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Shared Governance

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Shared Governance

Shared Governance is based on the principles of partnership, equity, accountability, and ownership, supporting the autonomy of practicing nurses and leading to empowerment.

Shared Governance

Shared Governance is based on the principles of partnership, equity, accountability, and ownership, supporting the autonomy of practicing nurses and leading to empowerment.

Overview

AU Health's Revitilization Journey

In late 2018, shared governance leaders recognized an opportunity to restructure shared governance and refine some of the existing processes to better empower our nurses to own their practice and to advance our organizational pursuit of nursing excellence.

We were fortunate to have Tim Porter O’Grady, a national expert in shared governance, as the guest speaker at the Professional Governance Forum held Friday, May 10, 2019 during Nurses Week. He shared a wealth of knowledge about shared governance and spoke on leadership essentials, all while entertaining a captive audience of shared governance members and leaders.

Key takeaways from his presentation regarding professional accountabilities and the core principles of shared governance were used to inform and guide the restructure and revitalization of shared governance at AU.

So why the need to Revitalize?

Periodically it is beneficial to review the effectiveness of the current structure to be sure both internal and external concerns of the profession are being addressed. It is also critical to analyze whether responses based on protocols and policy are appropriate based on the most recent evidence-based guidelines.

Reflection also leads to personal and professional growth. It is important to understand that meeting the standards does not indicate excellence. Standards are the foundation of good practice, reaching above the standard is excellence.

Professional Accountabilities

As a member of the nursing profession, you are accountable for:

  • PRACTICE: Delivering nursing care consistent with customary standards and expected procedures
  • QUALITY: The outcomes of the care you deliver
  • COMPETENCE: Ensuring you have the education, training and skills necessary to provide quality care
  • KNOWLEDGE: Contributing to the base of nursing knowledge including generation of new knowledge and application of current EBP

Members included representatives across the organization with a variety of experience in shared governance and spanned roles to include direct care nurses, ANMs, NMs and Directors. The Shared Governance revitalization steering committee:

  • Nadria Alicea, BSN, RN, CCRN, CPN Senior Staff Nurse, Pediatric ICU
  • Carla Allen, MSN, RN, RNC-OB Interim Nurse Manager, Perinatal Services
  • Carol Brody, MSN, RN, CNL, NE-BC Director Nursing Excellence, Nursing Administration
  • Sandra Clay, BSN, RN Nurse Manager, Medical ICU & 6 South Intermediate Care
  • Carrie Dellinger, MSN, RN, CMSRN, RN-BC Senior Staff Nurse, Shock Trauma
  • Jennifer Gillooly, BSN, RN, RNC-OBCharge Nurse, Perinatal Services
  • Debra Marranci, BS, ADN, RN, CAPA, CNOR Assistant Nurse Manager
  • Perianesthesia Shanna McBride, BSN, RN, CPN Senior Staff Nurse, Emergency Services
  • Kathryn Mathis, BSN, RN, CMSRN Assistant Nurse Manager, 4 West & 5 West
  • Damian Priessman, BSN, RN Nurse Manager, Shock Trauma & Surgical ICU
  • Noah Rees, MBA, PMP Operations Manager, Nursing Administration
  • Kim Sharkey, DNP, MBA, RN, NEA-BC Director, Cerner Magnet Advisory Program
  • Michael Somma, BSN, RN Staff Nurse, PACU
  • Lynne Wallom, DSN, RN-BC, NEA-BC Director Professional Practice, Quality & Education, Center for Nursing Education.

To address professional accountabilities the house-wide councils were designed as follows:

  • Practice Council- responsible for defining and controlling issues related to clinical practice. They are also responsible for monitoring the appropriateness and efficacy of care provided by the nursing staff while assessing and ensuring compliance with established standards of care and practice.
  • Quality Council- responsible for administering quality improvement plans for nursing through reviewing the Patient Care Services scorecard and identifying, prioritizing, and monitoring performance improvement initiatives.
  • Education Council- responsible for providing a forum to ensure educational standards are defined, implemented and maintained to promote professional growth, development and ongoing clinical competency.
  • Research Council- responsible for supporting the implementation of evidence-based practice through the generation, utilization and advancement of empirical knowledge while ensuring opportunities for staff to be mentored in their understanding, evaluation and conduct of research.
  • Operations Council- responsible for addressing the management and optimization of fiscal resources, material resources, human resources, staff support and organizational systems required to deliver quality patient care.

