Data-Driven Clinical Improvement: Oncology Nurse Leaders’ Perceptions and Experiences of Organizational Data Reports

Abstract

Aim:

To elicit oncology nurse leaders’ perceptions and experiences of accessing, using, and interpreting report data at the unit level, and their suggestions for future reports.

Background:

Nurse leaders are expected to use data reports for decisions about unit-level operations, yet data may be inaccessible, unavailable, and lack relevance for improving patient care and unit-level outcomes.

Methods:

A purposeful sampling was used to recruit 12 unit-level nurse leaders. Qualitative data were collected through semi-structured interviews and analyzed using thematic content analysis.

Results:

Consistent themes included the lack of accurate, useful, and meaningful data specifically related to patient care. Accessibility Challenges, Limits to Applicability, and Suggestions for Improvement were the main themes.

Conclusion:

Nurse leaders require real-time data to effectively implement clinical interventions and practice changes for improving unit-level patient care.

Implications for Nursing Management:

Nurse leaders emphasized that their insight into the development of customizable reports is crucial for obtaining meaningful data relevant to the varied unit-level healthcare setting. Reports targeting unit-level outcomes would provide meaningful data to facilitate clinical improvement where patient care is provided. Improved reports increase the likelihood of their use and the potential for enhancing the quality and safe care outcomes.

1|. INTRODUCTION

In highly technical clinical oncology environments, key unit-level stakeholders are the nurse leaders. A nurse leader’s organizational role is to oversee complex, inpatient, ambulatory, and interventional patient care environments and use data to make decisions about performance management initiatives, monitor unit level clinical patient outcomes, and translate organizational performance goals and quality improvement to frontline staff(Brockway & Monturo, 2021; Jeffs, et al., 2015, Tidwell, 2016). Decisions influencing patient care in healthcare environments are data-driven, meaning that report-structures harness and enhance the plethora of utilization, satisfaction, and patient data to improve the quality and safety of health care and improve clinical outcomes (Cascini, 2021). Within data-driven organizations, nurse leaders are expected to leverage available information to manage unit-level operations and transform care (Jeffs et al 2015; Murphy et al., 2013). However, available report data may be lacking. Little is known about how nurse leaders use institutional reports or whether they find the valuable information for unit-level decision-making (Jeffs et al., 2015).

Although dashboards may be helpful to examine performance, these tools do not consider other aspects of quality of care. They may not help managers improve quality in terms of cost reductions, clinical effectiveness, patient safety, and satisfaction, (Buttigieg, 2017). Moreover, it is unknown whether nurse leaders had any input into current report development, or how they would envision future patient outcome reports. This study aimed to elicit the perceptions and experiences of oncology nurse leaders about available organizational data reports.

1.2|. BACKGROUND

This current study was conducted in the context of a larger project (Mazzella-Ebstein et al. 2021, Manuscript in development) involving healthcare providers who are oncology nurses, physicians, and nurse practitioners, along with patients who contribute unique perspectives on quality and safety patient outcomes through satisfaction surveys. (Hoff et al 2021, Lawton et al., 2015; Ma et al. 2018; Rahn, 2016; Stimpfl et al, 2019). The Quality Health Outcomes Model (Mitchell et al., 1998) guided this research and proposes dynamic inter-relationships between organizational structures, processes that involve health care delivery interventions, and patient outcomes. Data affecting specialty patient populations that nurses care for, such as oncology, are also significant (Thorp, 2020). Data associated with metrics (i.e., satisfaction surveys and nursing-sensitive indicators, and clinical outcome data) provide greater recognition of these interrelationships to improve care. In a large national cancer institute, this includes systematically collected survey data and clinical information from multiple sources. Reports gleaned from this data can vary, thus increasing the challenges for nurse leaders to effectively manage their units (Murphy et al, 2013).

