Dynamic Leadership for Shared Governance Follow Up Materials June 14 15, 2018 Pittsburgh, PA

Transcription

1 Dynamic Leadership for Shared Governance Follow Up Materials June 14 15, 2018 Pittsburgh, PA CE Certificate Presentation Book Poster Presentations 5SE: Advancing our Future by Building on our Past Abbey Fabian, RN, Nationally Certified Medical Surgical Nursing, Froedtert and the Medical College of Wisconsin About Face: Whole System Focus Shared Governance Redesign Kathleen Bradley, DNP, RN, NEA BC, Executive Director, Center for Professional Excellence & Inquiry, Lucile Salter Packard Children's Hospital Stanford Jennifer Vargas, RN, BSN, RN BC, Clinical Nurse, Lucile Salter Packard Children's Hospital Stanford Developing an Evidence Based Practice Project Pathway for Unit Based Councils Leslie Wood, BSN, RN, ONC, Chair Elect, Nursing Professional Care Council, Lakeland Regional Health Kathy Hunt, BSN, RN, ONC, Director, Professional Nursing Practice, Lakeland Regional Health Engaging, Empowering, and Elevating Clinical Nurses Through Shared Governance Joy Parchment, PhD, RN, NE BC, Director, Nursing Strategy Implementation & Magnet Program, Corporate Nursing Administration, Orlando Health Nadine Garcia, BSN, RN, Program Manager for Nursing and Special Projects, Orlando Health Maryam Hemmali, MBA, BSN, RN ONC, Registered Nurse, Orlando Health

2 Home Care Nurses at the Bedside Improve Satisfaction and Safety Michelle Hiidel, RN, Regional Nurse Manager, Pentec Health Cheryl Mann, RN, Regional Nurse Manager, Pentec Health Implementing Shared Governance in an Integrated Healthcare System Sherry Burg, Director, Critical Care and Trauma Services, Altru Health System Jeanine Senti, Perinatal Clinical Nurse Specialist, Altru Health System Making the Connection...with each other, professional practice and technology Christina Eliason, RN, Registered Nurse, Hospital Float, Gundersen Health System Mara May, RN, Registered Nurse, Hospital Neuroscience, Gundersen Health System Navigating the Night Shift; Shared Governance at Work Karen Murray, RN, ADN, CCRN, Registered Nurse, Pediatric ICU, Children's Mercy Hospital Operationalizing the Shared Governance Structure Andrea Polach, BSN, RN, CPN, Nurse Manager, Phoenix Children's Hospital Connie Ford, BSN, RN, CPN, Manager, Professional Practice, Phoenix Children's Hospital Shared Governance: Large to Small You Can Make It Work Melanie Elsky, Director of Care Delivery, Baptist Health Sheila Savage, Clinical Educator, Baptist Health Starting a shared governance council: just keep swimming, just keep swimming Cassie Peacock, RN, Registered Nurse, West Florida Hospital

3 The American Organization of Nurse Executives CONTINUING EDUCATION CERTIFICATE Program: Dynamic Leadership for Shared Governance Date: June 14 15, 2018 Place: Provider: Omni William Penn 530 William Penn Pl, Pittsburgh, PA American Organization of Nurse Executives (AONE) 155 N. Wacker Drive, Suite 400 Chicago, IL This is to certify that: has attended and completed a continuing professional education program and earned a total of 14.0 Continuing Education Contact Hours. The American Organization of Nurse Executives (AONE) is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center s Commission on Accreditation. The American Organization of Nurse Executives is authorized to award 14.0 hours of pre approved ACHE Qualified Education credit (non ACHE) for this program toward advancement, or recertification in the American College of Healthcare Executives.

4 Dynamic Leadership for Shared Governance June 14-15, 2018 Pittsburgh, PA

5 Dynamic Leadership for Shared Governance June 14 15, 2018 Pittsburgh, PA 8:00am 12pm Thursday, June 14, 2018 Inspire. Engage.Transform: Introduction to Shared Governance The Value of Perspectives Beverly Hancock Beverly Hancock Why is dynamic leadership in shared governance so important? Tim Porter O Grady 12 1pm Lunch 1 4:30pm Why is dynamic leadership so important? (continued) Tim Porter O Grady Shared Leadership: Circle leadership principles Beverly Hancock Friday, June 15, 2018 Influencing Culture Beverly Hancock 8:00am 12:00pm Structures supporting Shared Governance Leadership Roles and Shared Governance Rachel Start Marj Maurer Effective Communication Marj Maurer 12:00 1:00pm 1:00 4:15pm 4:15 4:30pm Lunch Transforming Outcomes Leading Problem Solving & Decision Making Putting it all together: Running Effective Meetings Closing/Check out Rachel Start Rachel Start Marj Maurer

6 AONE Dynamic Leadership in Shared Governance Impact Participants in this course have the opportunity to explore the structures, leadership skills and behaviors to lead effectively in a shared governance environment, equipping them to cultivate a professional practice environment. Faculty Beverly Hancock, DNP, RN-BC Dr. Beverly Hancock is the Director of Educational Programs for AONE. She is responsible for developing educational resources and programs for AONE for nurse leaders at all levels. In this role, she also oversees the AONE Annual Meeting. Prior to AONE she worked at Rush University Medical Center in Chicago, IL where she held a variety of clinical and administrative roles and was involved in shared governance for more than 25 years, beginning as a direct care nurse on the unit council. She was also the Magnet Program Director for Rush s initial three Magnet designations. She has presented widely and published on the topics of environments of excellence, leadership development and Magnet Recognition. She has her certification in Professional Development through the American Nurses Credentialing Center. Marjorie Maurer, RN, MSN, NEA-BC Marjorie Maurer is a Consultant and Leadership Coach with Xcellero Leadership Inc, located in Naperville, Illinois. She began her career in health care over 40 years ago, in psychiatric nursing and has held several progressive management and executive level positons throughout her career. Marj retired from the VP Operations/CNE at Advocate Good Samaritan Hospital located in Downers Grove, Illinois, July 2016 after 19 years. Under her leadership, Good Samaritan attained the ANCCs Magnet Designation in 2009 and redesignation again in Marj was instrumental with the organization s obtainment of the Gold Level Illinois Excellence Award and the prestigious National Malcolm Baldrige Organizational Quality Award in Marj is board certified as Nurse Executive Advanced, and has earned post graduate training in executive coaching and project management. Marj has presented on a variety of topics including Transformational Leadership, Building High Performing Professional Nursing Staff, and How to Develop High Performing Teams. She has also served on several boards including the Illinois Organization of Nurse Leaders where she served as President in 2010 and on the Illinois State Board of Nursing.

7 Faculty cont. Tim Porter-O'Grady, DM, EdD, ScD(h), APRN, FAAN, FACCWS (GCNS-BC, NEA-BC, CWCN, CFCN) Dr. Tim Porter-O Grady has been involved in health care for 43 years. He is noted for his work on shared governance models, clinical leadership, conflict, innovation, complex systems, and health futures. Tim is currently senior partner of an international healthcare consulting firm in Atlanta specializing in health futures, organizational innovation, conflict and change, as well as complex health service delivery models. Tim has published extensively in health care with over 175 professional journal articles and 22 books, including his seminal work Shared Governance for Nursing: A Creative Approach to Professional Accountability, and is an 8- time winner of the AJN Healthcare Book of the Year Award. He has consulted internationally with over 600 institutions and has lectured in over 1200 settings internationally. Among a number of honors, Tim has been recognized by American Organization of Nurse Executives with their Lifetime Achievement Award and by the American Nurses Association with the Luther Christman Award. Rachel Start, MS, RN Rachel Start is the Director of Ambulatory Nursing, Nursing Practice and Magnet Performance at Rush Oak Park Hospital near Chicago. In her role she empowers and oversees exemplary nursing practice for all nurses at her organization were she helped establish shared governance and led them to their first Magnet designation in She is a past president of the Professional Nursing Staff at Rush University Medical Center in Chicago and is on the board of the Forum for Shared Governance. Rachel was co-chair of the American Academy of Ambulatory Care Nursing (AAACN) Nurse Sensitive Indicator Taskforce and the lead editor on the Ambulatory Care Nurse-Sensitive Indicator Industry Report (2016). She is now a member of the AAACN/CALNOC Collaborative Steering Group to develop indicators for ambulatory nurses. She has represented AAACN as an advocate for advancing nursing practice in ambulatory at the ANCC Magnet Commission and the National Alliance for Quality Care. She has published and presented on the imperative for meaningful measurement and nursing practice advancement as related to the shifting healthcare landscape at numerous national venues. Disclosures Today s presenters do not have any relevant financial interests presenting a conflict of interest to disclose. This session awards 14 contact hours. To earn contact hours, participants must attend the entire session and complete the evaluation. The American Organization of Nurse Executives is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center s Commission on Accreditation.

8 Dynamic Leadership for Shared Governance Conference: Poster Presentations 5SE: Advancing our Future by Building on our Past Abbey Fabian, RN, Nationally Certified Medical Surgical Nursing, Froedtert and the Medical College of Wisconsin Developing an Evidence-Based Practice Project Pathway for Unit-Based Councils Leslie Wood, BSN, RN, ONC, Chair Elect, Nursing Professional Care Council, Lakeland Regional Health Kathy Hunt, BSN, RN, ONC, Director, Professional Nursing Practice, Lakeland Regional Health Engaging, Empowering, and Elevating Clinical Nurses Through Shared Governance Administration, Orlando Health Nadine Garcia, PhD, RN, NE-BC, Program Manager for Nursing and Special Projects, Orlando Health Maryam Hemmali, MBA, BSN, RN ONC, Registered Nurse, Orlando Health Home Care Nurses at the Bedside Improve Satisfaction and Safety Michelle Hiidel, RN, Regional Nurse Manager, Pentec Health Cheryl Mann, RN, Regional Nurse Manager, Pentec Health Implementing Shared Governance in an Integrated Healthcare System Sherry Burg, Director, Critical Care and Trauma Services, Altru Health System Jeanine Senti, Perinatal Clinical Nurse Specialist, Altru Health System Making the Connection...with each other, professional practice and technology Christina Eliason, RN, Registered Nurse, Hospital Float, Gundersen Health System Mara May, RN, Registered Nurse, Hospital Neuroscience, Gundersen Health System Navigating the Night Shift; Shared Governance at Work Karen Murray, RN, ADN, CCRN, Registered Nurse, Pediatric ICU, Children's Mercy Hospital Operationalizing the Shared Governance Structure Andrea Polach, BSN, RN, CPN, Nurse Manager, Phoenix Children's Hospital Connie Ford, BSN, RN, CPN, Manager, Professional Practice, Phoenix Children's Hospital Shared Governance: Large to Small You Can Make It Work Melanie Elsky, Director of Care Delivery, Baptist Health Sheila Savage, Clinical Educator, Baptist Health Starting a shared governance council: just keep swimming, just keep swimming Cassie Peacock, RN, Registered Nurse, West Florida Hospital

