Hahnemann University Hospital in Philadelphia recently initiated a shared governance model, and we at the bedside are feeling its effects. After 28 years of nursing, I’m given the respect, admiration, and support I need to improve patient satisfaction and outcomes.
Judith Chabot, BSN, CCRN, director of professional development at Hahnemann, says shared governance is “our organizational structure in which clinical nurses have a voice in the determination of nursing practice, standards, and quality of care.” The bedside nurses are first engagers the first to the table with innovations. The manager’s role is now one of facilitation, coordination, and support. The manager assists the bedside nurse in changing practice to better care for the needs of the patient.
Unit shared governance
Using the guidelines of shared governance, I drew up a petition to change the floating policy for our LPN, Trish Lawlor, and circulated it among the unit staff. The petition stated that Lawlor be excluded from floating to the full-term nursery because she was already floating throughout the hospital as per her LPN contract. RNs in the neonatal intensive care unit float only to the full-term nursery. I noticed the strain floating to all the floors was putting on Lawlor and put my concern into action.
The petition was successful, and our unit floating policy was permanently changed in favor of Lawlor. Peggy White, RN, BSN, CEN, unit director, supported our initiative wholeheartedly. We were able to rally around our peer to support, nurture, and advocate for her.
When shared governance came to our unit, the bedside nurses formed four committees: education, professional practice, scheduling, and patient/employee satisfaction. The nurses would run the committees and drive practice on the unit.
Those of us on the Professional Practice Committee ran a “Performance Improvement Project,” which documents present practice and proves a need for change. Our goal is to have a nursing assistant on duty from 7 a.m. to 11 p.m. daily. We believe this change will improve patient and family satisfaction and keep the nurses at the bedside.
To prove this need, the committee asked all unit bedside nurses to document every activity performed that was considered a nursing assistant’s function. The results of the nine-day period were tallied on a graph. The graph showed that nurses performed between 52 and 181 nursing assistant tasks per day, taking us away from nursing care at the bedside. I presented this data to White, who will take it to the advisory council for consideration.
As a member of the Education Committee, I initiated the Journal Club. We highlight one nursing article a month and run informal discussion sessions on the unit during all shifts. Through these up-to-date articles, we explore new ways of implementing the latest research into nursing practice.Deborah Davis, RN, BSN; Trish Lawlor, LPN; Director Peggy White, RN, BSN, CEN; and Beth Smith, RN, BSN
All the way to the top
At the next level of shared governance are five councils made up of staff nurses, managers, and staff eduation personnel from around the hospital. The councils are education, quality, diversity, research, and practice. The Research Council recently completed a study of blocked gastric tubes, or G tubes, on adult units and discovered best practices for unblocking them. Viokase was found to be the most efficient agent to use when warm-water irrigations fail to unblock the tube. The Research Council shared its findings with the Practice Council, which revised the hospital’s feeding-tube policy. This revised policy went to the Education Council, which will disseminate it to the staff.
At the top of the nursing hierarchy is the Executive Council. This council includes the chief nursing officer, Stephanie Conners, RN, MBA; the four nursing directors; a member of Drexel University school of nursing; Chabot; and a bedside nurse. The chairs of the five councils attend Executive Council meetings to share their councils’ monthly findings and recommendations. It is exciting to see administration and staff working together with the common goal of providing the tools and support the bedside nurses need to perform their duties the best they can.
As a bedside nurse, I love being on the front lines. I love coordinating the care of my patients with all other disciplines to promote the best outcomes.
Now at Hahnemann, I have a voice in how our unit can be run to promote the best care possible for our beloved newborns. My work matters, and I can go home at night knowing I have made a difference.