Nurse Leader Perceptions of Data in the Veterans Health Administration: A Qualitative Evaluation

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.

Figure 1 –. Simplified Veterans Health Administration (VA) System Organizational Chart From National to Unit Level

There are 18 Veterans Integrated Service Networks (VISNs) that range in size from 5 to 11 hospitals per network. Facilities are categorized into one of five complexity levels based on hospital characteristics. Services are designated by care type. Units are designated by specialty. The number of services and units within a facility vary by facility.