9 Welcome to AONE s Dynamic Leadership in Shared Governance Inspire Engage Transform Beverly Hancock

10 Patient Care in a Hierarchy Hierarchy Patient Centered Care

11 Hierarchy Shared/Professional Governance Used with permission from Cleveland Clinic Abu Dhabi

12 Shared/Professional Governance Professional Practice Environment

13 Structures Leadership Skills Leader Engaged Staff

14 Appreciative Inquiry Discovery Who is doing it well? In your organization? In this workshop? From the literature? Deliver Define the Topic Positively Dream Design What does that look like? What strengths do you already have that could help meet those ideals? 2014 AONE 1-2-Table-All What success have you seen in Shared Governance? (Who is doing it well you success or someone else) 1: Two minutes--individual reflection 2: Four minutes--share your ideas with the person next to you and together develop those ideas or come up with new ideas Table: Six minutes--share the best ideas with the table and develop those ideas/go deeper. Identify top ideas to share with the whole group. All: Share best ideas with the whole group

15 Offering our Perspective AONE What do you see? AONE

16 How many squares to you see? AONE What does this word mean to you? AONE

17 A New Age for Healthcare If you want to build a ship, don t drum up people to gather wood, saw it and nail the planks together. Instead, build in them a passionate desire for the sea. The Future of Professional Governance Professional Practice for the Future Tim Porter-O Grady, DM, EdD, ScD, APRN, FAAN, FACCWS

18 After 25 Years, What we Know: 5 Principles and the Critical Elements for Sustaining Professional Practice presented by: Tim Porter-O'Grady, DM, EdD, ScD(h), APRN, FAAN Validated Principles for Sustainable Professional Governance (The Non-negotiables and the foundations) 4

19 NEW RESOURCE FROM THE NATION S LEADING VISIONARIES Interdisciplinary Shared Governance Tim Porter-O Grady, DM, EdD, ScD, APRN, FAAN Call or Order From Amazon s Website: Or jbpub.com 5 Magnet Principles

20 Creating Sustainable Value Balancing the Value Equation Outcomes Quality Time Work = Value Cost Resources

21 Value-driven Practice Good infrastructure Fit process - outcome Know your user(s) Evidentiary Excellence Fiscal fit Knowledge capital Resource Value equation Engine Validation of value Partnership Care Ownership Integration Engagement Build Sustainable Value Establish floor for cause & effect goodness-of-fit System for measuring performance / outcomes Clear established protocols for best practice The ability to change practices quickly Drive new ideas for relevant solutions Lean/Hossen, etc. is a foundation, not ceiling

22 Lean and Hoshin Lay Foundations Many different approaches

23 13 14

24 15 Global Issues in Nursing & Health Care To be compassionate and caring professionals fully engaged in proudly serving humanity to honor God Compassion Accountable Respect Integrity Nurturing Giving Knowledge, Innovations & Improvements People Service Quality Finance Growth Community Empirical Outcomes Recruitment and Retention Patient Experience Clinical Practice Quality and Safety Policy and Procedure Informatics Education and Research Community Med Surg Critical Care Unit Based Practice Councils Facility Based Practice Councils Emergency Services Service Line Councils Perinatal Care Perioperative Care Rehab Shared Governance Steering Committee Nurse Executive Board Cardiology Telemetry Transformational Leadership Structural Empowerment Serving Humanity to Honor God July 23 rd, 2012

25 17 Professional: Definitions Mature profession (Magnet ) Not employee work group Professions are a social contract Greater than the workplace Personal obligation (person and profession are one) 1 8

26 Definition of Shared Governance Shared governance is a professional practice model, founded on the cornerstone principles of partnership, equity, accountability, and ownership that form a culturally sensitive and empowering framework, enabling sustainable and accountability-based decisions to support an interdisciplinary design for excellent patient care. 19 Laying the Foundations Equity Transition (Chaos) New Accountability Partnership Age Adaptation Ownership Driving Forces Socio-political Economic Technical

27 Principle 1: Decisions Its about making decisions Change IS a profession s work Professionals judge/decide/act Evidence-driven Purposeful Bylaws Clearly describe the professional model Outline authority for specific decision-making Define the professions relationship to the organization Distinguish between clinical and management authority for decision/action Enumerate the relationship of the professional organization to the institutional structure

28 PG Decision Cornerstone Right decision Right person(s) Right place Right time Right purpose Principle 1: PG Foundations Standardization is NOT excellence The clinical ladder is the vehicle for performance Demonstrate not regulate (evidentiary) This IS professional governance Must link to the organizational structure

29 Principle 2: Staff Driven Power of any profession is in its practice SG by expectation, not invitation Structure for sustainable behavior Driven at the unit/service level Principle 2: Staff Driven: Obligations of Membership Profession is a membership community Participation is a requisite of membership Participation is not an option for members Participation must be a part of the structure Participation in SG should be built into staffing

30 Principle 3: Accountability Essence at the core of profession governance Secured in roles by staff producing fit Facilitates partnerships for sharing decisions Accountability grid, (shared agreement) Often used interchangeably (wrongly) with 27 Accountability vs. Responsibility Accountability Outcome defined Self-described Embedded in roles Relies on partnership Evaluation shared Value in contributions Responsibility Relates to functions Delegated by another Dictates specific routine Isolates work and staff Evaluated by supervisor Tasks driven/focused 28

31 Accountability Characteristics Accountability and consequence A culture of accountability Accountability, structure, and impact 29 Accountability Elements Autonomy-the right to decide and act Authority-the power to decide and act Competence-the ability to decide and act 30

32 Principle 4: Locus of Control Management (context) Profession (content) Resource driven Practice-based Human Fiscal Quality/Evidence Materiel Competence Support Knowledge Systems 31 Principle 5: Managers are critical to success Focus on creating context Agent of the decision (both staff and management) Responsible for success of SG Develops staff leaders (mentors them, too) Helps staff evaluate/change/adapt Must live shared governance 32

33 Leadership Characteristics Enthusiastic Embracing / Modeling From Control to Engagement Learning SG roles/processes together Managing Context Guiding/facilitating skill, techniques, methods 33 Leadership & Power Old Power ( 20 th Century) Currency Held by few Downloads Command Leader-driven Closed New Power (21 st Century) Current Made by many Uploads Shares Peer-driven Open Figure 1 Jeremy Heimans

34 New Power Values Collaboration Participation Networked Governance Transparency Do It Ourselves Speed Fickle More Affirmative Jeremy Heimans Leadership & Accountability You are leading a profession not an employee work group

35 Don t Manage People Manage relationships Manage interactions Manage intersections New 21 st Century Leader Skills Quantum leader skills Willingness Setting the table (gathering) Tough love language Confronting dependencies Leading movement Storytelling the journey Transferring skills for practice Making the journey safe

36 New Language Of Leadership Vulnerability to the risks Approachable to others Intuition and good signpost-reading Empathy with passion and truth Care about the work of healthcare Skill-development not charisma Practice Coucil Basics Focus on standards of practice Factors affecting unit clinical work Control all practice decisions Define specific nursing role Impact on care and patient experience 40

37 Service Units and Team Accountability (Unit Council) Coordination NursingPractice Medical Administrative Interpretation & Application Standards of Practice Interdisciplinary Relationships Decision Processes Problem Solving Service Quality TEAMS Protocols Practices Relationships Partnerships Work Processes Magnet Clinical leaders CNS Nurses Physicians Providers Interdisciplinary Professional Governance Affirms centrality of Nursing Strengthens lateral decisions Build essential intersection for evidence Build ground of disciplinary contribution Integrates essential locus-of-control 42

38 Laying the Foundations Equity Transition (Chaos) New Accountability Partnership Age Adaptation Ownership Driving Forces Socio-political Economic Technical System Division/ Discipline Unit/Pointof-Service Frames for Locus of Control

39 System Interface & Intersection Whole Profession Generic Standards & Direction Sample System SG Coordinating Councils Coordinating Council AUTHORITY: aimplement system and strategic initiatives aset general policy frame for the profession acommunication and linkages at point of service, unit and system aprovides intersection with the clinical / administrative system

40 Executive and Senior Leaders Support for distributive decision-making Advocacy for profession and its decisions Translating strategy and performance to both staff and senior leaders of system Executive member of the Coordinating Council 47 Professional Governance Division/ Discipline Council structure Management Structure Decision-making Structure

41 Council Accountabilities Coordinate With: Generic Practice Standards Systems Interaction Policy / Directives Inter-council Conflicts Best Practices Framework Accountability Nursing Medical Administrative Community Associates Other disciplines FOCUS: Direction Evidence Decisions Systems Clinical Effectiveness Clinical leaders CNS Unit staff Associates Staff Nurses Service Units and Team/Individual Accountability Coordination Nursing Medical Administrative Standards of Practice Interdisciplinary Relationships Decision Processes Problem Solving Service Quality TEAMS Protocols Practices Relationships Partnerships Work Processes Clinical leaders CNS Nurses Physicians Accreditation Staff

42 Sample Council Structure: Practice, Education, Research, Quality and Management QA/EBP NE/RC NPC Core PG Councils NMC Division Managers Modeling willingness and support to make shared governance work Assure competence and support of first line leaders Guiding the development of specific managers Evaluating outcomes and impact of operations fit with staff and unit decisions 52

43 Unit-based Shared Governance Unit/Pointof-Service Practice Council Full Staff Engagement Individual Membership Accountability Unit Managers Modeling willingness and skills to make shared governance work Assure competence and good process of unit staff decision-making Presence and monitoring of unit council and staff role in decisions and actions Evaluating and guiding performance and impact of staff skills, decisions and actions 54

44 Professional Shared Governance: A Complex Responsive System Governance RN Councils RN Practice Quality Research Education RN TEAM TEAM RN Service/Unit Service/Unit Service/Unit RN TEAM Management

45

46

47 The End 62

48 Shared Leadership: Calling the Circle (C.Baldwin & A. Linnea) Beverly Hancock The Three Principles of Circle Leadership is rotating Responsibility is shared Reliance is on the spirit of the group: its clarified intention, common purpose or highest goals.

49 The Three Practices of Circle Attentive Listening Intentional Speaking Conscious Self Monitoring Setting Guidelines for the Group: what do we agree on? Collaborative process Each member safeguards, monitors and contributes to the purpose/intention of the meeting What behaviors would allow for that to happen? What is said in a circle belongs to that circle

50 Pay Attention to Group Dynamics Was something important said-- and heard? Are there underlying, challenging dynamics? Call for a pause The role of the guardian Practicing Circle Concepts Identify: Lead facilitator Talking piece (one person talks at a time) Guardian Open and close the circle with a check in and a check out During the circle: Review the agreements Follow the 3 practices,3 principles Make sure everyone has the opportunity to speak Monitor the time Guardian: Be aware of group process Call for a pause if needed

51 Reflective Questions for Developing the Leader Within 1. What do I like about my leadership style? Why? 2. What could I do on my unit right now that would excite/challenge me? 3. What is my least developed skill as a leader? What can I do to strengthen it? 4. What scares me about being in a leadership role? 5. If I could have any leadership job, what would it be? 6. Who is the most successful leader that I know? Why do I think that? How could I be like that?

52 INSERT COLOR PAPER

53 Influencing Culture: Being A Transformational Leader Beverly Hancock If your actions inspire others to dream more, learn more, do more and become more, you are a leader.