This study explored the perceptions and experiences of using database-generated reports in a sample of oncology nurse leaders. Understanding nurse leaders’ insights for using organizational reports are fundamental for sustaining process improvement efforts based on relevant data and for facilitating unit-level interventions at the point where care is administered. Including nurse leaders in the development of data reports increase the likelihood that the reports will regularly be reviewed and thereby increase the potential for improving quality and safe care (Arnetz et al., 2015; Juran, 2019). The study’s outcome could highlight any limitations nurse leaders encounter when using data reports, which would provide the foundation for developing unit-level prototype reports aligned with improving patient care outcomes.

2|. METHODS

2.1|. Aim

The primary qualitative aim sought to understand how nurse leaders to access, interpret and potentially apply available data at the unit level.

2.2 |. Design, setting, and timeframe

A qualitative descriptive design was chosen for this study. Using semi-structured interviews conducted between October 1 and October 30, 2020, the aim was to elicit the nurse leader’s experiences and perceptions of unit-level reports at a comprehensive cancer institute in the northeastern United States. Individual interviews enabled the researchers to elicit in-depth information from nurse leaders about their perceptions and experiences of using data from available reports and the applicability of the data to their specific units.

2.3|. Sample

Nurse leaders were purposively sampled by unit and the organizational nursing division. The researchers aimed to capture a diversity of perspectives and balance across the organization’s network of inpatient, outpatient, critical care, and interventional units, as well as years of experience from the sample of nurse leaders (N=41). Interim nursing leaders were not included since they were temporarily assigned to the leadership role. Nurse leaders were recruited via an organizational email that briefly stated the study’s overview and the purpose of the interviews. Individuals who were interested in participating responded to the principal investigator (PI) by email and agreed to interviews through web-based teleconference applications due to social distancing concerns during the COVD-19 pandemic.

2.4 |. Participants

Thirteen nurse leaders responded to the study invitations (31% response rate) but 12 participated in a semi-structured interview. (Table 1)

Table 1:

Nurse Leader Participants and Experiences with Data Reports (N=12)

Unit Levels Main Campus	N	Regional Network	N
Inpatient	5	New York	2
Critical Care	2	New Jersey	2
Perioperative/Interventional	1
Experiences with Data Reports
Having some experience			42%
Had Some - Moderate experiences			8%
Had Moderate experiences			17%
Very experienced			33%

2.5 |. Data collection tools and process

The research team with expertise in both nursing and qualitative methods developed the semi-structured interview guide using a funnel approach (Roller, 2020), beginning with broad questions to elicit background and contextual characteristics related to participant experience, and subsequently narrowing to specific probing questions to obtain detailed feedback on unit-level reports. The interview guide was organized into four topics with increasing levels of specificity: 1) Description of the unit, including unique characteristics and the reports used to get information about their unit. 2) Experiences working with reports 3) Current barriers and challenges to working with reports 4) Future directions and suggestions for unit-level reports. The guide included the flexibility to ask additional, spontaneous probing questions to enable the participant to elaborate further (Creswell, 2014). The principal investigator, who is also a nurse, conducted the interviews. Before recording the interview, participants were asked to quantify their years of experience in the role and if their experiences with using data better equipped them when navigating the organization’s reports. These descriptive questions were meant to start a conversation about how the nurse leader learned to use reports. Novice nursing leaders’ perceptions or lack of learning experiences may differ for user reports. Those nurse leaders with more experience were asked to describe how they learned to use the reports to find meaning in them. (Table 1) All interviews lasted 30–60 minutes, were audio-recorded using an encrypted device and transcribed for analysis.

2.6 |. Ethical considerations

This study was approved by the organization’s Institutional Review Board (X19–054 A1). All participant responders provided verbal agreement to be audio-recorded during the interview and were notified when the recording was terminated. All transcripts were de-identified for specific contents from the participants’ statements and references to the individual units were hidden to protect the anonymity of the responders. All interviews were voluntary, and the participants had the right to terminate the interview at any time without influence on their employment.

