1. Overgaard, Penny Morgan BSN, RN, FAHCEP

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One thing you don't learn in nursing school is project management. Or do you? Although nurses may not receive formal training on business topics, there are many skills you do learn that can help you conceive and manage projects in the workplace. In fact, the nursing process provides an ideal background for using project management techniques. The nursing process incorporates a systematic method of assessment, diagnosis, planning, implementation, and evaluation. Project management encompasses similar procedures for successful results.


Project management includes the following steps: project initiation, planning, execution, monitoring, and closing. Originally conceived as a tool to ensure that projects using many disciplines would be correctly budgeted and completed within a scheduled time frame, project management has become useful in a variety of settings from writing a book to building a skyscraper. The use of the systematic steps in project management can eliminate costly mistakes, increase quality, and save time. The nursing process may help the nurse manager understand how using a systematic process to complete a project is beneficial.



The first step in project management is initiation, which corresponds to the first two phases in the nursing process-assessment and diagnosis. It's crucial that the goals and objectives of any unit project align with the overall goals and objectives of the organization. For example, if a hospital has an unacceptable number of mislabeled lab specimens, the project of decreasing the number of mislabeled specimens may be assigned to a unit as part of the institution's quality assurance goals.


At this point the overall goal is clear-to decrease the number of mislabeled specimens on the unit-but you must further define the objective by clarifying the outcome expected, as well as the constraints of the project in terms of budget, manpower, and time commitment. In many cases, these constraints may have already been defined as part of the larger organizational goals, such as how the outcome will be measured in terms of time and success. For our unit project of decreasing mislabeled specimens, adding the needed information will give us a well-defined objective. The unit will decrease mislabeled specimens by 20% per quarter until it reaches zero mislabeled specimens. Progress toward the goal will be reported by the unit manager on a monthly basis and also reported at monthly quality assurance meetings. Well-defined outcomes in terms of time and measurement criteria are essential to make the evaluation process clear.



When the outcome criteria are established, you're ready to move to the next step-the planning phase. In our example, the number of mislabeled specimens on the unit must be established and the expectations identified. These may include identifying what constitutes a properly labeled specimen, what items are needed to properly label a specimen, and what the current process for labeling currently involves.


You should recognize that this is a process problem and look for process solutions by identifying patterns and trends. If the data are examined they may show, for instance, that many mislabeled specimens occur more frequently when the labs are done within 2 hours of admission or when they involve nurses who are floating and not regularly on the unit. Identified trends allow the team to look for possible reasons for the problem and begin to formulate a plan.


Planning is a crucial phase in both the nursing process and project management. Initiation and planning are at times almost seamless. Project plans should be both detailed and transparent. Plans should identify process changes, materials needed to complete the change, and any educational needs. Everyone involved in a project should know what's expected of them. This means that sharing a plan for change with the larger unit staff is a key to buy in, as is sharing the progress toward meeting the goal. Identification of unit champions is also a component of success in bringing the project to fruition. Finally, the timeline for each step and monitoring procedures should be detailed.



The next step in project management is the execution phase, which corresponds to the implementation phase of the nursing process. Project execution requires that every member of the unit staff understands the goal, expectations, and timeline. A well-run project allows all participants to be able to instantly access the data. Success depends on every team member being a part of the implementation process in ways that are vital and change oriented. In our project, involvement of the whole team also allows every mislabeled specimen to be an opportunity to evaluate where the process broke down and what was missing to allow for success. No one person is responsible for making a mistake, but every team member is responsible for investigating why the mistake was made and contributing to the process change.



The monitoring, or evaluation, step in both project management and the nursing process is dynamic. The best results are produced when there's constant evaluation and feedback. Whereas the manager in this project reports progress to administration monthly, results on the progress and why errors occurred should be given even more frequently to the unit team in order to allow for new information to be assimilated and the plan to be modified as needed. New information should be strategically added to the plan and then revaluated.



The final step in project management is closing the project. This is a valuable step in the process because it ensures that the results of a project are complete and sustainable, and it allows for reflection about how to improve future endeavors. In our mislabeled specimen example, after the target outcome has been reached, the team should spend time making sure the new process is sustainable and that measures are in place to trigger a team review if the mislabeled specimens count rises again. The team should also review the project management process itself.


A project end review sums up the process and allows team members to refine their project management skills. Lessons learned allow team members to utilize the project management technique in other areas. The astute nurse manager may mentor team members by assigning them to lead another unit project using the same five-step project management process.


Mastering the steps

Although nurses aren't usually specifically educated in business and management concepts, there are ways to adapt the unique skills involved in nursing to many of the nurse manager's administrative and leadership responsibilities. Successful nurse managers can fulfill their business responsibilities using skills they've already mastered.