54 You are the Driver Leading with Vision Start with Why Why How What Simon Sinek Start with Why (2011) 2014 AONE

55 Vision What would it look like if shared governance functioned at its highest level? What impact would it have on: People Processes Outcomes Environments? 2014 AONE 5 Leadership Styles Transactional Responsive Works within organizational culture Make employees achieve organizational objectives through rewards and punishment Motivates followers by appealing to their own selfinterest Transformational Proactive Work to change organizational culture by implementing new ideas Motivate and empower employees to achieve company s objectives by appealing to higher ideals and moral values Motivate followers by encouraging them to transcend their own interests for those of the group

56 Transformational Leadership Leader has a vision Empowers others using: inspiration intellectual stimulation individual consideration Challenges and develops followers to be innovative and creative nurturing independent thinking If you want to build a ship, don't drum up people together to collect wood and don't assign them tasks and work, but rather teach them to long for the endless immensity of the sea Antoine de Saint Exupéry

57 Cultivating Culture: What can a leader do? Hire people that reflect the culture you are growing Communicate clearly; use language that reflects your culture Set a positive tone Know people s strengths and expertise--and use it Provide feedback

58 Foundational Structures for Professional Governance Rachel Start, MSN, RN, NE-BC Structure: Pick the vehicle that fits your organization best Whatever affects one directly, affects all indirectly. I can never be what I ought to be until you are what you ought to be. This is the interrelated structure of reality Martin Luther King

59 Defining Professional Governance Structure Structure that empowers the professional voice of nursing to manage discipline specific practice issues. (Kramer and Schmalenberg, 2002; Hess, 1995; Porter O Grady, 2003) What s in a Name? From Shared to Professional Governance

60 First Steps to Choosing Structure Inclusivity of every specialty voice involved in nursing practice Representation at the beginning stages sets your course towards good engagement down the road Do a thorough review of structures, both within and external to your organization Be educated and educate others to have this discussion Corporate Visioning- helps you choose what structure (or vehicle) you need to get you where you want to go Predominant Models of Professional Governance Structure Councilor Model Professional Model

61 Example of the Councilor Model Management Practice Coordinating Council Performance Improvement Coordinating council integrates decisions made by managers and staff in subcommittees. (Hess, 2004) Education Example of Professional Model [structured] after the medical staff model to support parity with physicians and good understanding within the organization of the role of the nursing shared governance structure. President of Nursing Professional Governance Organization Nursing Professional Governance Executive Committee/Structure Hospital Board of Trustees Chief Nursing Officer Nursing Administrative Leadership Meeting/Structure (Start, Wright, McIntosh, Murphy, Catrambone, 2013) Department Advisory Committees and Standing Committees Unit/Clinic Advisory Committees Inpatient, Outpatient and other Nursing Administrative Units

62 Your Structure from the Organization s Perspective Create a structure that is understandable across the organization and supports parity of decision making in ALL venues Board or Governing Body of Organization Nursing Professional Governance Structure Administrative Structure Medical Professional Governance Structure Essential Components to a Structure Nursing shared governance models have always focused on nurses controlling their professional practice. (Hess, 2004) Guiding Question: What committees do you need to effectively manage practice?

63 Alternative and Emerging Structures: Follow Same Principles System Professional Governance What are meaningful system decisions that need to be made? Who needs to be at this table for equity, partnership, ownership, accountability? Outpatient or Ambulatory Professional Governance Structures Many organizations cohorting similar office/outpatient populations as unit/clinic level committee and maintaining an overall practice committee level structure Sample Ambulatory Structure Overall Organization professional Governance Oversight Committee Evidence Based Practice and Research Department of Ambulatory Nursing Advisory Committee Adult Primary Care Committee Recognition Standing Practice Committees Clinic Advisory Committees Adult Specialty Care Committee Policy Education Pediatric Specialty Care Committee Pediatric Primary Care Committee

64 Essential Components to a Structure What committees do you need to do the following: Evaluate Practice Evaluate Quality of Nursing Care Provided Develop new Practice: Evidence Based, Research, etc Educate on Practice Recognize Good Practice Evaluate Resource utilization needed for Practice Oversight for Structure: Support health of professional governance structure and provide oversight for healthy culture Have specialty level practice areas manage practice improvement? Essential Components to a Structure Aside from standing committees, there must be a foundational level of committee(s) that is closest to the point of care. Standing committees must have representatives from the point of care that direct practice change that is most relevant.

65 Additional Support for Effective Committee Structure Bylaws- legal, binding and updated at regular intervals Time for meetings and officer/leader time Transparency Structures: Storage of information and minutes in general location Elections with good representation and term definition Templates for meetings help guide structure, goal setting and membership accountability Examples of Structures: Unit/Clinic Level Committee Charge Committee Purpose develop yearly pair with outcomes Committee Chair Meeting Frequency Meeting Time Meeting Location Agenda Setting Agenda Distribution Meeting Documentation Member Name Committee Charges Monthly Please specify Tbd Specify who prepares Agenda Specify who prepares Minutes Unit/Clinic Representing

66 Example Agenda: Learning the art of Practice Management Item Purpose Subject Leader (s) Time I Reflection II Review/Discuss Quality of patient care and nursing practice III Review/Discuss Education needs in practice areas IV Review/Discuss Evidence Based Projects and research V Review/Discuss Ongoing professional development in practice area VI Review/Discuss Financial Issues/Staffing VII Review/Discuss Recognition of excellence in area VIII Review/Discuss Magnet Issues/Needs IX Review/Discuss Peer Review X Review/Discuss Other Issues Exercise: Organizational Checkpoint Do you have an inclusive structure that allows for organizational nursing practice management? Reflecting on your current structure: What works well? Where are the gaps? What voices need structure for empowerment? Who needs to be educated about structure?

67 Beyond Professional Governance Committees Recognition of professional Governance Branded Look Advocacy and Education to outside groups/key stakeholders Incorporation of SG leaders in administrative or organizational decision making committees to represent Nursing SG practice perspective. What might this look like? Mentorship Growing leaders, setting staff up for success An autonomous nursing staff is feasible. It is professionally exciting. It cannot be done FOR nurses; it must be done BY them. Will nurses aspire to this level of professional development? -Luther Christman, PhD, RN, FAAN 1976

68 References Christman,L.(1976). The autonomous nursing staff in the hospital. Nursing Administration Quarterly, 1(1), Clavelle, J., Porter O Grady, T., Weston, M., Verran, J. (2016) Evolution of Structural Empowerment: Moving from Shared to Professional Governance. JONA. Vol 46: 6, pp Hess, R., (January 31, 2004). "From Bedside to Boardroom Nursing Shared Governance". Online Journal of Issues in Nursing. Vol. 9 No.1, Manuscript 1. Available: bleofcontents/volume92004/no1jan04/frombedsidetoboardroom.aspx McIntosh, Waskiewicz, Catrambone, Start. (2014) Sustaining a Shared Governance Organization. American Nurse Today. Mar 2014 Vol.9.No.3. Porter-O Grady, T. (2003). Researching shared governance. Journal of Nursing Administration, 33, Schmalenberg, Claudia, and Marlene Kramer. "Essentials of a productive nurse work environment." Nursing research 57.1 (2008): 2-13.

69 Leadership Roles and Shared Governance Marj Maurer A little about me: CNE at a large community hospital in western suburb of Chicago and part of the largest healthcare system in Illinois. Nursing not uniform across the organization. Variation across departments and shifts, some areas were strong, but overall nursing was mediocre at best. Low nursing satisfaction Low physician satisfaction with nursing Low patient satisfaction Average health outcomes. Very autocratic leadership. No advanced practice nurses available to the front line nurse None of the managers had their masters degree, and some, no degree at all.

70 A RADICAL DEPARTURE! Elevate the level of professional nursing practice Everywhere All shifts 7 days a week The direct care nurse will be the driver of professional practice What Will It Take To Move From Traditional hierarchal model to a relational partnership model Shared Governance

71 ..to a Professional Practice Environment? Nursing staff have authority over all nursing practice decisions Direct care nurses define unit-based operational processes Direct care nurses drive the structure of the Shared Governance process A coordinating direct care provider and management group provides guidance about issues affecting the department of nursing Management becomes servant leaders Grounded in clinical practice Implemented service-wide Treat people as if they were what they should be and you help them become what they are capable of becoming. Johann Wolfgang Von Goethe

72 Governing Together Shared Governance empowers nurses (other professionals) at every level to make decisions related to quality, practice and competence. Sit together at decision tables: direct care providers and administration (manager/cno) Uses principles of partnership, equity, accountability and ownership Goal: maximize teamwork and relationships and to share governing our profession as a whole Leaders will need to effectively involve others and elicit participation because tasks are complex and information is too widely distributed for leaders to solve problems on their own. Edgar Schein, former professor at the MIT Sloan School of Management, expert in organizational development

73 Creating a new future for health care through the creation of Shared Governance Change versus Transformation Change: doing or having something better or different than what already exists. Transformation: doing what isn t currently possible unless as a leader you change how you are being. Enrolling others The heart of change is in the emotions. Changing behavior is less a matter of giving people analysis to influence their thoughts than helping them to see a truth to influence their feelings. THE HEART OF CHANGE by John Kotter

74 Organizational transformation requires transformational leadership - Achieve breakthrough improvement versus incremental change. -Make happen what would not happen with out their leadership through engaging both the heart and the head. Transformational leaders - are first and foremost, truth tellers, and create an environment of trust!

75 If you could get all the people in an organization rowing in the same direction, you could dominate any industry, in any market, against any competition, at any time THE FIVE DYSFUNCTIONS OF A TEAM by Patrick Lencioni

76 TRUST ONE ANOTHER When team members are genuinely transparent and honest with one another, they are able to build vulnerability based trust. RESULTS ACCOUNTABILITY COMMITMENT CONFLICT TRUST ENGAGE IN CONFLICT AROUND IDEAS When there is trust, team members are able to engage in unfiltered, constructive debate of ideas. COMMIT TO DECISIONS When team member are able to offer opinions and debate ideas, they will be more likely to commit to decisions. HOLD ONE ANOTHER ACCOUNTABLE When everyone is committed to a clear plan of action, they will be more willing to hold one another accountable. FOCUS ON ACHIEVING COLLECTIVE RESULTS The ultimate goal of building great trust, healthy conflict, commitment, and accountability is one thing: the achievement of results. Foundational to Trust: Respect for Expertise Core to High Reliability Organizations is a Deference to expertise When seeking a solution ask the question Who is the expert in this area? What is the expertise of: Direct Care Provider Advanced practice nurses Manager Executive

77 How Leadership Looks in SG: CNO Create a supportive and empowering environment where others can make decisions Create an environment where the expectation is shared governance Hire with those expectations Role model empowered leadership and valuing direct care nurses input Provide needed resources---including data and information Mentor/coach Servant leader Creating the Environment There are two ways of being creative. One can sing and dance. Or one can create an environment in which singers and dancers can flourish. Warren G. Bennis

78 How Leadership Looks in SG: Manager Empower and equip direct care providers through facilitative leadership Listen and Advocate Mentor and coach, educate and support Develop council chairs and members Provide guidance regarding issues and projects Demonstrate respect for direct care givers Expect and value their opinion Support creative problem solving How Leadership Looks in SG: Manager Empower and equip direct care providers through facilitative leadership Create goals to accomplish to improve patient care Put into budget time for participation at professional conferences Separate peer review from performance reviews Create dashboards of metrics to measure nursing contributions to clinical and quality outcomes Post visibly on the unit Celebrate! Hire based on SG values

79 How Leadership Looks in SG: Direct Care Nurse Leadership Take ownership of professional practice Create a culture where nurses are consistently making practice decisions not just in meetings Engage key stakeholders Run effective meetings How Leadership Looks in SG: Direct Care Nurse Leadership Take ownership of professional practice Ongoing monitoring and assessment of practice Identify what should be brought to SG Set individual goals for what can be done to improve patient care for that unit; bring to peer review Participate in peer interviewing for effective hiring Be active participant in unit based SG activities

80 Putting it into Practice What structures or leadership roles/behaviors need to change to achieve a professional practice environment?

