1. Laskowski-Jones, Linda MS, APRN, ACNS-BC, CEN, FAWM, FAAN

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I read a very thought-provoking and compelling article entitled The Quadruple Aim: Care, health, cost and meaning in work.1 The authors expand on Berwick and colleagues' widely adopted concept of the Triple Aim, which focuses on improving population health and the individual healthcare experience while lowering cost.2 The authors advocate that we add joy and meaning in work as the fourth aim.

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Numerous organizations around the world have embraced the Triple Aim in defining their strategic priorities for healthcare transformation. The authors assert that the Triple Aim framework fails to acknowledge the need for a fully engaged healthcare workforce and contend that "improving the experience of providing care" must be specifically included to achieve success.1


I've long held the belief that patient experience and nursing engagement are highly correlated. It's difficult to imagine how a patient could have an excellent experience with a nurse who doesn't find joy or meaning in his or her work.


Most nurses enter the profession with a deep desire to make a meaningful impact on the lives of those served and derive joy from that opportunity. But once embedded in the profession, something happens that takes a significant toll on many in our ranks. Typical culprits include overwhelming workloads, toxic work environments, safety concerns, moral distress, inadequate workplace education, and lack of coworker or managerial support.


We need to talk to one another about the reasons we chose nursing as a profession and then identify the most important factors to tackle that can otherwise kill the sense of joy and meaning. There's no magic bullet here because our work environments are complex, but having honest, healthy dialog with coworkers and leaders is a place to start. We need to research and unravel system issues that can be fixed at the organization level as well as address unit issues that are more within our span of control-such as how we treat and support each other every day and through challenging times. The Quadruple Aim framework has merit for all of us-nurses are a critical component of the transformation equation that can't be ignored.


Until next time,


Linda Laskowski-Jones, MS, APRN, ACNS-BC, CEN, FAWM, FAAN

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Editor-in-Chief, Nursing2016 Vice President: Emergency & Trauma Services Christiana Care Health System, Wilmington, Del.




1. Sikka R, Morath JM, Leape L. The Quadruple Aim: care, health, cost and meaning in work. BMJ Qual Saf. 2015;24(10):608-610. [Context Link]


2. Berwick DM, Nolan TW, Whittington J. The triple aim: care, health, and cost. Health Aff (Millwood). 2008;27(3):759-769. [Context Link]