Sustaining a Quality Improvement

. Address Operational Barriers

Identify Creative Solutions: Meet with the clinic director or nurse manager to brainstorm staffing alternatives that do not compromise the EBP.

Suggestions:

Staggered Time Off: Implement a policy to limit the number of nurses who can take vacation simultaneously during the summer.

Non-RN Verification: Can another credentialed staff member (e.g., a Pharmacist, LPN with specific training, or even a credentialed Medical Assistant for the type but not the dose—though two RNs is best) perform the second check, under strict guidelines?

Incentivize Summer Shifts: Offer a small bonus, higher hourly rate, or extra PTO to nurses who commit to working high-demand summer shifts.

3. Integrate into Culture

Formalize the Process: Ensure the two-nurse check is hardwired into the official policy and the Electronic Health Record (EHR) workflow. If the EHR requires a second login/scan to proceed with vaccine administration, it becomes much harder to bypass.

💡 Creating New Enthusiasm with Nurses

The nurses are currently supporting the CFO's suggestion because they feel the current staffing model makes the QI process a burden. You need to turn the process into a source of professional pride and ease.

Peer Recognition and Ownership:

QI Champions: Identify the nurses who currently champion the two-nurse process and give them formal recognition and titles (e.g., "Vaccine Safety Champions"). Have them lead brief in-service sessions to share best practices.

Shift the Narrative: Highlight that this process elevates the clinic's standard of care above their peers at other facilities, positioning the nurses as leaders in patient safety.

Highlight the Reduction in Stress:

Focus on Error Prevention: Remind the nurses that every error prevented is a significant source of stress and burnout avoided (e.g., the fear of harming a patient, filling out incident reports, attending peer review). The two-nurse check is a safety net for them as much as it is for the patient.

Efficiency Wins:

Streamline the Process: Ask the nurses, "How can we make this 2-nurse check faster?" Use their input to reduce the time burden. Maybe the second nurse only needs to verify the prepared syringe and label, not the entire preparation process, or designated "Check Stations" can be created. Involving them in the solution creates buy-in.

🗣️ Responding to the CFO

Your response to the CFO must acknowledge the financial and staffing reality while firmly anchoring your professional recommendation in risk management and brand integrity.

Sample Answer

This is a classic change management challenge that pits quality and patient safety against operational efficiency and staff satisfaction. Since you're dealing with evidence-based practice (EBP) that directly impacts patient safety, your approach must be strategic, data-driven, and highly focused on communication.

🤝 Building Support and Sustaining the Improvement

To build support and sustain the two-nurse verification process, you need to address the root causes of resistance (staffing fatigue, vacation issues) while reinforcing the patient-safety value of the change.

1. Reaffirm the "Why" with Data

Targeted Communication: Share the specific success metrics of the quality improvement (QI) initiative with the nurses, the clinic director, and other stakeholders. You noted the success wasn't fully communicated to the nurses—this is the most critical first step.

Example: "In the six months since implementation, we've gone from an average of 4.5 vaccine preparation errors per month to zero."

Safety as Non-Negotiable: Frame the two-nurse check not as an "extra step," but as a patient safety barrier (a high-reliability principle). Clearly state that sacrificing this barrier, even for a short time, is a direct threat to patient safety and the clinic's reputation.