81 Effective Communication Marj Maurer We are in a relationship business!!! And effective communication is foundational to building and strengthening relationships.

82 ANA Social Policy statement defines nursing as this nursing is the diagnosis and treatment of the HUMAN RESPONSE to an actual or potential healthcare problem or need... Nurses enter into an almost sacred relationship with their patients. Effective communication is a requirement in assessing and addressing and meeting our patient s needs. Nurses are also part of the larger healthcare team and the communities where we work. Effective communication is necessary if we are to be a part of the dialogue to advance care.

83 Fundamental concepts of communication: -95% of communication is non-verbal (38% paralinguistic/ 57% body language) -Two levels of messages: manifest (spoken word) and latent (underlying meaning) -Both sender and receiver send simultaneous messages. Manifest and Latent messages -when congruent, the verbal matches the latent, message is clear, when incongruent, unclear as to the meaning and therefore, how to respond. If we believe that 95% of communication is nonverbal and we spend most of the time responding to the verbal manifest message and we are not addressing the latent or underlying meaning, we miss opportunities for better understanding and creating a shared pool of meaning.

84 Active Listening!! One non-verbal activity of communication is active listening. Deliberately paying attention to the non-verbal queues and having the courage to address them to have better clarity of meaning. Matching the mode of communication to the message. Need to consider the emotional load and the needs of the recipient/audience. least effective better most effective phone conversation face to face

85 Truth Telling As leaders connect back to purpose and the vision Leading in difficult times and delivering unpopular messages; leaders need to be truth tellers Encourage candid conversations and create a safe environment to address the issues; create a mechanism to give every nurse a voice Encourage use of the issue consideration form To instill hope and confidence in the collective wisdom of the nursing staff

86 Advocacy Definition: one who speaks or pleads for another Nurses are advocates for their patients Leaders are advocates for their staff to create the environment where they can perform the work of professional nursing So what does advocacy look like?? Courageous or Crucial Conversations Leaders must role model and coach front line staff. May want to consider offering professional development on the fundamentals of Crucial Conversations.

87 Leaders need to create a safe environment prepare to step out of the conversation look for mutual purpose and areas of agreement convey mutual respect apologize when appropriate verbalize togetherness, more alike than different Crucial conversation dialogue model: Understand that people respond to stress in two ways, through SILENCE, which includes behaviors of withdrawing, avoiding, or masking. Or through VIOLENCE, that includes behaviors that are controlling, labeling, or attacking. The objective is to try to create a safe environment where the individual feels safe, can enter into dialogue and thereby a shared pool of meaning can be created. Responding to the latent underlying emotions and maintaining ones own self control to not react, helps to move the conversation to an effective exchange.

88 Putting it all together As leaders we enroll and lead others through communication. Communication is the ACTION of leadership. Questions???

89 Transforming Outcomes Rachel Start, MSN, RN, NE-BC Leadership is not defined by the exercise of power but by the capacity to increase the sense of power among those led. The most essential work of a leader is to create more leaders -Mary Parker Follett 2

90 3 Healthcare Across the World: Being Willing to Lead Solution Making Understanding what is at stake- Looking at holistic picture and empowering the individual as well as the population: This is the Work of Nursing Better health enables children to learn and adults to earn. Gender equality is essential to the achievement of better health. Reducing poverty, hunger and environmental degradation positively influences, but also depends on, better health. (WHO, 2015)

91 Zeroing in on Our Biggest Opportunity: Chronic Diseases "Without action, almost 400 million people will die from chronic diseases in the next 10 years. Many of these deaths will occur prematurely, affecting families, communities and countries alike Premature deaths in countries like China, India and the Russian Federation are projected to cost billions of dollars over the next 10 years. -Dr. Catherine Le Galès-Camus, Assistant Director-General for Noncommunicable Diseases and Mental Health (WHO, 2015) The Big Picture: The Opportunity The United States spends far more on health care than other high-income countries...yet the U.S. population has poorer health than other countries. Poor access to primary care has contributed to inadequate prevention and management of chronic disease delayed diagnoses, incomplete adherence to treatments wasteful overuse of drugs and technologies and coordination and safety problems. (Schneider et al, 2017) 6

92 Big Picture: The Opportunity 7 (Schneider et al, 2017) Big Picture: The Opportunity 1. Healthy Lives 2. Access to Care 3. Health Care Quality 4. Efficiency 5. Equity 6. Health Care Spedning 7. Individuals with Chronic Conditions 8. Multiple illnesses combined with social complexities 9. Social Determinants of Health are low priority

93 The Key to Effective Transformation: Nursing Leadership in All Roles and All Settings Nurses must lead the transformation of healthcare in all settings (IOM, 2010). Patient populations and where they receive care is changing drastically (AAACN, 2017; AHA, 2015; IOM, 2010). Strengthening primary care service delivery is key to achieving Triple Aim- RNs are ideal team member to help expand primary care capacity. (Macy, 2016) Most trusted profession for 16 years (Gallup Organization, 2017) Our social contract with society demands that professional accountability constantly work towards health. (ANA, 2010) 9 What impact can Professional Governance have in all of this? Grow leaders Empower Top of Scope/License Practice Connect Nursing to Professional Accountability and Practice Management Problem solving and decision making Produce positive outcomes for patients and staff Improve interprofessional collaboration that has equally empowered voices from all disciplines

94 Hardwiring Outcomes In a world where nurses must lead and all healthcare disciplines must show impact and role in patient care, Outcomes are essential. 11 There are two possible outcomes: If the result confirms the hypothesis, then you ve made a measurement. If the result is contrary to the hypothesis, then you ve made a discovery. -Enrico Fermi In other words: You Can t Fail if you are Trying you will only Learn. 12

95 Exercise: Leveraging your Expertise But, what's the REAL ROI?????? 2 CNOs and 2 PG Leaders share stories of return on investment from professional governance Our Story: A Sobering Example ROPH in 2006: MSN: 0% BSN: 15% Certification: 0% Turnover: >24% Cauti: 9.2% Hapu: 24% Clabsi: 2.3% Staff Led Improvements Core Measure Compliance: 65-75% Readmission Rate: >25% ROPH Now: MSN: 14% BSN: 69% Certification: 42% Turnover: 7.8% Cauti: 0% Hapu:.76% Clabsi: 1.38% Core Measure Compliance: 100% ALL Readmission Rate: 7.3%

96 What outcomes would show your progress? Use of data Population Health metrics Community Outreach Metrics Nurse sensitive indicators/quality Improvement Measurement Engagement/satisfaction data Employee turnover/vacancy Certification/Education rates Research and Dissemination Professional Organization Involvement 15 Organizational Plan Nursing Strategic Plan and Annual Goals Departmental Goals Unit Goals Individual Goals 16

97 Setting Goals and Creating Ownership How can you assure accountability for outcomes? Hardwire outcomes Establish expectations Measure progress Build individual accountability Align behaviors with goals Communication Recognize and reward 18

98 It is not the critic who counts; not the man who points out how the strong man stumbles, or where the doer of deeds could have done them better. The credit belongs to the man who is actually in the arena, whose face is marred by dust and sweat and blood; who strives valiantly; who errs, who comes short again and again, because there is no effort without error and shortcoming; but who does actually strive to do the deeds; who knows great enthusiasms, the great devotions; who spends himself in a worthy cause; who at the best knows in the end the triumph of high achievement, and who at the worst, if he fails, at least fails while daring greatly. -Teddy Roosevelt, 1910

99 Effective Problem Solving & Decision Making Rachel Start, MSN, RN, NE-BC Decision Making Yes, leadership is about vision. But leadership is equally about creating a climate where the truth is heard and the brutal facts confronted. There s a huge difference between the opportunity to have your say and the opportunity to be heard. The good-to great leaders understood this distinction, creating a culture wherein people had a tremendous opportunity to be heard and, ultimately, for the truth to the heard (Good to Great, Jim Collins, 2001)

100 What s the Big Deal with Decisions? Why do we need to SHARE them? Putting patients first means realizing they need ALL perspectives and disciplines to speak from an empowered and expert voice. If any one discipline is weaker- or not empowered- then the patient loses. In the same way- as we manage nursing practice, all relevant specialty representatives must be a part of decisions for best outcome to occur. Definition of an Empowered, Discipline Specific, Expert Voice: Autonomy Think First: Who Should Be at this Table? For effective problem solving and decision making within nursing: both direct care nurses and administrative nurses must be at the table. Without both or more perspectives, the full diorama of information will not be available for the best solution to be identified. No voice at this table should be silent. This same principle applies, then, to the interprofessional realmwhere all disciplines must be represented as essential for the best outcome through a decision making process. The better the representation, the more valid and powerful the outcome and decision. 4

101 Establish a Positive Environment Frame the issue Establish ground rules re respect and open, honest and inclusive discussion Agree on an objective Have all stakeholders been considered? Agree on a process to move the decision forward Size of group is also important---small enough to facilitate effective decision-making and large enough to be appropriately inclusive 5 Explore the Alternatives Evaluate the risk in each alternative Consider potential consequences of each Determine if resources are adequate Choose the best alternative Have a contingency plan 6

102 Deciding Locus of Decisions Urgency of decision may drive where it can be made Leadership: Long-range, strategic Committees and Unit Councils: Daily operations, work flows, tactical plans Decisions can be delegated if: The leader is willing to live with the outcome The decision presents an opportunity for a group to learn and grow The decision will increase ownership and successful implementation (engagement) The group will offer a more innovative approach than that from a single leader 7 Problem and Decision Examples Increased Flash Sterilization UAC requests addition of 2 new trays Increased Readmissions PG develops new way to review readmissions with new workflow Unstandardized Performance Evaluation Process PG creates standardized clinical advancement process and administers it Increased Acuity and Staffing Problems PG creates a committee to regularly review acuity, staffing and budget concerns, advocating for new acuity system, bed huddle process, collaboration with administration

103 Problem and Decision Examples Increased Turnover of RNs PG creates exit interview process focused on valuing possibly leaving RNs No involvement in evidence based literature review PG EBP committee starts journal club Increased Door to CT Times UAC decides to have patients go, fully clothed to CT before any thing else, per a protocol System integration Inclusion of all key stakeholders within PG included in any system redesign of PG Common Pitfalls Giving lip service to professional decision making Failing to communicate boundaries Failure to share overall vision Micromanage council decisions Failure to address unequal power gradient Second-guess decisions after they have been made Failure to provide framework, access to key information and resources Abdicate all responsibility and accountability Under-notice, under-praise and under-appreciate 10

104 Collaboration True collaboration is a process, not an event. It must be ongoing and build over time, eventually resulting in a work culture where joint communication and decision making between nurses and other disciplines and among nurses themselves becomes the norm...the unique knowledge and abilities of each professional are respected to achieve safe, quality care for patients skilled communication, trust, knowledge, shared responsibility, mutual respect, optimism and coordination are integral to successful collaboration (AACN, 2005)

105 Running Effective Meetings Marj Maurer Meetings That Count Time is money! Create and conduct a meeting that is meaningful to attend 2