2.7 |. Data analysis

All audio-taped interviews were conducted and transcribed verbatim in English. The transcripts were analyzed according to an independent and collaborative process of Thematic Content Analysis TCA (Anderson, 2007) and used coding to develop themes and subthemes that present the context related to the research objective (Creswell, 2014; Saldana, 2009). This method was used to create meaning by summarizing themes and subthemes from complex raw data derived from interview transcripts. The analysis was conducted by the principal and co-investigators in this study. Two forms of codes were used: an a priori set of codes that were derived from the key ideas we are seeking to understand (e.g. barriers, current habits), and a set of inductive codes that emerge from the data themselves. A data dictionary was developed that included all codes, their definitions, and decision rules for applying the code. (Saldana, 2009)

The first phase of TCA involved independently coding all transcripts. In the second phase, the team sorted the coded data into categories to identify key themes within each interview topic. Two team members independently reviewed the data within each category. The emerging themes were discussed by the research team and qualitative specialist to ensure agreement and enhance the study’s rigor. Global themes were identified and summarized across the domains. In this study, we found thematic saturation after 12 interviews(Bowen, 2008; Guest 2006).

2.8 |. Validity and reliability

The consolidated criteria for reporting qualitative research (COREQ; Tong et al., 2007) were used when planning this study. To clarify participants’ statements during interviews, the interviewers restated the responses and asked for confirmation from the participant related to the perspective and meaning of their statements. Themes and sub-themes were constructed based on the verbal responses from the participants. Data was presented to all five team members who met to reach a consensus on primary thematic content.

3 |. RESULTS

Overall, nurse leaders noted a lack of accurate, useful, and meaningful data that is specifically related to unit-level patient care. This feedback emerged from three major themes: Accessibility Challenges, Limits to Applicability, and Suggestions for Improvement. Each theme contained various subthemes and is described in Table 2.

Table 2:

The main themes and subthemes from qualitative data

Themes	Subthemes
1. Accessibility Challenges	1.1 |Reporting differences 1.2 |Data is multi-sourced 1.3 |Inconsistent location and timing
2. Limits to Applicability	2.1 |Data reports are not user-friendly 2.2 |Lack of meaningful data 2.3 |Obstacles, barriers, and technical issues
3. Suggestions for Improvement	3.1 |Interventions for addressing report variances 3.2 |Limits of patient satisfaction reports 3.3 |Limited staff engagement metrics and reports

4 |. THEME 1: ACCESSIBILITY CHALLENGES

The accessibility theme encompasses the information about reports available to the nurse leaders. Analysis revealed three sub-themes: Reporting Differences, Data is Multi-Sourced and Inconsistent Location and Timing of reports. (Table 3)

Table 3:

Accessibility Challenges

Sub Themes	Codes	Descriptive	Sample Responses
Reporting differences	Nursing units have unique report type needs	Inpatient reports target equipment, compliance, and staff training	“(As a regional facility) our unit is unlike (other units) at Main Campus … we see every type of (oncology) disease… so the nurses (are exposed to) see a little bit of everything (R10)
		Reports do not meet critical care needs	“Our unit is unique, and no one knows where we fit…this adds to the kind of complexity (in understanding) the patient population.” (R1)
		The one-size-fits-all report are not beneficial for all nursing units (main and regional networks)	“I wish there was more extravasation data. I can count how many telephone calls (nurses) make but I cannot measure the work (in terms of documentation) of preparing patients for a procedure. I want to have a metric that measures that work, and how it impacts the patients.” (R12)
		Units have a mixed focus	“Nursing assessment documentation is overwhelming. I asked for (the data from the assessments) to become a dashboard… (currently) it is a manual monthly report” (R5)
Multiple sources for available data	Reports provided in various forms	Dashboards have data in one place	“Tableau (type of dashboard) can be helpful to quantify the amount of work and the volume (of work) that nursing provides” (R5)
		Multi-sourced data is hard to manage	“Reports are coming from all over the place (emanate from different sources- dashboards, and periodic emails) … you have to mine through (sort through the data) … to see what is important” (R12)
Inconsistent location and timing of reports	Reports are not in-sync with unit needs	Reports not generated timely	“It takes (several) months to get the data… I feel we are …trying different initiatives, and we do not know what is going to work” (R7)
		Regulatory reports are consistently available	“I prefer to have this report (medication reconciliation report) daily because it refers to medication safety… I’m appreciative …that it does come out first thing in the morning… when I…start my day I can look at it (reports) quickly and see if anything is going on. (R9)
	Old data	Difficulty in making decisions and effecting change based on old data	“If we are trying to make changes to practice and outcomes, ( i.e. patient falls ) we can …go back to the nurses that cared for that patient during that (timely report) timeframe …and ask what was going on with the patient? But trying to do this retrospectively, is a bit harder” (R8)

