Innovation Through the Voice of the Direct Care Nurse

Cidalia J. Vital, PhD, RN, CNL, CRRN

There are moments in your professional career that change you. The Art of Questioning event did just that. The event was held in March 2015 to inspire staff nurses to question their practice using the Population, Intervention, Comparison, Outcome, Timeline (PICOT) method. As I stood in the conference room on Margaretta Madden Styles birthday, I was completely in awe of the number of staff nurses present, the outpouring of posters in the room, the insightful and thought-provoking questions asked and for the first time, we had a standing room only nursing event. There was a palpable buzz in the room and the nursing team who led this event received so many accolades. The Art of Questioning left a historic mark and its meaning to nursing has been felt for years.

So, you may be thinking, what is the crux of the campaign? Why did it “work” and cause a shift in engagement, innovation, evidence-based practice, and research interest? The campaign engaged nurses in asking questions about their practice, whether the nurses questioned why we use a 10 cc syringe instead of a 5 cc syringe on central lines or why are we giving Lasix at bedtime when patients are up all night urinating and not getting rest. Nurses also offered questions about improving workflow and workforce optimization. These may seem like simple and easy questions with even simpler answers, but they were meaningful and empowering. Leaders were in the room, and they were listening. Staff nurses were the focus, and their questions were incredible.

Who would have thought that asking nurses to reflect on their practice and pose a question on how to make it better would spark and ignite this incredible inquiry and innovation journey. The various questions that were professionally presented on posters demonstrated that nurses innovate daily. They are constantly bending and morphing into the fast paced and ever-changing hospital environment. As I think about the word innovation, it’s about changing or shifting from the status quo and finding better ways to care, improve processes and to streamline workflows. Innovation is not meant to be difficult or more time consuming but rather provide evidence-based solutions and improve outcomes. Bottomline, nurses need to be at the table to support innovation. Art of Questioning did just that. 

Here we are in 2023 and nursing staff are still talking about the event, how important it was to their career and how it shifted their focus to promote evidence-based practice, quality improvement and research. Many members of the committee and nurses who participated in the event went on to other roles in the hospital and several staff nurses went on to advance their degrees. Personally, as the chair of the committee, the event changed me and how I look at the greater whole of nursing as a profession. I wanted to support nurses through inquiry, and I knew I needed to do that after I received my PhD. 

The Art of Questioning led to the Art of Answering in which staff spent time answering and resolving the questions through EBP, quality improvement and research. In 2023, we are rebooting the original campaign and adding a bit of an innovation twist. Our Art of Questioning and Innovation Campaign will include our clinical engineering teams and will have an interdisciplinary feel. With our current work with the University of Massachusetts Amherst and the Elaine Marieb Center for Nursing and Engineering Innovation, it is imperative that nurses innovate early. This past year, we began introducing biomedical engineering students into the hospital to see the real-world struggles of care. The five biomedical engineering students toured the hospital, asked clinical staff including nurses’ questions about clinical care and provided an innovative solution to decrease falls in our hospital. They are working with nurses early in their career to understand workflows and challenges. The Art of Questioning and Innovation in partnership with clinical engineering will give us opportunities for nurses to improve their workspaces, technology, and workflows. Sometimes nurses just need to be asked, “How can we make it better.” Giving them a voice and having nurses provide solutions can improve the future of healthcare as we know it. Nurses have always been the eyes and ears, let’s allow them to innovate using their voice.