106 Agenda Plan a good agenda with substantive issues Include updates and follow-up from previous meetings 3

107 Examples of Structures: Unit/Clinic Level Committee Agenda Item Purpose Subject Leader (s) Time I Reflection II Review/Discuss Quality of patient care and nursing practice III Review/Discuss Education needs in practice areas IV Review/Discuss Evidence Based Projects and research V Review/Discuss Ongoing professional development in practice area VI Review/Discuss Financial Issues/Staffing VII Review/Discuss Recognition of excellence in area VIII Review/Discuss Magnet Issues/Needs IX Review/Discuss Peer Review X Review/Discuss Other Issues

108 Meeting Leadership Conduct a lively meeting Get everyone s input Listen and synthesize 7 Action Oriented Determine action to be taken and distribute accountabilities Set next steps

109 End on time! Facilitate Attendance at Meetings Mangers and leadership are key! Budget HPPD for this Schedule well in advance Publish an on-line calendar of meetings Consider virtual meetings 10

110 Shared Governance Structures: Bylaws Excerpt from Rush Oak Park Medical Center Bylaws 8.2 Duties of Officers. All officers actively contribute to the leadership of the nursing staff and shall perform other activities as identified by the President and Executive Committee President. The president will be the presiding Officer of the Staff, and in such capacity will: a. Aid in coordinating the activities and concerns of the Institution Administration and of the Medical Staff with those of the Nursing Shared Governance Organization, b. Act as a liaison between the Nursing Shared Governance Organization members, nursing and hospital administration, medical staff and Board of Trustees; c. Be responsible to assure compliance with these Bylaws for instances in which Nursing Shared Governance Organization members are involved in corrective action proceedings; d. Call, create the agenda, and preside at all general meetings of the staff; e. Serve as Chairperson of the Executive Committee; f. Appoint the Chairperson and membership of the standing committees and the special committees with consultation of Executive Committee; g. Will address issues in a timely manner and encourage appropriate dissemination of information throughout the membership; h. Perform such other function as may from time to time be assigned by the Executive Committee consistent with these Bylaws. i. Participate in mentorship and handoff of pertinent projects and business of organization to the president elect

111 9.1 4 Duties. The duties of the Executive Committee include the following: a. Monitor standards and promote clinical nursing excellence; b. Review, evaluate and act upon reports of the standing committees; c. Coordinate the activities of the standing and ad hoc committees; d. Consult with NSGO president for input into hospital and system wide committees. e. Monitor financial viability on a regular basis of the NSGO. f. Recruit, select and develop future chairs and officers of NSGO. g. Maintain NSGO commitment to assessment and development of initiatives that meet health promotion and education needs of the community. h. Assess corporate culture for safety, quality, and engagement for retention or development of nurses. 9.1 a.5 Nursing Peer Review: The purpose of the Peer Review Committee will be to provide oversight and review for bedside clinical nursing care in order to support safe, ethical and autonomous nursing practice. The committee will be charged with reviewing and evaluating the merits of specific complaints related to individual nursing care events and formulating a determination or recommendation regarding each situation based on evidence based practice and due diligence. The committee will consider systems and processes in their reviews. Rush Oak Park Hospital Used with permission

112 Nurse Executive Council Agenda/Meeting Minutes Agenda Discussion Recommendations/Actions Target Date/Persons Responsible

113 NURSING SHARED GOVERNANCE COUNCIL [Click to select date] [Time] [Location] Meeting called by: Facilitator: Type of meeting: Note taker: Timekeeper: Attendees: Review the agenda AGENDA ITEMS Topic Presenter Time allotted CREATE A W W W EVALUATE THE MEETING PLAN THE NEXT AGENDA ADJOURN Observers: Resources: Special notes:

114 Top 10 Professional Governance Leadership Tips 1. Start with why 2. Be focused: keep the patient at the center 3. Think big: what impact are you having on professional practice and the current state of health care environment? 4. Create structures and formalize processes and follow them 5. Always ask: where does this decision belong and who needs to be involved in it? Top 10 Professional Governance Leadership Tips 6. Conduct robust meetings and include meaningful, influential decisions 7. Demonstrate return on investment. 8. Respect the expertise of others; listen to understand; 9. Remember you are representing your colleagues and professional practice -- not your opinions 10. Mentor new leaders

115 Ecocycle Planning Where in the loop is your Shared Governance? Renewal Maturity Poverty Trap Not investing Rigidity Trap Not letting go Birth Creative Destruction

116 5SE: Advancing our Future by Building on our Past The Road a New Unit Took to Empower Nurses through Shared Governance Abbey Fabian, RN-BC Background To address the high demand for inpatient capacity at an academic medical center, a new Internal Medicine unit, 5SE, was opened in January SE is a 25 bed general medical unit, with the majority of patients having multiple co morbidities. The unit was primarily staffed with nurses with little to no experience; many had less than one year of experience working in an acute care setting. An experienced nurse in the role of nurse educator facilitated orientation, competency assessment, and educational offerings to address learning needs. A charge nurse, initially only on day shift, was added to night shift for 24 hour support. Creating a Culture 5SE created a culture of involvement and a desire to continue to be better than the day before. It was required for every nurse to be a part of at least one unit based council. Each nurse could choose to participate in either the Development, Practice, or Quality Council. The unit expectation was set for nurses to be present for at least 80% of the monthly meetings over the course of a year. The chair or co chair of each unit council represents the unit at the housewide council meetings. 5SE adopted the philosophy of holding peers accountable when it came to shared governance. It is a unit expectation to have ongoing involvement in shared governance activities. For additional information please contact: Abbey Fabian, RN BC 5SE Internal Medicine Froedtert & the Medical College of Wisconsin Froedtert Hospital Abbey.Fabian@froedtert.com Initial Barriers Many nurses did not feel confident in voicing concerns or ideas at a council due to inexperience. Many nurses were not familiar with the role of shared governance in their profession, and the many benefits that can be obtained through shared governance, due to inexperience. The initial stages of establishing shared governance were slow at first due to the numerous other challenges involved in the opening of a new unit. Slow, but Steady, Progress A nurse manager from another unit stepped up to facilitate the opening of the unit; shortly thereafter, a new nurse manager was hired with accountability for the unit. The new nurse manager brought new expectations, including education and accountability. She: Helped enhance the culture of involvement for 5SE. Expanded nurse autonomy and led nurses in increasing their professional growth, confidence in their skills, and education. The development helped nurses find their voice to become more engaged in decision making. As new nurses were hired, the nurse manager sought those that had the same views towards shared governance. Over the first year of 5SE opening, much growth has occurred. The Impact of 5SE Shared Governance The unit based shared governance councils have implemented many processes to engage nurses and provide autonomy. There are signs posted on the unit listing the next meeting dates, times, and locations in order to involve all nurses that would like to attend (even if it is not the council they represent) There is a binder of minutes and agendas available for any nurse to read and provide input A Stoplight board has been created where all nurses can anonymously identify needs for the unit and make requests for changes. The nurse manager is able to provide an answer regarding her follow up (green for completed, yellow for in progress, and red for when something cannot be done at this time and why) A certified nursing assistant (CNA) committee has been created for the unit in order to improve communication between nurses and CNAs, as well as allow the CNA staff to have a version of shared governance. This will help CNAs to more easily transition into shared governance once they become RNs (as many CNAs tend to do within the organization). Whether the CNA transitions to an RN role on the unit, or another unit in the health system, or another system altogether, they will have experience and be prepared for shared governance. Improved patient outcome as a result of unit based shared governance One significant success the unit experienced was with decreasing catheterassociated urinary tract infections (CAUTI). In a two month period (June/July 2017), there were three CAUTIs on the unit. The 5SE Practice Council decided to conduct audits of catheter care, provided re education, and had all nurses engaged in discussing whether their patients continued to need a catheter at daily interprofessional care coordination rounds. As a result of these efforts, 5SE can proudly say they have had zero CAUTIs since, currently 337 days CAUTI free and counting! Where Do We Go from Here? 5SE has had a year filled with exponential growth in shared governance. The nurses will look to continue maturation of the unit based councils, taking on additional projects to address unit and organizational goals, learning best practices from other units councils, and becoming even more engaged in organization level teams and committees..

117 The previous Nursing Shared Leadership structure did not align or connect with organizational interprofessional committees. Targeted goals were to expand interprofessional and direct care involvement at the local/departmental level, define how resources would be used for staff involvement and align house-wide Quality & Safety committees House-wide Committees New Council Structure New councils for all levels of nursing Integrated Local Practice Councils with Local Improvement Teams (LITs)* Aligned nurse membership with local, regional, house-wide representation Reallocated resources to the local practice area for improvement initiatives A 12-step process for whole system decision making realignment was used 1. Organizational gap analysis of decision making 2. Development of a strategic planning outline 3. Creation of a team 4. CNO and nurse executive support and input 5. Integration of inter-professional stakeholders 6. Targeted alignment of the strategic plan and goals 7. Implementation of a communication plan 8. Budget realignment at the organization and unit level 9. World cafe immersion educational event 10. Evaluation of the nursing union environment and contract 11. Standard templates 12. Realignment of quality and safety committees Creation of metrics Defined inter-professional approach Communication Plan Talking Points Renamed NSL to Shared Governance to support inter-professional collaboration and decision making Standardized communication platform Shared Governance Redesign Timeline December 2016 June 2017 December 2016 Taskforce designed Q 2weeks meeting Strategic plan for SG established January 2017 Gap analysis (Purpose/ Function) Review of Nursing & Org goals/ strategy Start charters February 2017 Finalized charters Start plan for election & education CNO-Town Hall to introduce new structure March 2017 Plan for election & education Quality Committees alignment Budgets designed April 2017 May 2017 June 2017 Plan for election & education Quality committees representation Budgets finalized w/ department alignment Voting for councils/ committees Education final planning World Café Style Education for all Council & Committee members First meetings of new councils Ongoing training What makes this Whole System Focus: A parallel work stream was built into the redesign for organizational Quality and Safety Committee realignment Interprofessional Council Structure E-Improvement/ Project Submission Centralized budget Creation of organizational E-Improvement/ Projects Platform Renee Kathy Krystle Amy Sarah Nancy Sheryl Linda Raji Jeanine Kelsey Cheryl Kristine Jen Jessica Tanu Jessey Paul Cassie Jamie Billner-Garcia Bradley Cabico Chapman Ferrari Glidden Goldstein Jordan Koppolu Misemer Parkinson Slaney Taylor Vargus Matei Vashist Bargmann-Losche Sharek Bergero Vik BSN, RN DNP, RN, NEA-BC MSN, RN, RNC-MNN MSN, RN-BC MSN, RN, CPHON MSN, RN-BC MSN, RN, NE-BC PA-C MSN, RN, CPNP-PC/AC, MSL BSN, RNC-MNN BSN, RN, CPHON MSN, RN, CPN MSN, RN, PCNS-BC BSN, RN-BC BSN, RNC-NIC, PHN MS, MPH MPH MD, MPH MSN, RN DNP, RN Clinical Nurse IV, Sequoia Executive Director, Center for Professional Excellence & Inquiry Assistant Patient Care Manager, Maternity Director, Patient Care Services, Acute Care Clinical Nurse Specialist, Hematology, Oncology & SCT Clinical Nurse IV, Cardiology Patient Care Mgr, Intermediate & Newborn Nurseries Advanced Practice Advanced Practice Providers, General Surgery Clinical Nurse IV, Maternity Clinical Nurse III, Oncology Clinical Nurse IV, Cardiology Director of Practice, Innovation & Magnet Clinical Nurse IV, Medical-Surgical Clinical Nurse IV, Neonatal Critical Care Float Director of Quality Improvement Executive Director, Center for Quality & Clinical Effectiveness Chief Clinical Paitent Safety Officer Director of Patient Safety and Infection Prevention & Control Director of Nursing, Ambulatory April 2018

