Editorial Ethics, Evidence-Based Practice, and Economics: The Metrics of Quality T Donna M. Nickitas, PhD, RN, NEA-BC, CNE, FAAN AMERICAN NURSES Associa- tionhas declared 2015 as the Year of Ethics. This is in recognition of the newly revised Code of Ethics for Nurses with Intepretative Statements (ANA, 2015), known as the Code. In celebration of the Code and nursing’s contributions towards a commitment of quality, I have created the following motto: “Ethics, Evidence-based Practice, and Eco nomics: The Metrics of Quality.” The 3 Es of quality remind me that all nurses have an imperative to protect the rights, health, and safety of individuals and populations they serve. Nurses protect and serve society with honesty, integrity, and knowledge. The ethical principles offered by the Code provide specific guidance for practice when confronted with ethical dilemmas. It is our standard of ethical conduct that has garnered such a high level of trust from the public. However, neither ethics nor evidence alone are sufficient to ensure quality and address the wicked problems arising from health care costs. HE Quality as a Core Metric of Care The 3 Es must be integrated into care delivery and power nurses and other health care providers to have conversations with individuals and families about treatment decisions. Choosing Wisely®, an initiative of the ABIM Foundation launched in 2012, is assisting health providers and patients to discuss concerns about the overuse of tests and procedures and support efforts to help patients make smart and effective care choices. This means choosing care that is supported by evidence (not duplicative of other tests or procedures already received), won’t harm patients, and ordered/provided when truly necessary. Choosing Wisely provides lists created by national medical specialty societies that represent specific, evidence-based recommendations clinicians and patients should discuss. For example, the American Academy of Nursing (2015) has a list of “Ten Things that Nurses and Patients Should Question.” This list of “Don’ts” identifies and encourages nurses to avoid treatment and procedures that would potentially cause harm to patients. Each item contains evidencebased practice information and rationale. The extent to which patients and their families are involved in making decisions and feel prepared to manage their conditions is critical to improving quality and reducing cost (National Quality Forum [NQF], 2015). According to The Commonwealth Fund, patient and family-centered care that incorporates shared decisionmaking can reap potential health care savings of $9 billion over 10 years (NQF, 2015). By incorporating evidencebased decision making and intersecting it with traditional principles of ethics (caring, beneficence, and justice), nurses are fostering care strategies for individuals and populations while addressing underlying systems issues that may impact care including facilitiating a culture of safety that supports reporting errors and near misses, and promoting a healthy work environment of respect and civility among co-workers. By endorsing ethics, evidence-based care, and economics as metrics to acheive quality, nurses demonstrate how high-quality care can be cost-saving and, potentially, even revenue-generating. Quality and Finance Matter In today’s health care environment, aligning and articulating a business case for caring and achieving quality and financial outcomes are essential. It means linking quality nursing care, ethical principles, and a strong evidence-base practice to increase revenues, save costs, and achieve a positive return on investment for nursing services. To achieve quality outcomes and financial savings there must be a strong evidence-base practice environment that guides collaborative patient-provider decision making. Whether continued on page 131 122 NURSING ECONOMIC$/May-June 2015/Vol. 33/No. 3 Editorial continued from page 122 the issues are improving a clinical problem (e.g., hospital-acquired infections or pressure ulcers), or Hospital Value-Based Purchasing Program (e.g., patient satisfaction), the ability to apply evidence-based practice models will help justify the costs of implementing and sustaining a practice change. Nurses who use ethics, evidence, and economics to choose wisely for individuals, populations, communities, and health care institutions do so to achieve quality. And, those are the only metrics that really matter! $ REFERENCES American Nurses Association. (2015). Code of ethics for nurses with interpretive statements. Silver Spring, MD: American Nurses Association. American Academy of Nursing. (2015). Ten things that nurses and patients should question. Retrieved from http://www.choosingwisely.org/wp-content/uploads/2015/02/ AANursing-ChoosingWisely-List.pdf National Quality Forum (NQF). (2015). Person-centered care. Retrieved from http://www. qualityforum.org/Topics/Person-_and_Family-Centered_Care.aspx 131 NURSING ECONOMIC$/May-June 2015/Vol. 33/No. 3 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
