1. Marshall, David R. JD, DNP, RN, CENP, NEA-BC, FAAN


In this month's Magnet(R) Perspectives column, guest author Dr David Marshall, JD, DNP, RN, CENP, NEA-BC, FAAN, system chief nursing and patient care services executive at the University of Texas Medical Branch (UTMB), explores nursing's proud history of innovation and looks at ways we can give nurses the means, opportunity, and motivation to unleash innovation and transformation. Dr Marshall shares details of UTMB's successful medical makerspace, where nurses and others bring ideas to life.


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Nurses are natural innovators. Where there is a nurse, there is an idea about how to make patient care safer, more convenient, or more comfortable. Nurses were inventive from the start, say Massachusetts Institute of Technology (MIT) researchers Jose Gomez-Marquez and Anna Young. "Nursing has a rich tradition of making-one that has produced numerous devices and tools that created a direct path to improved patient outcomes".1 As far back as 1900, the American Journal of Nursing featured practical tips and hints under the headline "Improvising." Later, this column became "The Trading Post," where nurses exchanged ideas about how to make themselves or their care more efficient.2 By the 1950s, the focus had shifted from everyday innovation to research using the scientific method. What has happened to all those ingenious ideas to improve patient care? Nurses still have them, but they need the proper environment and encouragement to bring them to life.

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Creating the 1st Hospital Makerspace

At the University of Texas Medical Branch (UTMB), nurses have somewhere to turn when the lightbulb goes on. We opened the nation's 1st official hospital makerspace in 2015, where nurses can tinker, explore, test, and collaborate to transform their ideas to reality.3,4


Created with the help of our friends from MIT's MakerNurse5 as well as generous funding from the Robert Wood Johnson Foundation and UTMB, the dedicated space is filled with devices not normally found on the unit, from high-tech 3-dimensional printers and laser cutters to everyday items such as sewing machines, hand tools, and glue guns.


What have been developed? One cardiac catheterization laboratory nurse created a bracing structure to hold a patient's arm securely during catheterization procedures. A medical-surgical nurse created a Velcro-backed Plexiglas hook for patients' urinary drainage bags in the intensive care unit. Others have devised fixes to improve wound coverage during showering, protect intravenous lines from disruption, and create activity aprons for dementia patients.


Our makerspace has proven so popular that, in just over 3 years, it has expanded well beyond nursing to include clinical staff, physicians, and students. As one user said, "It's a place with no hierarchy. People work side by side, sharing ideas and theories, creating prototypes, and turning dreams into reality."


The Magnet(R) Difference

The Magnet environment is another key driver of nurse innovation. Breakthroughs in patient care, nursing, and the practice environment are hallmarks of organizations receiving American Nurses Credentialing Center Magnet Recognition(R). "The Magnet Model is, in itself, innovation," says Cole Edmonson, DNP, RN, NEA-BC, FACHE, FAAN, chief nursing officer at Texas Health Presbyterian Hospital Dallas (THD). "New knowledge, innovations, and improvements are clearly an outcome of the Magnet culture. They manifest not only through empowerment, structures, and processes, but also in the unleashing of all creative and innovative forces within an organization, complete with permission and expectation to make change happen, drive forward, and create the future."


Texas Health Presbyterian Hospital Dallas was the earliest pioneer of the Resuscitation Quality Improvement Platform from the American Heart Association and Laerdal. Nurses led the adoption of this disruptive technology for cardiopulmonary resuscitation and advanced cardiac life support training. They created the innovation implementation pathway and shaped the future of the technology. Resuscitation Quality Improvement has improved outcomes in post-cardiac arrest by 21%, improved nurse satisfaction with training, and saved more than $350,000 annually in education and training costs.


Last fall, THD became the 1st hospital in the world to pilot Moxi, a mobile manipulation, artificially and socially intelligent assistive robot, in a patient care setting. Nurses guide Moxi to learn how the robot can assist them by taking on routine, low-value tasks such as delivering supplies or retrieving equipment. This allows nurses more time for high-value, high-impact care processes and interaction with patients and families. "Early results are very promising and it is exciting to know that we are shaping the future of robotics in nursing and setting a research agenda for the nation," Dr Edmonson says. Later this year, UTMB will join THD in the Moxi pilot.


Means, Motive, and Opportunity

The Magnet framework and dedicated resources such as UTMB's makerspace give nurses the means and the opportunity to innovate. They also need the motivation. That is the impetus for the American Nurses Association's (ANA) framework for innovation. The initiative aims to transform healthcare through nurse-led innovation. "Nurses are natural innovators, yet few see themselves this way," says Bonnie Clipper, DNP, RN, MA, MBA, CENP, FACHE, vice president, Innovation, ANA. "Our goal is to ignite nursing innovation, cultivate and inspire future nurse innovators, and help nurses turn their very best ideas into reality. Whether it's modifying an existing technology or using disruptive innovation to come up with something that doesn't yet exist, it's important to find ways to help nurses hardwire their innovation skills and develop competencies."


The Innovation Lab of ANA brings together designers, engineers, and business experts to work alongside nurses and help them build out their ideas. The fun, fast-paced NursePitch events help nurses sharpen their skills in problem definition, solution testing, and business plan development. The ANA Innovation Awards, presented in partnership with the global medical technology company BD, reward nurse-led innovation that improves patient safety and outcomes.6 The $25,000 individual nurse award and a $50,000 nurse-led team award advance viable innovations and even bring them to market.


Nurses' best ideas can advance patient care, make processes more effective, and improve safety and outcomes. With the proper time, space, materials, and encouragement, the sky's the limit for every nurse who has ever said, "There's got to be a better way!"




1. Gomez-Marquez J, Young A. A history of nurse making and stealth innovation. 2016. or Accessed October 14, 2018. [Context Link]


2. The Trading Post: an exchange for ingenious ideas about nursing. Am J Nurs. 1947;47:660. [Context Link]


3. Marshall DR, McGrew DA. Creativity and innovation in health care: opening a hospital makerspace. Nurse Lead. 2017;15(1):56-58. [Context Link]


4. Nation's first medical makerspace opens in Texas. 2015. Robert Wood Johnson Foundation News. Accessed October 14, 2018 [Context Link]


5. MakerNurse website. Accessed October 14, 2018 [Context Link]


6. American Nurses Association. ANA Innovation Award. Accessed October 14, 2018 [Context Link]