, and a solid base of evidence for the powerful influence of nursing care over patient outcomes, the time is ripe for staff nurses and nurse leaders to partner in creating a work environment that fosters solid basic nursing care.
American Nurse Journal. 2025; 20(8). Doi: 10.51256/ANJ082504
Lillee Gelinas, DNP, RN, CPPS, FAAN
Editor-in-Chief
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