118 Developing an Evidence-Based Practice Project Pathway for Unit-Based Councils Leslie Wood, BSN, RN, ONC, Kathy Hunt, MSN, RN, CCRN Restructure of Governance Identifying an Evidence-Based Practice Change Model & Project Framework Highly Engaged Frontline Leaders AONE Dynamic Leadership = Catalyst for Change After attending the AONE Dynamic Leadership for Shared Governance Conference in Atlanta, GA in May 2014, an assessment of the current nursing governance structure was made. In collaboration with bedside governance leaders and nursing leadership, it was determined that we were in a state of Creative Destruction. Through reflective evaluation of the Principles Guiding Shared Governance (Equity, Accountability, Partnership, and Ownership) as defined during the conference, it was found that there was an opportunity for continued growth of bedside leaders. As a result, in FY2015 Nursing Governance was changed to Interprofessional Shared Governance Nursing councils focused on nursing professional practice issues and nursing professional development Interprofessional councils focused on informatics & innovation and professional inquiry & evidencebased practice The Interprofessional Care Council (ICC) was created as a mechanism for Unit Based Council (UBC) chairs to become more engaged in the overall Shared Governance structure Developing the Professional Inquiry & Evidence- Based Practice Council After transforming from a traditional to contemporary shared governance structure, the Evidence-Based Practice and Research Council evolved into an interdisciplinary council focused on: Raising awareness of evidence based practice resources throughout the organization Fostering a work environment that encourages professional inquiry, discusses strategies to connect the interprofessional care team to best practices and standard work, and provides feedback to the interprofessional care team wanting to examine current practice when compared to best practice. Increasing the educational component of professional inquiry and EBP, while strengthening the use of the research process. Advancing use of Evidence-Based Practice (EBP) and providing a supporting link between EBP and research. Facilitating support for the IRB process Mentoring the unit based councils to translate knowledge of best practices into practice Reviewing Quality and Safety Data to identify opportunities for improvements and standardization of work utilizing EBP Increasing regional and national visibility through dissemination of best practices. In 2010 The Quality Caring Model by Dr. Joanne Duffy was selected as our professional practice model and guiding organizational framework. From this point, the organization, with support of the CEO, adapted the principles of the theory into organizational Promise Statements which guide ideals for the culture of our organization. In 2015, The Professional Inquiry and Evidence-Based Practice Council (PIC) was tasked with developing a supportive structure for EBP project development for Unit Based Councils. The Rosswurm and Larrabee Model for Evidence-Based Practice Change was selected by PIC due to its understandability and ability to connect to Dr. Duffy s Eight Caring Behaviors, which provided a conceptual framework for projects and led to further enculturation of Quality Caring Model concepts for direct care interdisciplinary team members. Unit Based Councils were provided with an EBP Project Guide that outlined a framework and project timeline which allowed for sustainability of project momentum. Unit Based Councils and department managers were also paired with an EBP Coach. Coaches were identified based on their knowledge and experience with the EBP process. Outcomes and Dissemination Increased interdisciplinary engagement from staff at all professional levels in Shared Governance councils 17 projects were completed and presented at a November Poster Symposium with 2 additional posters completed and presented in May 2017 Of the 19 projects, 7 have been presented outside of the organization at national conferences and symposiums Highlighted Project Outcomes Dissemination Pain First, Sedation Second: Caring for the Open Heart Patient Implementing a Mobility Bundle to Decrease Postoperative Pulmonary Complications After Open Heart Surgery Education for Nurses to Improve Breastfeeding of NICU Infants Reducing Central Line Bloodstream Infections (CLABSI) % of CABG patients vented >24 hours from 23.33% to 10.0% over 6 months % of CABG patients vented >6 hours from 66.66% to 40.0% over 6 months Through 39 retrospective chart audits three months after the implementation of the mobility bundle, the average length of stay post-operatively decreased from 6 to 5 days The readmission rate for pulmonary related complications within 30 days of discharge decreased from 7 to zero in the % from 74% to % of infants receiving mom s own milk at discharge after both the initial and refresher education provided to staff. CLABSIs on a general surgery unit over 6 months from 7 to 2 (71% ) Oral Care Protocol in Non-Ventilated Patients Standardizing the oral care kits across nursing units with a Q8 oral care kit it is expected to have a cost avoidance of approximately $40, staff adherence to oral care protocol Standardizing the Procedural Time-Out Process 40% in activity suspension during Time Out process 20% in the introduction of team members to 100% compliance 10% in team member communication regarding critical case details 70% in the communication and verification of sterility being maintained at the field Nurse Adherence to a Delirium Assessment in the ICU Delirium in the Hospitalized Adult Surgical Patient: A Nurse Understanding Adherence to a daily delirium assessment in inappropriate use of unable-to-assess ratings Poster presentation at 2018 The National Teaching Institute & Critical Care Exposition Poster presentation at the 2018 ANA Quality and Innovation Conference, receiving honorable mention from the ANA Podium presentation at the 2017 inaugural Helene Fuld Health Trust National Institute for Evidence-Based Practice in Nursing and Healthcare at The Ohio State University Poster presentation at the 2017 AORN Global Surgical Conference & Expo Poster presentation at 2018 The National Teaching Institute & Critical Care Exposition nurse understanding & recognition of delirium in the orthopedic patient Poster and short podium presentation at the 2018 National Association of Orthopaedic Nurses Annual Congress In partnership with our Nursing Professional Development Team and organzational EBP experts, Unit Based Council chairs participated in EBP workshops and attended educational sessions at ICC meetings on the EBP and research process. This empowered frontline leaders through the Unit Based Councils and within the Interprofessional Care Council to bring forward ideas and solutions to provide optimal outcomes for a better patient and family experience. Topics Included: Identifying a clinical question through inquiry Creating a research or PICO(T) question Searching and appraising literature Designing and implementing a project Creating a poster presentation Disseminating project results Dynamic Continuous Work Continue developing an EBP project structure using the Rosswurm & Larrabee model of EBP change to guide work on unit and department specific improvement projects by Working closely with PIC and organizational EBP experts to create a meaningful and supportive structure for project development Continuing to improve internal dissemination of best practice findings Utilizing PIC as a vetting process for projects, mirroring IRB templates to set project leads up for future success in disseminating project outcomes Structuring EBP process inservices and workshops to be interdisciplinary and continuously offered to meet the needs of those seeking project assistance where ever they are in the process Identifying EBP Coaches based on areas of interest and connection to projects rather than pre-assigning coaches to certain units or departments Bridging the knowledge-practice gap by translating research into practice Resources AONE. (2014). Dynamic Leadership for Shared Governance. Atlanta, GA. Duffy, J. R. (2009). Quality caring in nursing: applying theory to clinical practice, education and leadership. New York, NY: Springer Duffy, J. R., & Duffy, J. R. (2013). Quality caring in nursing and health systems: implications for clinicians, educators, and leaders. New York, NY: Springer Pub. Kear, M., Duncan, P., Fansler, J., Hunt, K. (2012). Nursing Shared Governance: Leading a Journey of Excellence. Journal of Nursing Administration, 42(6), Rosswurm, M.A & Larrabee, J.H. (1999). A model for evidence-based practice change. Journal of Nursing Scholarship, 31(4), Together, our Promise is YOUR HEALTH.

119 Engaging, Empowering, and Elevating Clinical Nurses Through Shared Governance Elizabeth Bradley, BSN, RN, CPON; Maryam Hemmali, MBA, BSN, RN, ONC; Nadine Garcia, MSN, RN; Joy Parchment, PhD, RN, NE-BC Orlando, Florida Background Interventions Outcomes Shared governance councils were created in 2008 to promote nursing practice decision-making Recent conversations with members identified inconsistencies; poor engagement of clinical nurses and low functioning Nursing Practice Councils (NPC) One out of six Hospital NPCs (HNPC): Led a council driven nursing and/or quality improvement project Had a succession plan Had a designated mentor Sporadic bi-directional communication Fragmented use of paid time for council work Lack of equipment and access to a designated workspace to complete council work Hardwired paid time out of unit staffing for Chairs Provided designated space for council work Purchased computer equipment for councils Six out of six Hospital NPCs: Implemented a nursing and/or quality improvement project Have a succession plan for council leadership roles Received a designated mentor for council leadership Provided ongoing leadership support and education to promote professional growth and development Mentoring class Peer review class Goals The goals of the initiative were to: Assess the functioning of all NPCs Create highly functioning NPCs throughout the hospital system Leadership Priority scheduling for Unit NPC and HNPC Chair Ensure hours out of unit staffing for Chair Facilitate attendance and participation Engagement Identify strengths and assign role responsibilities Open invitation to attend NPC meetings Promote a professional mindset Processes Standardize consistency of meeting schedules Utilize communication process Annual NPC orientation Resources Provide computers and designated workspace Increase frequency of Facilitating NPC classes Provide mentors Summary Hardwiring the functioning of NPCs empowers clinical nurses to take ownership of their practice, engage in decision-making, and creates a pipeline to elevate clinical nurses to grow professionally into formal nurse leadership positions. Next Steps Issue follow-up questionnaire at regular intervals Revise Facilitating Nursing Practice Council course for Chairs Provide additional leadership development courses

