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Nursing News HighlightsNurses Leading Innovation

Nurses Lead the Way to More Positive Patient Outcomes

Close-up of patient laying in hospital bed with a hospital gown on with medical personnel in background
When a patient is in critical care, nurses are there through every step of their care, from performing assessments and administering therapies, to educating patient families and opening new pathways to improving patient care.

Nurses are a pivotal force in ensuring positive patient outcomes and implementing advanced patient care. When a patient is in critical care, nurses are there through every step of their care, from performing assessments and administering therapies, to educating patient families and opening new pathways to improving patient care.

profile photo of Rachel Culpepper

Nurses of all specialties, ages, career paths and education levels can become leaders in their communities and beyond. “The first step in becoming a leader is to find confidence in becoming an agent of change,” said Rachel Culpepper RN, MSN, CCRN, a perianesthesia clinical manager and educator at Eskenazi Health in Indianapolis, Ind., and a 2012 participant of the American Association of Critical-Care Nursing (AACN) Clinical Scene Investigator (CSI) Academy. Nationwide, more than 246 nurses at 68 hospitals in eight states have participated in the program thus far. The CSI Academy is a 16-month, hospital-based leadership and innovation training program designed to empower bedside nurses as leaders and change agents whose initiatives measurably improve patient and fiscal outcomes.

Through the CSI Academy, Culpepper has been part of the project to decrease hospital acquired pressure ulcers (HAPU) in her Medical Intensive Care Unit (MICU) for the last five years.

Pressure ulcers are skin sores caused by prolonged pressure on the skin when a patient remains in one resting position for too long. HAPUs are a national concern due to patient morbidity, treatment cost, and reimbursement issues. The Agency for Healthcare Research and Quality (AHRQ) estimates a cost of $43,180 per pressure ulcer, and one hospital (the Wishard Hospital Adult ICU) in Indianapolis, Ind., had 42 HAPUs in 2011 before the project began.

In 2012, Culpepper and her team engaged the healthcare community to work together and implement a program to help prevent HAPUs and “save patients’ skin.”

“A multidisciplinary approach is important when implementing new protocols, policies, or anything in healthcare, but nurses can and must drive change and innovation in healthcare,” said Culpepper. “Frontline staff are the most important to be involved in changes at the bedside and should be included in decision making.”

The team created an algorithm to allow nurses to assess a patient's risk of developing a pressure ulcer, revised a hospital-wide skin care protocol, provided education to nurses and patients about the new protocol and goals of the program, and introduced hydrocellular foam dressings to be used in the hospital.

Since then, the project decreased the occurrence of HAPUs by more than 50 percent and resulted in an estimated $582,930 of annual fiscal savings. Shortly after the success in the MICU, the project went hospital-wide and has continued to grow and evolve. It’s now a part of orientation for newly hired nurses.

Culpepper encourages nurses, especially new nurses, to bypass their comfort zones and become agents of change. The CSI Academy experience gave Culpepper the courage to step forward and become an innovative nurse leader. 

“Being innovative means bringing new ideas and concepts to the table…Not all of them will work – and that’s okay. Continue to pursue excellence and push through the pitfalls you may face along the way,” said Culpepper.

Culpepper said her experience in the CSI Academy shaped her future in leadership by teaching her valuable skills in communication, strategic planning, collaboration, innovation, public speaking, marketing, and advancing patient care.

Learn More About the AACN CSI Academy

By empowering bedside nurses to lead innovation, the AACN CSI Academy develops staff nurses as leaders and change agents who drive improved patient and fiscal outcomes.

As part of its broader goal to inspire and empower all acute and critical care nurses to lead change that benefits their patients and improves the effectiveness of their organizations, AACN offers online access to CSI Academy innovation projects – including project plans, clinical interventions, data collection tools, outcomes and references.

With more than 33,000 unique downloads of project materials, the CSI innovation project library has become a resource for hospitals throughout the United States and abroad, as healthcare administrators and clinical leaders seek solutions to improve patient outcomes and reduce costs. For more information about the program, visit the CSI Innovation Projects webpage or

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