Practice Council

  • Developed and recruited members for two additional subcommittees, including: Nurse Peer Review Committee and Policy Committee
  • Refined Practice Council charter and developed new charters for the Policy Committee, the Nurse Peer Review Committee, and the Clinical Ladder Committee 
  • Organized and launched Nurse Peer Review program for nurses at AUMC in collaboration with Clinical Quality Excellence
  • Restructured policy review process to ensure policies, protocols and guidelines are reviewed in a standardized, efficient process, ensuring current evidenced-based practices are incorporated before documents are routed to senior leadership for approval
  • Integrated shared governance participation into the job description for nursing positions
  • Enhanced and streamlined several nursing processes:
    • Piloted a new Fall Prevention Program on several units and then adopted in the adult hospital and integrated into Powerchart
    • Amended catheter management policy to support specifically trained nurses in the Urology Clinic to remove specialized catheters
    • Updated multiple aspects of Powerchart to more accurately reflect nursing processes
    • Augmented I & O documentation to allow nurses to record percentage of meal consumed
    • Expanded perinatal charting to include fields for various types of inductions
    • Enhanced iView for easier charting
    • Improved specimen collection process and associated documentation to provide an easier way to sign off labs at the bedside.
  • Clinical Ladder Committee 
    • Revised Clinical Ladder Program requirements
    • Managed the application, submission and review process for biannual clinical ladder cycles

Quality Council

  • Improved the pain assessment documentation process which included pain reassessment documentation.
  • Collaborated with Nursing Informatics to address an issue regarding patient weight documentation and the process for nurses to have documentation corrected when entered in error.
  • Addressed opportunities for HAPI improvements and reinforced consistent use of the skin risk assessment upon admission and the subsequent use of Mepilex foam bordered dressings when indicated.
  • Assisted the Hospital Falls Prevention Committee with a trial of a Lap Belt in the ER and the use of the Falls Patient Agreement throughout the hospital.

Education Council

  • Collaborated with Dr. Brandy Gunsolus from the lab to address lab labeling errors. Developed a reference poster and distributed for use in units throughout the hospital to aid in decreasing specimen collection and lab labeling errors.
  • Partnered with Clinical Quality Excellence and reviewed SOS trends with Kim McGahee to identify education needs.
  • Applied for and received approval for the No Pass Zone class which was awarded 3 continuing education nursing contact hours.
  • Formed a Skills Fair subcommittee that recommended each unit develop their own skills fair catered to unit-specific needs.
  • Added a representative from the Education Council to the Patient Value Team to keep abreast of new products and product changes.
  • Reviewed and approved patient discharge instructions and uploaded to patient education section with EHR for easy access by nursing staff, including: atrial fibrillation, heart failure, and ENT surgery.
  • Administered annual nursing education needs assessment survey to inform annual nursing education plan.
  • Surveyed nursing staff to identify nurse certification review course to be offered in 2021.
  • Developed Coude catheter protocol and competency assessment and forwarded to the CAUTI Committee for approval.
  • Evaluated education resource needs at the unit-level. Developed a position description for unit-based educator and submitted recommendations for locations and FTEs.
  • Identified and communicated a need to revive the Preceptor Class. The Nursing Education department responded by scheduling Preceptor Training Classes

Research Council

  • Challenged all council members to complete CITI training
  • Reviewed and evaluated EBP models and voted to adopt the Johns Hopkins EBP model
  • Voted to also support use of the Iowa model by providing access to resources for nurses already familiar with and preferring use of Iowa
  • Sponsored multiple training sessions for hospital staff, each with 1.0 nursing education contact hour:
    • What is the Difference between EBP, Quality Improvement and Research? [two sessions offered: 2/10/2020 and 2/11/2020]
    • IRB Part 1 – Differentiation of Research and Review Types [11/16/2020]
    • IRB Part 2 – IRB Application Process from A to Z [11/23/2020]
    • Facilitation of the EMR for Research [11/18/2020]
    • Research: The Basics for Bedside Nurses [two sessions offered: 11/30/2020 and 12/4/2020]
  • Distributed communication about Center of Nursing Research monthly lunch seminar training sessions
  • Monitored and provided updates of IRB submissions with AUMC RNs as either PI or co-I
  • Published first quarterly Research Council newsletter November 2020
  • Developed Research & Innovations Scholars (RISP) fellowship program with plans to launch first cohort Spring/Summer 2021

Operations Council

  • Intrahospital Patient Transport Policy revised
  • Promoted use of Travel Nurse Competency Assessment to ensure consistent practice of travel nurses
  • Recruitment and Retention Committee:
    • Pulse Check Survey disseminated to Health System RNs
    • ADN to BSN Recruitment and Educational Assistance program developed and launched
    • Attendance Policy Revised
    • PTO Buyout approved at a rate of 100% in 2020
    • Collaborated with Human Resources to review pay for PCTs and Unit Clerks
    • Holiday Pay approved Christmas Eve, Christmas Day, New Year’s Day 2020
  • Special Events Committee
    • Collected over 12,000 pounds of food for Golden Harvest Food Bank
    • Delivered 900+ biscuits to nurses during Nurses Week for a pandemic-friendly celebration
    • Raised thousands of dollars through fundraisers to pay for multiple activities
    • Donated over $1,000 worth of toys/items for CHOG Child Life services
  • Recognition Committee
    • Revived DAISY Award winner presentations and nomination presentations; 21 DAISY Award winners selected across 2019 and 2020
    • DAISY Award nomination boxes added and/or replaced in several areas
    • Collaborated with Division of Communications and Marketing to develop electronic nomination and recognition campaign
    • Managed Annual Nursing Specialty Awards nomination and selection process for 2020 Nurses Week
    • Bee Award program developed for non-nurse team members
    • Daisy and Bee Award QR codes made available to patients and families
  • Communications Committee:
    • Information collected and collated for Nursing Biennial report for distribution in 2021
 

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