Nursing At Children's

“We are privileged to enter the lives of our patients and families. Ultimately, we make a choice between service and self-interest.”

This quote is paraphrased from a 2002 address by Donald Berwick to thousands of health care professionals attending the Institute for Health Care Improvement, seeking ideas and methods to make our capacity to deliver health care better. He challenged that today’s practice of patient- and family-centered care is an impoverished shadow of what we could and should be doing.

My first response was to feel extraordinarily defensive on behalf of Children’s. After all, we pride ourselves on delivering extraordinary family-centered care.

But Berwick went on: Families come to us with wisdom, resilience, strength, hope, dreams, histories, their love for each other, their natural powers of healing, as well as their anxieties, fears, needs, and preferences in care. They place their trust in us to care for their child and support their family.

I listened to exemplars tell their stories of engaging with families in care and service. How did we compare? How do we perform in our ability to accept and support the gifts and contributions of families to care for their child? How does our environment, both physical and human, create an experience of confidence, security, and services—so that all energy can be brought to bear in healing?

We do well, but we can do much better. We have episodes of brilliance and we have those of failure. We have a wide range in variability—the experience is uneven. In this, we have the opportunity to better serve, innovate, and improve health care—and nurses can lead the way.

Children’s Service Standards, released this past fall and developed by members of Children’s community, are aimed at reducing the variation in experience and giving guidance to bring our individual and collective best to each child, each family, each time, each day. And this starts with how we show up with one another. It is a big order, but I believe we can meet it. We can take pride in the appearance and cleanliness of our environments, the quality of our communication — just as much as we do in the skills of our technical care and critical-thinking process.

If you haven’t already, please read the Service Standards, the next generation of our Standards of Behavior. While they are intuitive (often the sign of deep insight), they do require commitment and discipline to fully integrate them into each and every interaction at Children’s.

Everything does matter. Each action is a thread in the overall tapestry of experience for children and their families, whether it is a smile, a “Hello” in passing, getting directions, or in the care process.

Did you know that the key driver of family satisfaction of quality of care is communication? And that the key driver of quality is nurse communication and the observed communications of nurses with physicians and other members of the health care team? Key elements of communication for families means being fully present, listening, making eye contact—interestingly, not the volume of communication or the amount of time spent. We are judged by 68% as very satisfied, and so we have an improvement opportunity.

Being fully present and listening is the first sign of respect: That you care enough to know and understand a family’s needs, strengths, and preferences. Listening for what is said and what is not said allows you to be a better nurse by more accurately understanding child and family needs. Confirming your understanding explicitly with patients builds confidence, which limits uncertainty, and frees energy to the healing and well-being of the child and family.

Eye contact and smiling are calming behaviors that demonstrate care. When families see stress, worry, or conflict in the faces of their caregivers, calm and confidence is undermined and adds to their burden.

When something is delayed or goes wrong, an apology communicates accountability and a willingness to solve the problem and set things right.

For many families, nurses are the face of Children’s. It is Children’s commitment to improve service, so that you as nurses can focus on improving communication with families, with one another, with the clinical team, and with all members of Children’s community.

It can and will make a difference. The Service Standards help guide the way.