“Clark Kent has his Superman cape, while I have my spreadsheets of data and the ability to set goals and track them.”

This guest post is by Tasha Poslaniec. A registered nurse for 16 years, Tasha has worked in multiple areas, including obstetrics and cardiology. She currently works as a perinatal quality review nurse. She is one of the most viewed nursing writers on Quora, and has had essays published by the Huffington Post.

sm1018-0021In the world of comics, Superman’s alter ego is the incognito Clark Kent. But in fact, that nerdy, data-oriented, and unassuming reporter, whose mission is to “bring truth to the forefront, and fight for the little guy,” could very easily be a quality review nurse.

The comparison between the two might seem a stretch at first, but there are some parallels that are worth pursuing—especially in the context of understanding who and what your quality nurse is, what quality nurses do, and how Clark Kent’s mission isn’t far from quality nurses’ own motivation for what we do.

An anonymous nursing role.

First, let me put into perspective exactly how anonymous most quality nurses are. Do you know who works in your quality department? Do you know where your quality department is? Did you even know that you have a quality department? If you said no to all three of those questions, then I can relate. It was a little over a year ago when I first noticed a job posting in my hospital for a “Perinatal Quality Review Nurse.” As an OB nurse with over a dozen years of experience, I was intrigued, but I was also quite uncertain as to what the “quality review” part meant.

So I investigated. I had someone walk me to an office that I never knew existed, met people I’d never seen before, and slowly  became aware of a parallel universe full of terms, agencies, and processes. Who is responsible for compliance with the Core Measures? (I didn’t even really know they existed.) Who monitors the clinical quality of the physicians? (Quality nurses monitor the physicians?) What is the process for when a problem with the clinical quality is identified? The scales fell from my eyes and I was hooked.

Quality is bidirectional: QA and QI.

Florence Nightingale in the Crimean War (detail)

Florence Nightingale in the Crimean War (detail)

The world of quality moves in two directions, quality assurance (QA) and quality improvement (QI). Quality assurance is the part where we look at the results or outcomes. We compare ourselves against benchmarks to determine if we are on the right path— or if we have managed to settle onto a raft that is carrying us toward a waterfall of doom.

Quality improvement can take its direction from opportunities identified from QA, as well as from a plethora of other sources, such as identifying the moving target of “best practices” and then creating a process for them to be introduced and sustained.

Examples that are pulled right out of my own work include:

  • 1) collecting data on our hospital’s C-Section rates (brushing up on statistical analysis became a necessary evil),
  • 2) identifying the national benchmark to compare against (far trickier than it sounds),
  • 3) determining if our rate could be improved (Yes), and then
  • 4) researching the best practices for decreasing these rates, as well as who has actually achieved these rates.

Quality initiatives change lives.

Of course, this isn’t work that is done in a vacuum. There must also be meetings and emails with the appropriate physician committee or champion who will carry forward the information and momentum to bring about the desired change. Nursing done on this scale is both intimidating and also incredibly rewarding. Initiatives that I have researched and painstakingly promoted have the ability to change thousands of lives in a year.

And while I may occasionally miss the bedside, I can’t complain that I’m not affecting lives. Clark Kent has his Superman cape, while I have my spreadsheets of data and the ability to set goals and track them. As Florence Nightingale herself found, not only can lives be improved by helping people to heal, but they can be also be positively affected by statistical data analysis. It was Florence’s pie charts that finally convinced doctors to wash their hands regularly.

And that is the epic kind of nursing impact that your data-driven quality peers also strive towards.