120 Home Care Nurses at the Bedside Improve Satisfaction and Safety Michelle Hiidel, BSN,RN,LSW,CCM; Cheryl Mann, BSN,RN, CPPS; Gabriel Scott, RN Background Timeline Nurse Satisfaction Remote Home Health Setting Poses Unique Safety Challenges: Pentec Health s Registered Nurses (RNs) provide in-home care to patients with Intrathecal Drug September 2015 December 2015 Nursing Department Transitions to Shared Governance Model Bedside RN Submits Bright Idea What the Nurses are Saying: Yes I have had an error prevented. We have helped prevent errors. I am constantly learn- Delivery Devices. The medications provided are considered to be high risk due to drug class and route of delivery. Best practice when administering these medications is to have another nurse February 2016 Nursing Professional Development Council Conducts Research Vendor Identified by Council and Volunteers Begin Testing App It s exciting to see a nurse with a passion for new technology and nursing excellence ing as new issues are brought up. It is very encouraging and insightful. (Staff Nurse) perform a double-check of calculations and pump settings prior to leaving the patient s home June 2016 Three Month Trial of App Begins in Select Region see a project through from start to finish-a anytime changes are made. communication is not always readily available to home Trial Extended (usage of app continued in selected region) project that benefits ALL our nurses. Using the Shared Governance model, the project was in- health nurses in remote locations. This makes HIPAA-compliant, real-time, two-nurse double November 2016 Proposal to Management by Nursing Development Council vestigated, analyzed and trialed by nurses interested in shaping their future at Pentec Health. checks of complex programming problematic. Obtained ANCC Accreditation Pathways to Excellence (Patty OConnor Council Chair) Summary Statement Staff-led Initiative Reduces Errors and Enhances Culture: One of our first shared governance projects was initiated by an independent staff idea. This represented a change in our traditional leadership behavior because the project was entirely initiated, developed and directed by staff nurses as a solution to support two-nurse checks of complex programming in the home environment. The use of a HIPAA-compliant texting app improved patient safety by contributing to a decrease in medication programming errors. It also impacted department culture by improving communication and connectedness among remote staff nurses which improved staff satisfaction levels. Jan -Apr 2017 Continued Usage of App by Managers and Selected Region April 2017 Department-wide Trainings Provided by RNs Who Initiated Process Trial Team Present at Trainings to Provide Feedback, Tips, and Best Practices May 2017 Training Completed, Department-Wide Roll Out Implementation and Usage Compliance Average Volume: 97.7 daily messages (Topics vary from verification requests to educational and social interactions among peers) Read Rates: Group requests have a 97% read rate for all recipients. All messages are read and responded to by at least one recipient. Average Volume of Two Nurse Checks: 14.7 requests per day Being empowered by Shared Governance was strange to say the least. I felt as though my opinion, work, and effort were being recognized by those who normally wouldn t have. When we (the NPDC council) identified the need for a better communication tool, we spoke up and were heard. From research to testing, we led the project and saw it bloom into a powerful way of keeping our nurses connected, our patients safe, and our results outstanding. I am very proud of our work as a council and motivated by this model of Shared Governance. (Gabe Scott-Project Champion) Comments from Staff Nurses An error was prevented! I have prevented errors for others. I love the easy access to reach out to each other with protection of the patient s information. The team has developed read backs from top to bottom. By emphasizing these points during the telemetry checks, errors have been avoided, educational opportunities have presented, and learning has been acquired. Transition to Shared Governance: A New Model Pilot study: Average response data Average Time to First Response: 3.4 minutes Average Number of RNs Responding per Request: 2.3 Unexpected Benefits Increased Interaction, Teamwork and Education It definitely gives a peace of mind before leaving the patient s home. I greatly appreciate the ability to know that with one text I can have someone from my team check me, encourage me, and just be there! I have learned a lot just looking at others orders, telemetry reports, how others respond, etc. Conclusion Results and Outcomes Use of HIPAA-Compliant Texting App Reduces Errors* and Impacts Culture in Home Health Setting * The success is combined with additional initiatives Error Rates (# errors/total # visits) total error rate Clinical support of remote home health nurses is essential for patient safety. Shared Governance provided an effective mechanism with which to launch a staff-driven safety initiative. Adoption of a HIPAA-compliant texting app was utilized as a solution to the difficulties faced in performing independent 2-nurse double checks remotely in the home health environment. Not only was patient safety improved, but unexpected impacts on department culture included improved staff interaction, teamwork, education and satisfaction. Contact the Authors Michelle Hiidel: mhiidel@pentechealth.com Cheryl Mann: cmann@pentechealth.com Q Q Q Q Q Q Q Q Q Q Q Q Q1 Gabriel Scott: gscott@pentechealth.com

121 Implementing Shared Governance in an Integrated Healthcare System Sherry Burg and Jeanine Senti, Altru Health System, Grand Forks, ND Leadership: Planning/Gaps Identified» CNO, Administrators & Directors Collaboration and Visioning» Selection of Nursing Theorist - Jean Watson: Theory or Human Caring»Gap Analysis from Nursing Feedback Survey (used with permission)»shared Governance Model Designed Vision and Goals»Transformational Leadership: Change the nursing organization to meet the future»structural Empowerment: Develop staff to be empowered to accomplish organizational goals, policies, and programs» Professional Practice: Creating a comprehensive understanding of the role of nursing and the interdisciplinary team»quality, Safety, and Innovation: Achieving excellent clinical outcomes S.W.O.T. Nursing Feedback Survey How many years of RN nursing experience do you have? > 20 Years 23% Years 5% Years 14% Nurse Manager 3.1% Patiet Care Supervisor 4.7% PCC 7.5% Staff LPN Staff RN PCC Other 14.8% < 1 Year 17% 5-10 Years 21% What is your highest nursing degree? Staff LPN 13.9% 1-3 Years 10% 3-5 Years 10% Diploma (LPN) Diploma (RN) AD/AS BSN MSN Other What is your position? Staff RN 56% Patient Care Supervisor Nurse Manager Other Shared Governance Model Current Perceived Authority to Make Decisions Group That You Believe Should Make Decisions Survey Findings and Gap Analysis Administration/ Management Only Administration/ Management Only Primarily Administration/ Management - Some Primarily Administration/ Management - Some Equally Shared by Administration/ Management Equally Shared by Administration/ Management Primarily Staff Nurses - Some Administration Primarily Staff Nurses - Some Administration Staff Nurses Only Staff Nurses Only Process»Vision and planning with nursing leaders»nursing survey»gap analysis»bylaws developed»managers and supervisors updated»nursing staff invitation from CNO»Applications submitted and members selected»welcome letter from CNO»Kick-Off Workshop and Goal Setting for each Council»Set day and time for meetings Measurement»Shared Governance Model Implemented February 2018»Goals achieved by each council by end of the year»increase in employee engagement measured 1st quarter of each year»baseline data: % % Acknowledgements We express gratitude to Dr. Havens for permission to use the survey. Havens, D. & Vasey, J. (2003). Measuring staff nurse decision involvement, Journal of Nursing Administration, 33(6), We acknowledge Janice Hamscher, CNO, for her vision and leadership and Altru Health System for their support.

122 Making the Connection With Each Other, Professional Practice and Technology Katie Cook, MA, BSN, RN; Mara May, BSN, RN; Christina Eliason, RN; Jill Blackbourn, RN With Each Other Professional Practice Improved relationships, leadership, behaviors and culture: New structure/measurable outcomes: In 2016, a new clinical informatics group, the Committee of Clinicians Creating Computers (C4), was developed and launched with the purpose of designing and supporting nursing practice and technology intersections in the clinical setting. In the fall of 2017, the Department of Nursing sponsored a retreat for members of the councils and committee: Inpatient Council Outpatient Council Nursing Professional Excellence Council Committee for Clinicians Creating Computers (C4) Objectives of the group: In partnership with Councils and the Department of Nursing, define practice/process content for technology using current evidence and best practice The purpose of the retreat was to create a space for recognition, appreciation, gratitude, connection and an understanding of each council s role and work. Outcomes: Evaluations showed heightened awareness of each group s work, reinvigoration for participation and leadership, joy in spending time getting to know colleagues, and gratitude for the opportunity to experience self-care in an inviting setting on a beautiful fall day. Technology New initiatives: In 2017, the Nursing Professional Excellence Council went through a major transformation. A conversation among members that began with a review of the Council s purpose led to a thoughtful reevaluation. Outcomes: This reevaluation resulted in a new purpose, a new name (Nursing Professional Excellence Council, previously known as Nursing Marketing and Communication Council), new energy and a new vision for what this group could do included education in workforce planning, review of the nursing survey and Nurses Day celebration with new direction for this event in 2018, oversight of the Nursing Professional Framework and review of the Nursing Professional Portal. Determine the designs for practice and technology intersections impacting nurses Define the standards of best practice in nursing documentation and support standardization Develop a mutual understanding between Nursing and Information Systems on the prioritization of issues Establish metrics to ensure continuous evaluation and improvement of technology use and integration The committee s first project was to simplify the nursing admission process in Epic. The goal: Create and implement a valuable set of admission screens in a usable design to facilitate knowledge-driven care. Staff in various departments and roles, along with a patient advisory focus group, partnered to redesign portions of the inpatient nursing admission process and Epic design. Outcomes: Implemented in 2017, this project led to the elimination of non-value added documentation and decreased redundancy. Results also showed increased documentation completion, improvements in nurse satisfaction and improved use of nursing time. An anticipated 2.6 hours per day/365 days/year of nursing time was saved equating to an estimated $45,000 annual savings.

123 Navigating the Night Shift; Shared Governance at Work Karen Murray, ADN, RN, CCRN ( kmurray@cmh.edu) INTRODUCTION Shared governance empowers staff to take ownership of their practice that leads to increased job satisfaction and improved patient outcomes. A team of night nurses share their journey of establishing a night shift council, the approach to improving resources and supporting night nurses healthy lifestyle. BACKGROUND Shared governance includes structures and processes that provide an innovative environment where strong professional practice flourishes to achieve the outcomes important to our patients and their families. Expectation of professional practice is 24/7 Held open forums to gather information regarding resources that were lacking for the night shift Took information to Chief Nursing Officer Night council was developed BARRIERS Working nights and having to work with staff who primarily work 9-5 Buy in Culture change Constantly evolving list of things to work on Children s Mercy Kansas City, Kansas City, Mo. Other hospital if applicable GOALS/ACCOMPLISHMENTS Improve engagement, satisfaction, recognition and access Additional partner logo may go Decrease/eliminate here. To make inserted graphic transparent, FORMAT, Recolor, sleep interruptions caused by non-emergent text paging Set Transparent Color, place cursor Address specific night shift concerns using a shared decision making over white spot of graphic and click. structure Resources for the night shift Education Access to additional food options at night If the expectations are the same for the night shift then the resources should be equal. Night Shift Survey 1 Sleep Facts 2 67% reported all Shared Decision Making (SDM) events occur during their sleep. 75% of mandatory education takes place during sleep time Over half indicated that when special events are held, the event for the night shift (if there is one) is of substantially lesser quality. Only ½ meet recommended exercise guideline 10% admit to nodding off while driving home 44% of night shift workers don t get enough sleep Elevated accident risk in the workplace Reduces workplace productivity Can reduce job satisfaction References: 1 Carney, M. L. (2015). How the other half lives. Nursing Management,46(7), doi: /01.numa f4 2 ANA. Executive Summary American Nurses Association Health Risk Appraisal (HRA). Preliminary Findings October October Retrieved from Feb 1, 2017.

124 # of submissions per month Operationalizing the Shared Governance Structure Connie Ford, MHA, BSN, RN, NEA-BC and Andrea Polach, MSN, RN, CPN Abstract Results Interventions (continued) In our efforts to rollout a formalized structure for a growing organization, we redesigned our governance structure including the addition of a new Professional Practice Board. Nurses at all levels participate on this board. Additionally, the team created a new process to engage nurses and provide access to nursing governance thru a web-based repository. Nurses are encouraged to submit new ideas, innovations and suggestions for improvement to the Professional Practice Board thru the webbased repository. Objective Engage nurses to participate in nursing governance Establish a process for managing inquiries and suggestions Establish a framework for dissemination of information Submissions to the Professional Practice Board Develop standard communication templates available on the shared network Develop tracking method Add representatives from Nursing Practice Council, Nursing Research & EBP Council, Nursing Leadership Board, and Nursing Strategic Boards Develop a rollout strategy to promote the survey EBP seminar Board Basics training for Unit Board Council chairs STAT organization newsletter Digital display boards Staff meetings/department Newsletters from council-to-council Direct inquiries and suggestions to the appropriate Staffing/Workforce Quality/Safety Professional advancement Policy/Procedure nursing governance council or hospital committee Patient experience Other - documentation Other - Cost saving measures Other - Annual TB testing Nursing practice New equipment/technology Magnet Conclusion Qtr1 Qtr2 Qtr3 Qtr4 Qtr1 The change in our governance structure, the new process, and standardized templates created a foundation for nurse Interventions Develop a survey tool for submission of questions, suggestions and new ideas related to: Submission Resolution Governance Council Evaluate mandatory holiday schedule Increased number of staff Workforce Management eligible to schedule in the Council more desirable holiday Nursing Leadership Board rotation. involvement in decision-making at all levels. The Professional Practice Board observed a >50% increase in the number of survey submissions and predicts this number will continue to increase as the year progresses. Process improvement New device for The proposed CAUTI committee The flow of communication and dissemination of information New technology/equipment Policy indwelling catheter securement securement device was approved. Improved catheter stabilization. Value Analysis Committee Nurse Practice Council throughout the governance structure was improved by providing a standardized template. This tool is used by all Procedure Golytely should flow over The frontline nurse Nurse Practice Council governance councils and ensures the council member Clinical practice Quality to I+O flowsheet presented the proposed change to committees and it was approved. This IT Governance Committee communicates consistent information. Safety solution improved Cost savings nursing documentation Staffing/Workforce of medication infusions.