4.1 |. Subtheme: Reporting differences

The nurse leaders described how organizational reports differ between inpatient and critical care units, and reports used by the ambulatory regional networks. Inpatient unit nurse leaders found that reports focused on equipment, regulatory compliance, and staff training. By contrast, nurse leaders in the regional networks commented that the staff sees all services but is not associated with cost centers like the main campus rendering current disseminated reports limiting. Regional reports involve patient volumes and efficiency for all of the individual units at the regional facility as a whole and do not specifically include patient-reported outcomes for any unit or service groups. Nurse leaders of highly specialized critical care units reported that the available data do not provide information that is relevant to the ‘uniqueness’ of the unit and attribute these perceptions to the report developers not fully understanding where the unit ‘fits’ in terms of the report structures. Nurse leaders felt that there were no data reports that specifically reflected their patient population and as a consequence, they resort to manually filtering current reports to obtain relevant unit-level information.

The regional network nurse leaders identified the reporting differences from the main campus- one size does not fill all units. They perceive being disadvantaged since regional facilities get reports structured for main campus users. Regional nurse leaders get reports that include all unit cost centers and are not filterable to those cost centers under one nurse leader. The regional clinical practices have special needs that could be missed or overlooked in the current report structure and underscore the influence on patient outcomes.

Although inpatient and outpatient nurse leaders use the patient satisfaction survey data for unit-specific information, the regional nurse leaders found reports challenging since the information involves the entire facility. Regional sites are a mix of various clinical practices and procedure units and as several leaders pointed out, are focused on patient volumes, efficiency, wait time, workflows and would like additional reports focused on the outcomes of patient care. As such, the data is not unit-specific and thus not meant for all groups.

4.2 |. Subtheme: Data is multi-sourced

Data are available in several forms. There are standard compliance reports, such as narcotics and medication reconciliation reports, which are associated with regulatory compliance and provide unit-level information on a monthly or quarterly basis. There are dashboards (i.e., Tableau) that provide large-scale data reporting that can be accessed by the nurse leaders through the organization’s intranet and is in one place. Nurse leaders voiced concerns that reports are generated from multiple sources and contain large amounts of data. Nurse leaders reported expending a lot of time filtering and sorting the information to get meaningful unit-level data.

4.3 |. Subtheme: Inconsistent location and timing

The participants also found that the timeframes for reports are not in-sync and nurse leaders use data from several reports and datasets for information. However, nurse leaders reported that regulatory reports have specific purposes, are consistently sent at the same time, and provide immediate information. Another concern was getting retrospective data about a patient outcome to develop interventions to improve care. Nurse leaders were frustrated by using old data.

5 |. THEME 2: LIMITS TO APPLICABILITY

The applicability theme emerged from concerns about the lack of reports and missing data from available reports. Four sub-themes were identified from the analysis: Data Reports Not User-Friendly; Lack of Meaningful Data, Obstacles, Barriers, and Technical Issues. (Table 4)

Table 4:

Limits to Applicability

Sub Themes	Codes	Descriptive	Sample Responses
Data reports are not user friendly	Data reports are not filterable for unit-level use	Data needs to be manually teased out	“Current patient satisfaction reports are difficult to navigate. Regional satisfaction reports are presented for the facility. In all of the metrics(available data reports), a lot of what is reported is not specific to the unit and you have to pull things and tease things out and get to the part that is specific to (unit-level) nursing.” (R12)
		Filtering options not available	“I would like a dashboard to look more like a report … that I can drill down (filter or customize the report) to get meaningful data.” (R13)
Lack of Meaningful Data	Reports lack information specific to inpatient units	Acuity is not reported and may influence nursing care hours	“Instead of digging through data- …I think we need the whole picture…(about) the activity on the unit, … (for example) medications administered, and the rapid responses (medical codes). Nursing care hours would increase due to the complexity (R3)
	Data is available but not in a usable form	Nursing data is linked to monitoring systems, but reports cannot be generated	“If there were some way that for CIS data(Clinical Information Systems is electronic medical record data)- I could run a report on the current patients that are admitted to the unit and to see if they have a daily weight on this specific date, or what was the weight entered… currently we collect this data manually.” (R4)
Obstacles, Barriers, and Technical Issues	Reports are noisy, have a lot of extraneous data – a general purpose- appear fragmented	Reports do not consistently provide accurate and reproducible data	“The dashboards (- i.e. Tableau) have to be cleaned up a lot (for the data to be useful) (R2)
			“…Anything (data reports) in real-time…and could pull (sort, filter, customize) information from year to date is important… My pet peeve is… I do not think we should be issuing reports just to issue them; if they are not correct.” (R6)

5.1 |. Subtheme: Data reports are not user-friendly

The nursing leaders found that large datasets, dashboards, and emails with data are available, but are not a one-size-fits-all report or user-friendly. Data within reports require additional efforts by the nurse leader to obtain information related to their units’ operations, and applicable for use in developing interventions to improve unit-level patient care. Many leaders described drilling down into the dataset, which was not easily filterable to get meaningful data about their specific unit for decision-making. This theme was reported consistently by regional nurse leaders about using data reports that included data for all nursing units.

5.2 |. Subtheme: Lack of meaningful data

Nurse leaders did not think that all reports provided meaningful data. Patient acuity reports do not exist which could influence nursing care hours. Reports used at the main campus were more targeted and helpful versus the regional sites that receive the same large-scale data report. Nurse leaders described continually digging for relevant care information as time-consuming, not easily reproducible, and manually performed every time the leader wants updated information.

5.3 |. Subtheme: Obstacles, barriers, and technical issues

The nurse leaders iterated that reports are noisy and not congruent with unit-level initiatives. They explained that reports have a general purpose, contain a lot of extraneous data, and are not specific for their units, making the report appear fragmented or noisy. Nurse leaders described a need for improved accuracy of reports which would require less effort on their part to make the information meaningful. Also, the reports do not have filter settings so that nurse leaders can customize the reports for their unit setting, meaning that the filters have to be re-set every time the report is reproduced. Refining report functionality would improve the accuracy of the report and decision-making based on true data.

6 |. THEME 3: SUGGESTIONS FOR IMPROVEMENT

The third theme, Suggestions for Improvement, involves circumstances where the nurse leaders identified areas that could be improved through reporting metrics. Three subthemes were identified in the analysis: Interventions for Addressing Report Variances, Limits of Patient Satisfaction Data, and Limited Engagement Reports. (Table 5)

Table 5:

Suggestions for Improvement

Sub Themes	Codes	Descriptive	Sample Responses
Data sharing among nurse leaders	Interventions for Addressing Report Variances	Experienced nurse leaders can share using reports with novice nurse leaders	“I’m not very savvy with how (to obtain and use report) data. (Need to) empower a nurse (leader) to (understand reports) and what is meaningful about it? Also, the (reports) pull so much data or (there is) a lack of data that is not …congruent with what we are doing. (R10)
	Limits of patient satisfaction data	Applying data is a skill developed by nurse leaders	“Data is a patient and the things that we do affect the patient…I feel that people need to get off numbers and realize those numbers are patients’ lives.” (R6)
		Align reports with outcomes	“ Understanding patient quality of life would be an outcome. I think knowing more about (unit specific intervention), patient comfort with the education, and set up and use would be helpful” (R5) “ What might be helpful to improve practice …would impact patient satisfaction (R10) “…I want to run a report on the acuity levels (R3). “ Reports involving the current patients that are admitted to the floor and to see did they have a daily weight on this specific date or the weight.” (R7) “ …Real-time notification of patient CLABSI’s and other nurse-sensitive indicators (NSI) rather than NSI quarterly reports. It is difficult to investigate old data.” (R8) “ I want dashboards to be filterable for customizable reports I can run myself” (R13)
Current reports present old data	Limited Engagement reports	Concern for improving unit-level employee engagement	“I am used to this report (staff engagement reports) being done yearly. Would like a staff survey, …more frequently than it is…not just for their satisfaction but, but do they feel that they work …as a team?” (R1)

