Nurse Leader Perceptions of Data in the Veterans Health Administration

Abstract

Healthcare systems and nursing leaders aim to make evidence-based nurse staffing decisions. Understanding how nurses use and perceive available data to support safe staffing can strengthen learning healthcare systems and support evidence-based practice, particularly given emerging data availability and specific nursing challenges in data usability. However, current literature offers sparse insight into the nature of data use and challenges in the inpatient nurse staffing management context. We aimed to investigate how nurse leaders experience using data to guide their inpatient staffing management decisions in the Veterans Health Administration, the largest integrated healthcare system in the United States. We conducted semistructured interviews with 27 Veterans Health Administration nurse leaders across five management levels, using a constant comparative approach for analysis. Participants primarily reported using data for quality improvement, organizational learning, and organizational monitoring and support. Challenges included data fragmentation, unavailability and unsuitability to user need, lack of knowledge about available data, and untimely reporting. Our findings suggest that prioritizing end-user experience and needs is necessary to better govern evidence-based data tools for improving nursing care. Continuous nurse leader involvement in data governance is integral to ensuring high-quality data for end-user nurses to guide their decisions impacting patient care.

Beyond Hospital-Level Aggregated Data

“…This is an example of how the identification of units and establishing a crosswalk are important steps that enable EHR data to feedback and inform patient care, a hallmark of a learning health care system. 31,32 Even with a crosswalk, we were not able to link all inpatient wards and BCMA locations to nursing units (Table 2). 22.71% (N = 859) of inpatient wards, translating to 10.54% (N = 119,843) of ward stays in our cohort, were not matched to a nursing unit, although we matched all NUMA wards to inpatient wards.…”

“…Using this crosswalk report, we linked 89.46% of patient ward stays and 93.10% of medication administrations to the nursing unit in which they occurred. This is an example of how the identification of units and establishing a crosswalk are important steps that enable EHR data to feedback and inform patient care, a hallmark of a learning health care system 31,32 …”

Beyond Information Design: Designing Health Care Dashboards for Evidence-Driven Decision-Making

“…Interviewees reported using data to improve care quality and streamline care delivery and to plan resources needed for adequate care, such as unit staffing and supplies; findings from these interviews regarding purpose are reported elsewhere. 22 Despite all being managers, nursing leadership on the unit, facility, and regional levels may require very distinct information types and presentations to do their jobs. Based on user feedback, we created a dashboard with views tailored to consumer organizational role.…”