Advancing the Nursing Profession through Innovation

*Tiffany F. Kelley*

## **Abstract**

To innovate is to bring forward positive change for a population of people who are affected by a pervasive unmet need. In nursing and healthcare, new innovations must address how to advance quality outcomes. These advancements can be through one or more of the six domains of quality *(e.g., safe, efficient, effective, equitable, timely, and patient-centered).* Nursing history is rich with innovation efforts to advance the profession. Nursing has recently experienced a new resurgence of focus on innovation through academics, practice, research, and scholarship. Nursing must continue to evolve and meet the contemporary needs of our peers and the people which we serve. Embracing the power of innovation as a profession can help us address the many pervasive unmet nursing and healthcare needs across the globe. This chapter will aim to: Define innovation, nursing, and healthcare innovation 1. Describe aspects of nursing innovation throughout history 2. Describe the role of quality as an outcome measure for innovation efforts 3. Examine how innovation can be a focal point in academics, practice, research, scholarship, and policy 4. Critique the risk of not embracing innovation in nursing and healthcare for the future.

**Keywords:** nursing, innovation, future of nursing, nursing advancements, innovations in healthcare

## **1. Introduction**

The nursing profession has seen a growing focus on innovation over the last decade. Yet, more work remains to solidify innovation as a necessary learning element for the benefit of the care delivery and professional nursing contributions to individuals, families, groups, communities, and populations at large [1, 2]. Yet, innovation remains a new domain for many in nursing and healthcare. The purpose of this chapter is to describe how the nursing profession can advance through the integration of innovation into our knowledge, skills, and abilities across all areas where nurses work. The chapter is broken into five topical areas. Each topical area builds on the one(s) before it.

### **1.1 Chapter objectives**

• Define innovation, nursing innovation and healthcare innovation.


### **2. Define innovation, nursing innovation, and healthcare innovation**

What does it mean to innovate, to be innovative, or to create an innovation? This is a common question for many when innovation is discussed in conversation. At times, innovation can lead to misconceptions, be seen as something ethereal (e.g., magic), be resisted, and may also be misunderstood. Innovation may be perceived by some as risky to healthcare while others may see it as the panacea for current challenges. In this section, innovation will be clearly defined and measurable for those reading along. By the end of the chapter, one will be confident in knowing that innovation can be taught. One can learn to innovate, be innovative, and develop an innovation for nursing and healthcare at large. The terms *innovation*, *nursing innovation*, and *healthcare innovation* are defined in this first section of the chapter.

Innovation is all around us in the marketplace, society, and how we interact with the world each day. Yet, it can be difficult to pinpoint innovation without a clear definition of the term. An *innovation* is often an outcome, but it can also be an action taken or process [3]. One can develop an innovation for use in the marketplace and society. One can also develop an innovative process for how something is done. Thus, the term can be used as a noun, adjective, and a verb. This chapter will primarily focus on innovation as an outcome.

**Innovation** *(defined)* is a new product, process, and/or service introduced into a marketplace or society that addresses an unmet need of a target population of people. This definition of innovation is purposely generic to apply to any industry. Innovations can be developed as new products, processes, and/or services.

*A* **product innovation** is often a tangible item. Something that takes a physical form. However, in the digital age, digital products are becoming more common. Product innovations may include *(but are not limited to)* the lightbulb, smartphone, or electric car. All three of these products were invented and innovated to address unmet needs of a population of people.

*A* **process innovation** is the way in which something happens or occurs. Process innovations may include *(but are not limited to)* step by step workflows and automated systems for how to do something. An example of a process innovation might be the adoption of mobile banking with digital photo deposits or video conferencing calls. While many are familiar with these process innovations today, they were not available in decades past. These process innovations changed the way in which people could complete their banking needs and/or complete their business needs.

*A* **service innovation** is something that is provided by a specialist to someone in need of that expertise. Service innovations may include *(but are not limited to)* the

*Advancing the Nursing Profession through Innovation DOI: http://dx.doi.org/10.5772/intechopen.110704*

internet, email, and delivery services (e.g., food, goods, medications and more). The internet and email provided a new service for how to access information and communicate with others. Delivery services provided a new service to allow items to be sent to the recipient instead of the recipient having to pick up at the corresponding store. These service innovations created new options for people to complete activities of interest or need.