6.1 |. Interventions for addressing report variances

The nurse leaders reported that it is advantageous for nursing leaders who are experienced with using reports to share information with other leaders at future workshops or meetings. Over time, the various reports could apply to more than one unit or be modified to facilitate future reports needed for groups of leaders with similar patient care units and services.

6.2 |. Subtheme: Limits of patient satisfaction data

Patient satisfaction was important for all nurse leaders who reported that patient data in numbers are ‘people’ and need to understand what those numbers mean (Jeffs et al., 2015). Nurse leaders want to see a patient’s quality of life outcomes resulting from nursing interventions, i.e., patient comfort with education and discharge, and which nursing practices improved their satisfaction with care. Another nurse leader suggested that the many nursing assessments should be accessible on dashboards rather than manually extracted. Another leader identified that patient acuity reports, and data from the medical record, i.e., summaries of all admitted and recently admitted patients with vital signs, weights, diagnosis, etc., would help nurse leaders get real-time data of their unit.

6.3 |. Subtheme: Limited staff engagement metrics and reports

The nurse leaders expressed that current engagement reports only provide old, irrelevant data. Nurse leaders want frequent and current information for keeping their staff engaged. The Nurse leaders also voiced deep concern for improving not only patient outcomes but for supporting the emotional well-being of staff, nursing workload, and efficiency. Consistently stated, the nurse leaders found that specific reports about the health of one’s unit were helpful for the inpatient leaders, but similar information was lacking for the regional site nurse leaders. The nurse leaders suggested that future research would involve metrics related to the psychosocial needs of the clinical staff to inform the development of interventions for supporting their emotional wellbeing.

7 |. DISCUSSION

This study explored and described nurse leader nurse leaders’ perceptions and experiences of database-generated reports to provide the foundation for developing unit-level prototype reports for improving clinical outcomes of care in the United States. The nursing leaders discussed how they access and modify data reports but consistently reported more challenges and limitations with relating the data to unit operations. These findings mirror those of a recent study involving the use of electronic health data, reporting that the end-users are key communication integrators for identifying the quality of extracted data in reports and applying the data to practice. (Hausvik et al., 2021). The nurse leaders highlighted a need for real-time data to effectively make decisions about performance management and monitor patient outcomes specific to their patient populations (Jeffs et al., 2014; 2015). Recent evidence reveals that nurse leaders may be lacking cognitive and informational support that captures nursing operations and thus warrants the development of intuitive and useful reports to meet the information needs (Salehi, 2021).

Consistent themes highlighted that data presented in dashboards and other largescale reports have some modifiable functionality. However, they are not intuitively filterable or customizable, user-friendly, or accurate, and consume time and effort to gain meaningful and useful information for their specific unit. This finding was further described as difficult for regional nurse leaders compared to those on the main campus. Regional nurse leaders explained that standard reports are not a ‘one-size-fits-all’ but could be better if the functionality was improved and located in one place.

Nurse leaders articulated the positive use of regulatory, compliance, and staff reports that are used to facilitate daily unit-specific activities, yet none provided patient acuity status. The data in regulatory reports only highlight dates and timestamps for tasks but do not provide the total picture of the event. The standard reports were perceived more favorably by nurses from inpatient units compared to leaders from regional sites that receive reports for the whole facility and are not unit specific. Though current dashboards were described as cumbersome for the nurse leaders, the premise of the dashboard and other large-scale reports assists the nursing leaders in obtaining some relevant, unit-specific data. These findings were replicated from an earlier study of nursing leaders in other organizations in support of dashboards as a positive strategy for monitoring unit performance and developing interventions to improve care.(Jeffs et al., 2014) Another study interviewing oncology nurse managers revealed nurses’ personal characteristics, such as fear of blame and punitive measures, are a barrier to accurate reporting of missed care events (Dehghan-Nayeri, 2018).

