The Power of Metrics in Nurse Leadership

Freeing yourself from traditional methods, measurements, paradigms, and ideas may help in achieving nursing recruitment and retention goals.

Editor’s note: This excerpt is from HCPro’s book, Nurse Manager’s Guide to Retention & Recruitment, Chapter 11: "Power of Metrics." For more information, go to https://hcmarketplace.com/nurse-managers-guide.

Changing the Paradigm

Traditionally in healthcare, we have measured turnover and vacancy rates of staff as a measure of workforce stability, and we monitor those metrics for developing problem-based interventions. A better and more appreciative way to measure stability is to change the focus to retention and loyalty rates as a broader measure of true stability that offers a prospective ability to predict organizational health. Leading from an appreciative perspective doesn’t mean ignoring the negative; it means the opposite: working to increase stability by leading with strengths and managing the negative.

An appreciative model of leadership has been referred to as appreciative inquiry, appreciative intelligence, or appreciative leadership. Essentially, an appreciative approach is about building on strengths to overcome weaknesses through an intentional framework that emphasizes the positive and manages the negative and is value driven. The Corporation for Positive Change (2016) believes there are five elements to an appreciative leadership model that individuals need to be successful:

• To know they belong
• To feel valued for what they have to contribute
• To know where the organization or community is headed
• To know that excellence is expected and can be depended on
• To know that they are contributing to the greater good

Freeing yourself from traditional methods, measurements, paradigms, and ideas may further help in assessing the reality of a changing situation. Matt Miller in his book The Tyranny of Dead Ideas (2009) challenges us to look deeper into what appear to be commonly accepted ideas or thoughts, which may actually prove to be myths. In his book, he dispels what he calls “dead ideas” about everything from schools being local matters to “your company should take care of you,” using data trends. The challenge is to understand what our dead ideas in nursing recruitment and retention may be, including negative or neutral measures.

Clipper, Cianelli, Freeman, Goldstein, and Wyatt (2016) propose a new set of competencies for nurse leaders that includes “divergent thinking, failure tolerance, agility/flexibility, risk taking and autonomy and freedoms.” These emerging competencies enhance the changing role of nurse leaders in creating environments that support innovation, boundary spanning, collaborative practice, and cultures of respect.

Proactive risk management and mitigation can seem counter to a culture of innovation that tolerates failure. In healthcare, we have low tolerance for failure due to the nature of our business: patient care. Innovation and risk management can and should live in the same space, as it is possible to hold these two realities concurrently. Innovation occurs on a continuum from incremental to disruptive innovation. Organizations may have low tolerance for innovation, as standardization, systemization, and reducing variances is the current philosophy and provides the framework for reliable care.

Changing the paradigm from problem-focused metrics and interventions isn’t easy for nurse leaders or for organizations; it’s hardwired into the industry on many levels. The first step nurse leaders can take to bring about this paradigm shift is to address their language and metrics. Instead of talking about turnover and vacancy, keep those measures but use the opposite language—retention and loyalty. For example, if you have a 9% turnover rate and a 7% vacancy rate, you can address them as 91% retention rate and 93% loyalty rate. Language is powerful, and it is human nature to focus more on the negative, especially when describing workforce outcome metrics. As nurses and leaders, we also tend to be problem, deficit, and variance focused, so changing the paradigm starts with you—introspection and then action.

From Data to Wisdom: Making Sense of It All

Changing the paradigm starts with you on many levels. You need to know the data in order to transform it to information, then knowledge (actionable information), and ultimately to wisdom (what did we learn from it?). Data sources abound, which is why we often hear “we are data rich, but information poor.” However, data can be hard to find, access, and understand, even internally within your organization. Information is power, and many people and organizations hold data close to the chest and limit access. In this age of transparency, it is necessary to have access to data, locally, nationally, and globally. Understanding our place in the global, national, and local community of data is crucial to decision-making and enhances our ability to make smart decisions.

Find out who keeps the data you need and how to get access to it. Most often, the data you need as a nurse leader come from finance (CFO), human resources (director of HR), quality/risk (quality director), and clinical data sources (chief nurse information officer or a nurse informaticist). Make it a point to know who these individuals are, and develop relationships with them before you need access to the data and outcome metrics from their departments.

External data can be more challenging to find, but it is becoming more accessible due to open records policies, public reporting requirements, and increased transparency. Most external data sources are aggregated, which offers some level of anonymity. Some of these sources include:

• State level turnover data—state hospital association
• Workforce data—state or national board(s) of nursing
• Quality—state health departments
• Financial data—hospital association

Data is most powerful when it can be turned into information. Most organizations have created and deployed dashboards of common metrics. These metrics may demonstrate relationships that exist and assist in decision-making for strategies, tactics, or deployment of resources. Dashboards assist leaders and the organizations in understanding movement toward goals or achievements of strategies by providing a view over time.

Consider sources of internal data for use or for a dashboard:

• Finance—financial data, turnover cost data, salary data
• Quality—clinical metrics, patient and population level data for impact, safety data
• Human resources—turnover data, wages and benefits, retention data, employee engagement/satisfaction data

It is also advisable for nurse leaders to develop relationships with a nurse scientist, researcher, quality analyst, and/or biostatistician. All can be sources that help make sense of data for decision-making and action planning. Be careful to not fall into the “linearity” trap. Embracing the complexity of what we do in healthcare is a must, from clinical to human resource outcomes. Care, cultures, and outcome management are rarely linear, meaning if I do “A” and then “B,” I will get “C”. There are many other variables, and understandings that will help you design better interventions based on the data.

Complexity science is the science of systems and understanding that many components exist, interact, and change as a result of the relationships in dynamic and often unpredictable ways (Linberg, Nash, and Linberg, 2008). Complexity science also incorporates many fields of study into the science with micro, macro, and metasystems within the concept of complex adaptive systems. The truest value of embracing complexity as a nurse leader is the realization that what we do in healthcare is most often predicated on relationships and our holistic education as nurses. This gives us an advantage as we attempt to understand and work in complex environments. Creating and improving professional practice environments that are built on respect, caring, evidence, and civility that produce positive outcomes may be one of the best analogies for complexity.

Cole Edmonson, DNP, RN, NEA-BC, FACHE, FAAN, is a co-author of Nurse Manager’s Guide to Retention & Recruitment.