These new innovations emerge to address an *unmet need* that is experienced by a target population of people. An unmet need is a recognized gap that is experienced when trying to reach a desired goal or outcome. Below two examples of unmet needs are shared with examples of available innovative solutions today.

### **2.1 Example one: hard boiled egg**

An example of an unmet need may be the desire to have a quick and easy way to peel a hard-boiled egg without making a mess and taking too much time. Peeling a hard-boiled egg often is frustrating to experience with little pieces of the shell breaking off as well as parts of the egg. An example of an innovative solution to this unmet need is the ability to purchase pre-peeled hard-boiled eggs (and avoid the egg peeling experience).

### **2.2 Example two: hanging a picture on the wall**

Another example of an unmet need may be the desire to hang a picture on the wall. One needs a tool to be able to have the picture displayed on the wall. A hammer may serve as that tool to meet that need with a nail. While a hammer is not an innovation today, there was a time when it did not exist. A more recent innovation that addresses this unmet need would be double-sided tape that is designed for hanging pictures on a wall. This is a more recent innovation that avoids the need for a hammer and nail.

For an innovation to be successful, there must be a *target population of people* who are served by the innovation and are looking for the solution to their unmet need. The target population should be more than one person or a few people. The more people that are affected by the unmet need, the greater the impact of the innovation. Therefore, when considering an unmet need, clearly define who represents the target population of people and how many people are part of that target population.

### **2.3 Nursing and healthcare innovation**

Now, the definition of innovation from above *(a new product, process and/ or service introduced into a marketplace or society that addresses an unmet need of a target population of people*) can be applied to nursing and healthcare innovation. However, there are some additions to that definition. Nursing innovation makes innovation more specific to the discipline of nursing. The American Nurses Association [2] defines nursing as "the protection, promotion, and optimization of health and abilities; prevention of illness and injury; facilitation of healing; alleviation of suffering through the diagnosis and treatment of human response; and advocacy in the care of individuals, families, groups, communities, and populations". The science of nursing is grounded in caring for others and delivering high quality care. As a result, the definition of *nursing innovation* can be refined as a

new product, process and/or service introduced into a marketplace or society that addresses an unmet need of a target population of people to support the delivery of quality nursing care.

Nursing innovations will also take on forms of new products, processes, and/or services. Some examples of nursing innovation products include the crash cart [4] and neonatal phototherapy [5]. A nursing innovation process example is the Wong-Baker Faces Pain Scale to evaluate pediatric pain [6]. Nursing innovation service examples include the American Red Cross [7] and the role of the Nurse Practitioner [8]. *(Section 3 describes several of these nursing innovations in more detail).*

Healthcare innovation has similarities to nursing innovation in definition. Healthcare is defined by the World Health Organization (WHO) as *"health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity"* [9]. With this guiding definition of healthcare and applying to innovation, *healthcare innovation* can be refined as a new product, process, and/or service introduced into a marketplace or society that addresses an unmet need of a target population of people to support optimal healthcare. Healthcare innovation incorporates nursing innovation into the scope and embraces the innovations of other healthcare disciplines *(e.g., medicine, pharmacy, allied health, and more)* and efforts.

Nursing and healthcare commonly rely on workarounds to address unmet needs that affect the ability to reach quality nursing and healthcare [10, 11]. Workarounds can take the form of products, processes, and/or services. Workarounds require innovative behaviors of others, but workarounds are not innovations. Workarounds are indicators of system, organizational, and/or societal unmet needs that need innovative solutions [10].

### **2.4 Theories of innovation**

To further understand the concept of innovation, one must also be aware of the prominent innovation theories. The prominent innovation theories are grounded in business, economics, and sociology (to name a few). The prominent innovation theories help us understand how to look at innovation and become better at creating new innovations that can be explained by innovation theories. Eight prominent theories and the associated theorist are listed below. An original source for each of the theorists is provided as a reference for the reader.