A major theme among the nurse leaders in this study was the lack of accurate, useful, and meaningful data that is specifically related to patient care. Data from large data sources and reports were defined as ‘noisy’ by the nurse leaders and required ‘finessing’ to get accurate, meaningful results applicable to unit-level needs. Reports lacking the functionality for filtering and modifying standard reports, added to the overwhelming workload of the nurse leader (Brockway et al., 2021) to reproduce the reports which could lead to inaccurate information and limited ability to develop unit-level strategies for improving patient care (Jeffs et al., 2018). Several nurse leaders, new to the role, addressed their lack of experience with using data reports and an understanding of how to use the available reports for their unit. They felt daunted by organizational reports and recommended collaborating with more experienced nurse leaders to better understand the reporting structures and how to use them in real-time. In turn, other experienced nurse leaders suggested that their experiences and creativity with customizing and applying data in their units could be useful for other nursing leaders in similar unit types. New nurse leader nurse leaders felt that data-sharing with other organizational nursing leaders would empower them to make better decisions in their units (Hughes et al., 2015).

The nurse leaders also identified a need for metrics related to the psychosocial needs of the clinical staff to inform the development of interventions for supporting their emotional wellbeing. However, augmenting current organizational structures and testing their value in real-time unit-level operations could be challenging. This is consistent with another study that found further research is needed on nurses’ psychological empowerment (Bogaert, 2016).

The strengths of this study are the candid interviews with key nurse leaders’ nurse leaders that contain deep content and the effort required to create meaningful data from available reports. The purposeful sample of nurse leaders underscored differences and applications of report structures from all areas of the organizational continuum. Participants were free to describe their experiences and perceptions of the current reporting structures in a comfortable and safe virtual environment. There is limited qualitative evidence, evidenced by the older studies used for this study, describing the nurse leader’s perceptions and experiences of using organization reports. However, this study’s findings emphasize the importance of nurse leaders as critical stakeholders in organizational reporting structures and imply a greater need for improved data reports to ensure smooth transitions of care based on appropriate usage of metric data in unit-level patient care units.

This qualitative study found thematic saturation in a sample of 12 nurse leaders who may have strong positive or negative experiences with reporting and consent for an interview, creating selection bias. Unit-level reporting structures vary between hospitals and the experiences and perceptions of unit-level reports were limited to one organization. As a comprehensive cancer facility, the recommendations from the nurse leaders target changes for improving oncology unit-level data reports. However, the data reports discussed in these interviews are used by nurse leaders nationwide. Therefore, we are confident that study findings can inform the enhancement of reports used in unit-level decision-making for improving clinical outcomes.

8 |. CONCLUSION

This qualitative study sheds light on nurse leaders’ experiences with accessing available data reports and the consistent challenges and effort of curating the report data before they could use it. The nurse leaders commented more about the limitations related to the data reports which implicitly suggest constraints to the applicability of the data to make clinical decisions within their unit setting. These nurse leaders demonstrated extraordinary skills as strategic leaders and thinkers; their feedback will be a critical component for developing data structures to inform future reports aligned with outcomes of unit-level patient care.

9 |. IMPLICATIONS FOR NURSING MANAGEMENT

Nurse leaders emphasized the need for developing customizable unit-level prototype reports that target unit-specific outcomes of the inpatient, outpatient, and critical care settings The nurse leaders reported that the organization is data-driven and patient outcome-oriented. They articulated that aligning report structures with unit-level outcomes would provide them with the necessary tools to effect change at the unit level where patient care is provided. Moreover, nursing leaders want to be included in the development of structured reports which will in turn increase the likelihood that information will be used to inform unit-level interventions to maintain staff engagement, and patient satisfaction to improve the safe delivery of quality oncology patients care.