1. Smith, Joan R. PhD, RN, NNP-BC

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The need for innovative solutions has never been greater than today, as healthcare, its delivery to consumers, its technology, and its business models struggle to provide equitable, safe, and effective health services while reducing costs.1 Since nurses are the nation's largest group of healthcare professionals with 24/7 access to patients, and nearly every clinical interaction begins and ends with a nurse, it only makes sense that nurses are natural innovators. When faced with barriers to providing care, neonatal nurses are uniquely positioned to create workarounds by problem solving in the moment.2 In fact, neonatal nurses have a uniquely practical and caring perspective on healthcare solutions, products, and services. While neonatal nurses frequently and intuitively produce workarounds, the rapid change in healthcare requires frontline staff to strategically innovate and advance entrepreneurial skills to improve patient outcomes and health delivery. Therefore, these nurses need not only strong clinical training but also strong business training to prepare them to strategically innovate-training that includes finance, operations, strategy, and innovation to advance the nursing profession and healthcare. This will allow nurses to have a voice at the table as they engage in patient-centric medical product development, process and system improvement, and clinical outcomes research.



The term "innovation" has become a buzzword, resulting in overuse and generalization that lacks substance and clarity of meaning.3 For the purpose of this article, the definition of innovate is to put new ideas into practice or existing ideas into practice in new ways.4,5 Specifically, individuals who possess a combination of critical, conceptual, creative, reflective, and visionary thinking coupled with curiosity, resilience, the ability to collaborate, and the development of both observation and communication skills have the tools to be great innovators.3 Although the term "innovate" may conjure up ambiguous meaning, it is a term that is not new to nursing. In fact, much of modern nursing is the result of a true innovator-Florence Nightingale-who challenged the status quo of conventional medicine to elevate modern-day nursing. Florence Nightingale-a powerful, knowledgeable, and revolutionary woman who cared for injured soldiers-watched many perish from disease and illness related to unsanitary conditions rather than battle wounds. She meticulously documented and analyzed her observations to conclude that sanitation was directly related to mortality. Florence Nightingale implemented hygiene protocols including handwashing between patient contacts, use of clean linens, and sterilization of medical equipment. These not only decreased infection but also saved people's lives; through these methods, she reduced the number of deaths by two-thirds, sparking a worldwide healthcare reform. These interventions (hand hygiene and sterilizing equipment) are still commonplace today and are most effective in reducing horizontal transmission of disease and saving lives.6



There are many examples of nurses who innovate and bring their ideas to market in order to impact hundreds, thousands, or even millions of patients. In 1950s, Sister Jean Ward, a prematurity nurse, believed in the healing benefits of fresh air and sunshine and would routinely bring infants to the hospital's outside courtyard. She and the physicians noticed that the babies' skin was less jaundiced when they were exposed to sunlight during Sister Jean's outings. This clinical practice paved the way to the development and implementation of neonatal phototherapy-a worldwide intervention to decrease bilirubin that has positively impacted the outcomes of millions of infants.7 Intensive care unit nurses Teri Barton-Salina and Gail Barton-Hay recognized the complexity and risks of managing high-risk patients with intravenous (IV) catheters and multiple IV tubing. Quick identification of these lines is necessary to deliver appropriate lifesaving medications and fluids but can be risky since the tubing all looks the same made as it is made up of clear plastic. To reduce the risk of error, these nurses developed and patented the lines, ColorSafe IV Lines. These are just a few examples of nurses innovating and impacting millions of lives in healthcare.7



This same boldness, knowledge, creativity, and thought-leadership is needed today to transform healthcare. Never before in the field of nursing has innovation and entrepreneurship been promoted and incentivized. In June of 2018, the American Nurses Association launched an Innovation Award highlighting and recognizing nurse-led innovation that improves patient safety and/or outcomes.8 Winners have 1 year to further develop their innovation with the monetary award. The Cleveland Clinic hosts a Nursing Innovation Summit that collaborates with the Medical Innovation Summit to foster and ignite innovation and provides practical advice for turning ideas into reality.9 In 2016, the Northeastern University School of Nursing hosted a Nurse Innovation and Entrepreneurship Summit and Hackathon. Hundreds of nurses from around the country attended the 3-day event that resulted in innovation, entrepreneurship, and motivation for future discovery. Today, the school collaboratively hosts a Healthcare Innovation & EntrepreNURSEship event annually to foster the creation of pragmatic and sustainable required for practice, service, and research.10


As a result of this Summit, modern innovator and entrepreneur, Melissa Gersin, advanced her idea and took it all the way to the reality television show-Shark Tank. Melissa, a former maternity and nursery nurse, creatively designed and constructed a portable and versatile product for fussy babies that parents could take anywhere, anytime. With no background or training in engineering, business, or product development, Melissa handcrafted a prototype, founded a company, and began production of the Tranquilo Mat.11


This is an exciting time in healthcare, and neonatal nurses are well positioned to be at the table to innovate, negotiate, and advance nursing all while improving patient outcomes. Effective innovation is desperately needed to reduce healthcare silos and inefficiencies and to produce more convenient, effective, and cost-efficient treatments that are consumer-centric. Innovation does not require advanced degrees; it does require neonatal nurses to seize the moment/opportunity and passionately follow these dreams. As a neonatal nurse, if you see something that needs changing, channel your inner Florence Nightingale or Melissa Gersin. Challenge the status quo, meticulously and methodologically observe, analyze, create, collaborate, and innovate. Think about what the future could hold if we all took our creative ideas and problem-solving strategies from concept to reality-we can revolutionize modern nursing and transform healthcare!


-Joan R. Smith, PhD, RN, NNP-BC


St Louis Children's Hospital


St Louis, Missouri




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