The American Association of Critical-Care Nurses (AACN) Clinical Scene Investigator (CSI) Academy is a 16-month leadership program which mentors staff nurses to use their experiences to identify areas of critical-care improvement and become catalysts of change in their hospitals and communities.

“New nurses are usually looking for a broader scope of purpose as a nurse. We want to influence patient care, but sometimes lack the confidence to do so, especially when we are new to practice.,” said Gregory. “One way to achieve your professional goals is to join organizations and programs that affect patient care directly and give you the power to make lasting changes in healthcare. The leadership skills taught in these programs can last for the rest of your career.” 

Gregory is a nurse practitioner in thoracic surgery at the Fox Chase Cancer Center in Philadelphia, Penn., and participated in the AACN Clinical Scene Investigator (CSI) Academy in 2014. During the program, her team completed a project to decrease the occurrence of delirium among the patients in their intensive care unit (ICU). Gregory’s team provided research assessments and a protocol for nurses and other clinicians within the unit to address concerns relating to delirium in patients.

Following implementation of their non-pharmacologic, nurse-driven protocol, their unit saw a 50 percent reduction in the use of psychotropic medications for delirious patients. As a byproduct, nurse comfort in caring for delirious patients and confidence in assessing for delirium increased by 65 percent. Her project led to more large-scale multidisciplinary projects affecting inpatients at her hospital as well as plans to identify preoperative risk factors for delirium in the outpatient setting. Because of the project, Gregory’s task force led recommendations for anesthesia care for high-risk patients.

The CSI Academy program inspired Gregory to mentor others in how to develop their own evidence-based initiatives and advocate for change. Here are six pieces of advice Gregory wants to share with new and aspiring nurse leaders:

1. Be confident. Nurses can drive innovation by believing that they have the capability to do so. Very often we marginalize our efforts and the work we do without even realizing it. We need to believe that we belong at the table and we should speak up once we are there.

2. Question the ‘norm’. I learned that asking a question is the first step to finding the answer. Often, patient solutions are naturally sought after once a situation has been evaluated and someone is willing to step forward to implement change, no matter how small it may be.

3. Leading is hard; collaboration can be harder. Finding others who believe in your mission, purpose or project can be difficult. Persistence and patience in collaboration is key when trying to gain momentum in a staff-led initiative.

4. Patients and families want to be engaged. One of the most rewarding aspects of our CSI project was receiving enthusiastic responses when presenting our project to a patient or family. Many were deeply moved to hear that the staff nurses care so deeply for their loved ones and were impressed in the level of professionalism that it took to carry out such a project.

5. Ask for help. Our project required a lot of input and buy-in from other disciplines and physicians. We met with some resistance, but ultimately we found that our voices were heard and respected even among our biggest skeptics. We even had surgeons attending our in-services. We discovered cheerleaders that we never knew we had!

6. If you make your work about the patient, then no project can ever be a failure. For a while, our team was concerned that we would not have any outcomes at the end of our project. Our CSI leader encouraged us to persevere and assured us that the outcomes would follow. She was completely right. We found that even if we had not had the outcomes we did, this project was still a ‘win’. We modeled behavior for other nurses to feel empowered to create projects in our unit, and our doctors discovered how truly invested we were in the betterment of our patients and the care we deliver. Even more importantly, our patients felt educated about the issue of delirium. By keeping this project ‘patient centered’ we exceeded our long-term goals and the benefit of our participation in the CSI program can be felt today, almost three years later.

“Having a voice matters. Creating a safe and effective environment for your patients can begin at the bedside but is advanced through advocacy,” said Gregory. “My advice to other millennial nurses is to believe in your abilities to rise to the occasion to lead change and be the best nurse possible.”