How nurse 'change agents' saved hospitals $84M

The American Association of Critical-Care Nurses' Clinical Scene Investigator Academy has provided more than a 600 percent return on investment; the 97 participating hospitals realized a fiscal savings of $84.2 million, Marian Altman, PhD, RN, clinical practice specialist and supervisor of the AACN's CSI Academy, told Becker's.

This isn't about detectives working together to solve a crime like on TV's popular CSI shows. However, AACN's CSI is focused on enabling nurses to work together to take on innovative in-hospital projects that "give nurses a seat at the table" when it comes to leadership and decision-making, explained Dr. Altman, while also recognizing hospital nurses as "change agents." 

"Nurses have innovation intelligence. They have insights into the problems in hospitals because they're there —  24/7/365," she said. "When it comes to problems in hospitals, nurses have seen it all from the top down. But no one is asking them, 'How would you solve this problem?'''

What is the CSI Academy?

A hospital-based nursing leadership and innovation program, the CSI Academy not only encourages hospital leaders to ask nurses for input on challenges but also provides participating nurses with the skills and tools to solve problems that improve hospital operations and energize their hospital's nursing workforce.

Once a hospital chooses to participate in the program, a team of ​two to four direct care nurses will identify a challenge in their unit to work through. It could be an issue related to patient care, with the families of patients or something in their work environment. Then, they seek the solutions through the skills they learn in the 12-month CSI program and lead all efforts to make the changes they seek to improve as part of the project.​ ​​

CSI Academy is delivered via a combination of in-person and virtual sessions over a 12-month period. Typically, five sessions are in-person (​months ​one, two, six, eight and 12) while others are held virtually. In-person sessions are a full day; virtual sessions are three hours. The program is designed with flexibility, with a schedule that can be tailored to meet the needs of the hospitals and ​nurse ​participants. 

Each session provides participants with content delivered by the CSI faculty of experienced nurse leaders, team consultation and dedicated time for the team to meet and work on their projects. The teams report on their progress, share ideas and get feedback from each other and the faculty to help them work through any problems they may be encountering. The nurses will, of course, work on their projects outside of the class session. 

Here's an example: One cohort at a hospital wanted to focus on getting nurses to truly collaborate to improve their work environment which, in turn, would decrease nurse turnover in the hospital. The year before they participated in the CSI Academy, 44 nurses left that hospital. While they were doing the project, only 12 nurses left.

The program is a full 12 months long because research shows that it takes between three and six months to truly embed change in a work environment. After 12 months, the changes are completely embedded but are also able to be sustained for the long term, Dr. Altman said.

The numbers tell the story

There have been 486 nurses to date who have completed CSI Academy programs, but the effects of participation spread much further throughout nursing units and entire hospitals. Dr. Altman estimates that 6,820 nurses have reaped the benefits of their hospital's participation in a CSI Academy project. 

Of the 97 hospitals that have engaged with the CSI Academy, there have been 142 projects completed in 160 patient care units.

Further, according to feedback from participating chief nursing officers, more than 1.25 million patients have been positively impacted by the hospitals' participation in the program.

How do hospitals get involved in CSI?

Some hospitals pay to participate in the CSI Academy, but others get involved thanks to grants. For example, Edwards Lifesciences Foundation is funding three cardiac-focused cohorts of the CSI program, allowing AACN to provide it without charge to several hospitals. 

The first cohort, which included nurses from nine hospitals around the U.S. in rural areas, completed the program in the fall of 2022. The second cohort of nurses in Southern California is currently in process; it will wrap up summer 2023. 

The third cardiac-related cohort is gearing up to launch at 10 hospitals — two in New Jersey and eight in New York.

In addition to on-site programs, the AACN offers online access to its collection of CSI Academy innovation projects ― including project plans, clinical interventions, data collection tools, outcomes and references.  

Becker's also spoke with two nursing executives who have engaged their teams with the CSI Academy. 

Jane McCurley, DNP, RN, chief nurse executive at Methodist Healthcare System in San Antonio, said the effect of engaging with the CSI Academy has exceeded her expectations. "It engaged my front-line nurses in quality improvement initiatives. The ingenuity of the teams in their projects was inspiring to others and the outcomes had an impact on practice and to financial goals, as well."

Launette Woolforde, EdD, DNP, RN, is chief nursing officer at New York City-based Lenox Hill Hospital; Manhattan Eye, Ear & Throat Hospital; and Lenox Health Greenwich Village. She is also the deputy chief nursing officer at Northwell Health, based in New Hyde Park, N.Y. Dr. Woolforde has been involved with three CSI projects to date. "It has brought me great joy to see the growth of each nurse who has participated. Almost all have gone on to advance their education and engage in professional activities within and outside of the organization."

Editor's note: Responses have been lightly edited for length and clarity.

Question: Why should hospitals participate in the CSI Academy?

Dr. Marian Altman: Nurse turnover is at a historic high. Replacing a nurse costs a hospital tens of thousands of dollars, plus the loss of their experience and knowledge. The CSI Academy is a way to engage nurses to lead a project which can result in decreased turnover in their units.

During the pandemic, hospitals paused shared governance committees. Hospitals see the CSI Academy as a vehicle to help restart and ignite shared governance in the post-pandemic era. 

Dr. Launette Woolforde: Throughout nursing school and even professional practice, nurses learn extensively about clinical diagnoses and management of illness, but they don't learn much about the process of change. Meanwhile, healthcare is all about change and performance improvement. The CSI Academy equips clinical nurses with not only the tools, but the structure and support they need to maximize their impact as change agents.

Q: What are the benefits of CSI Academy participation for hospitals?

MA: Nurse administrators/leaders have consistently reported that the program has positively impacted patient outcomes, nurse leadership skill acquisition and organizational fiscal outcomes. Participants report greater confidence, empowerment and influencing abilities after completing the program.  

CSI is a proven program with successful outcomes for hospitals, nurse participants, patients and clinical units. Participants report advancing to leadership positions and utilizing the leadership and project resources in other units or settings in their hospitals to scale effects and create sustainable changes.

LW: The CSI Academy had a profound effect on the direct care nurses who participated in the program at Lenox Hill. It built not only their knowledge, but their confidence and competence. All of the nurses learned to collaborate with one another and with the interprofessional team in ways they hadn't before. And, as they achieved outcomes, their self-direction and innovative creativity increased.

Dr. Jane McCurley: I plan to continue to have my nursing teams participate in CSI Academy projects because past experience has proven the program truly creates change at the bedside. This is truly best-practice sharing at its best. The impact to patient care and nursing practice is so powerful. I see it as a recruitment strategy for our future nurses who want to contribute to practice and the profession.

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