125 SHARED GOVERNANCE: LARGE TO SMALL YOU CAN MAKE IT WORK S H E I L A S AVA G E, R N, B S N, M E L A N I E E L S K Y, R N, M A L L A R Y M Y E R S, M S N, R N - B C NURSING VISION BACKGROUND Nursing provides loving care within a sacred environment for the body, mind, and spirit for every person, in all our relationships, every time. Baptist Health is a faith based, not-for profit, 3 hospital system (689 licensed beds), located in Montgomery, AL. - Baptist Medical Center South (454 Beds) - Baptist Medical Center East (150 Beds) - Prattville Baptist Hospital (85 Beds) INSPIRATION To promote and improve the physical, emotional, and spiritual wellbeing of the people and communities we serve. The foundation of nursing excellence is a shared governance structure that gives nurses a voice related to the delivery of patient care. With Relationship Based Care (RBC), the activities of care are organized around the needs and priorities of patients and their families. Our foundation for nursing excellence is built upon: Caring and Healing Environment in this environment, care providers respect the dignity of each patient and utilize resources to accommodate the needs of the whole patient MIND, BODY AND SPIRIT. Leadership leaders are not defined by position, education, or licensure. Leaders know the VISION and consistently make patients, families and staff their highest priority. Teamwork teamwork predicts QUALITY. Team members learn together and create energy and interdependence necessary for the delivery of high quality patient care. Professional Nursing Practice patient care is a privileged and sacred TRUST. Professional Nursing Practice allows us to provide compassionate care to patients and families in a healing environment. Patient Care Delivery Provide the structure to support PROFESSIONALISM. The human aspect of care drives everything. Resource Driven Practice requires CRITICAL AND CREATIVE THINKING. Focus on priorities while balancing the needs of the patient population as a whole. Outcomes Measurement in the practice of outcomes measurement, useful data are those which are not only meaningful, but motivating. Use data to INSPIRE leaders and caregivers. So never lose an opportunity of urging a practical beginning, however small, for it is wonderful how often in such matters the mustard-seed germinates and roots itself. -Florence Nightingale INFRASTRUCTURE Patient Care Utilized a consultant from Creative Healthcare Management UPC s Leadership education including RBC theory, Unit Practice Council (UPC) function, and Department Managers transformational/empowering leadership UPC s kicked off in waves Results Council Every UPC goes through educational get smart Administration phase before project development. Facility Professional Practice Council (PPC) developed Implementation Lead roles developed in each facility to support the work of the department UPC s Director of Care Delivery role developed at largest facility Results Councils at each facility Continuing Education PRATTVILLE BAPTIST HOSPITAL In 2015, Baptist Health embarked on a Relationship Based Care shared governance journey, to provide frontline staff a voice in decision making. The focus was to improve relationships, promote collaboration and enhance nursing excellence through professional practice. EVIDENCE Reduction in Nursing Turnover RN Turnover (Traditional Turnover Method) RN Turnover (Traditional Turnover Method) 30% 30% 23% 23% 15% 15% 22.15% 22.15% 16.31% 16.31% 21.94% 21.94% 13.21% 13.21% 24.67% 24.67% 12.64% 12.64% FY 17 Actual FY17 18Actual Actual to Date FY FY 18 Actual to Date Emergency Department Unit Practice Council (UPC) Specimen Scanning Background In April 2016, the Emergency Department(ED) UPC was asked to address a trend regarding mislabeled specimens in the ED. Responsibility was allocated to the UPC to create a process to ensure accurate labeling of specimens. Implementation Process Equipment needs were determined by the team. The electronic medical record was configured to allow scanning. Education plan was developed and disseminated to all ED staff. Super Users, educators and clinical informatics provided support at GoLive. Reports were created to monitor compliance. Results were shared with all staff on a weekly basis. Scanning goals were established and increased monthly until compliance reached 95%. Current State: 95% compliance with patient and specimen scanning since June Last mislabeled specimen March % 8% 0% 0% BMCS BMCS BMCE BMCE PBH PBH BAPTIST MEDICAL CENTER SOUTH BMCS MICU HAI Reduction Project Focus on C-diff October cases of Hospital Acquired C-diff in a 12 bed unit Plan created: Checklist creation to ensure all rooms are properly cleaned post discharge. Creation of a clearly defined escalation process for noncompliance with proper PPE usage. Research driven proposal showing the risks and costs of curtain use verses the ROI of removing the curtains and installing blinds in glass. Current State: Curtains removed in all standard inpatient rooms throughout the hospital. Blinds in glass installed in MICU pilot department with plans to install in all ICU s throughout the system BAPTIST MEDICAL CENTER EAST Labor and Delivery/Post-Partum Collaborative Development and Implementation of Postpartum Hemorrhage Protocol Initiated by Postpartum UPC Collaborated with an OB Physician Champion, and Blood Presented at OB physician section meeting and Medical Executive Committees at BMCE and BMCS-approval granted Developed policy and procedure Developed CBLs and You Tube video for training Hemorrhage carts will be located on Postpartum and L&D Staff education and drills begin July, 2018 with implementation of the protocol October, P AT I E N T S F I R S T. C O M P A S S I O N AT E C A R E. P U R S U I N G P E R F E C T I O N. EDUCATION Leading the Empowered Organization classes for leaders Relationship Based Care 3 day Practicum Kick-off Education Days Retreats for leaders and staff Status checks Book clubs LESSONS LEARNED Ensure all members of leadership understand their role in shared governance (how they support it at all levels). Budget for projected hours spent on Relationship Based Care. Ensure shared governance work is aligned with strategic priorities. Remember, it takes years to evoke cultural change. It is a Journey, not a destination FUTURE Working through the cultivation and growth of a System Professional Practice Council. Advancing Communication Techniques (Social Media, Sharepoint, , etc). Continued roll-out of shared governance to ancillary areas and outpatient entities. Development of relational competencies Increased focus on nurse/ physician relationship. Development of continuing education and support for leadership. REFERENCES Felgen, J. (2006). I2E2: Leading lasting change. Creative Healthcare Management, Inc. Minneapolis, MN. Koloroutis, M. (2004). Relationship-based care: A model for transforming practice. Creative Healthcare Management, Inc. Minneapolis, MN.

126 Starting a Shared Governance Council Just keep swimming, Just keep swimming Cassie Peacock, BSN. Timeline Background 2015: Year one. I n 2015, West Florida Hospital in Pensacola Fl. began the journey to starting a Shared Governance Council. This began with a trip to Atlanta for a Dynamic Leadership in Shared Governance conference. This trip gave the team an insight into shared governance. SUCCESS Why Shared governance it offers dynamic staff-leader partnership that promotes collaboration, shared decision-making, and accountability for improving quality of care, safety, and enhanced work life. It helps to decentralized decision-making, share in ownership and accountability of work load, build partnerships among key stakeholders, and encourage high level of professional autonomy ensures clinical decisions are made at the point of contact. How did we implement shared governance? There are many ways to implement a shared governance council. The focus of our council was to build partnership between staff and leadership; with input by all impacted. The council created a collaborative decision making process by listening to front line staff and creating shared accountability and team ownership. This focus aimed to facilitate discussion rather than a directive approach. Another focus of the council was on unit based councils and by- in from the bedside nursing staff. Evidence tells us that the most successful shared governance bodies are those that have at least 6 structural elements: a charter, including outlining the boundaries of decision-making; collaboration between staff co-chairs and the area manager; regular meetings with a formal means of communication to all staff; mutually planned agendas (co-chairs and manager) distributed before the meetings; ground rules of how to work together, be it in-person meetings or online meetings; Striving for consensus decisions, meaning that everyone agrees to support them after having discussed the option. Developing Committees Time line of Shared Governance committee discussed INPATIENT AND ED DIRECTOR, MANAGER, ANM-INTRODUCTION TO SHARED GOVERNANCE EDUCATION LEADERS TO INTRODUCE SHARED GOVERNANCE CONCEPTS AND STEERING COUNCIL AT STAFF MONTHLY MEETINGS, ED DAY LUNCH AND LEARN INTRODUCTION TO SHARED GOVERNANCE EDUCATION SELECT UNIT BASED CHAIR FOR INPATIENT UNITS AND EMERGENCY DEPARTMENT ATTENDED CONFERENCE DYNAMIC LIEADERSHIP FOR SHARED GOVERNANCE in Atlanta ESTABLISH MONTHLY MEETINGS BEGIN TO ESTABLISH UNIT BASED SHARED GOVERNANCE COUNCIL 2016: YEAR TWO ESTABLISH BYLAWS CREATE FLYWHEEL VOTE ON CHAIR AND CO-CHAIR S CONTINUE TO FOCUS ON UNIT BASED COUNCIL SETUPS AHRQ SURVEY PRESENTED TO COUNCIL AND DISCUSS STRATEGIES TO ADDRESS GAPS IDENTIFED BY SURVEY VOTED ON USING SBART AS THE STARTDAD BEDSIDE HANDOFF TOOL NEW TELEMETRY MONITOR8ING NOTIFICATION PROCESS PRESENTED AND NEW PATIENT LOCATED FORMS PRESENTED VOTED ON NEW IV START KITS ATTENDED ANNUAL LEADERSHIP MEETING TO PRESENT THE COUNCILS FOCUS AND SUCCESS OF THE YEAR 2017 YEAR THREE Oncology/Medical floor unit: CHANGE IN ADMINISRATIVE LEADERSHIP FOCUS ON DEVELOPING A MORE COLABORATIVE RELATIONSHIP WITH OTHER COUNCILS MEMBERS ASSIGNED TO NRSING COMMITTEES, THESE MEMBERS WILL ATTEND COMMITTEE MEEITINGS AND REPORT BACK TO SHARED GOVERNANCE COUNCIL ENSURE ATTENDANCE OF ALL UNITS BY REACHING OUT TO MANAGERS TO HELP FACILITATE ATTENDANCE OF BEDSIDE NURSES PATHWAY OF EXCELLENCE PRESENTED, COUNCIL WILL FOCUS ON ENSURING BEDSIDE NURSES HAVE THE INFORMATION ABOUT PATHWAY OF EXCELLENCE POSTER PRESENTATION AT SAFETY FAIR AND VENDER FAIR ABOUT SHARED GOVERNANCE AND PATHWAY TO EXCELLENCE PRESENTED WITH NEW EBCD CHARTING SYSTEM, NEW WELCH ALLYN MONITORING TRAING, AND FLOOR STOCK OPTIONS. PATHWAY POSTER AND VIDEO VOTED ON PARTNERED WITH LOCAL UNIVERSY TO ASSIST WITH THE UNIT BASED COUNCILS OF THREE UNITS.(CCU, REHABB AND MED SURG UNIT) PRESENTED NEW STROKE DOCUMENTATION PRESENTED NEW PATIENT FALL DOCUMENTATION PROCESS ATTENDED ANNUAL LEADERSHIP MEETING TO PRESENT THE COUNCILS FOCUS AND SUCCESS OF THE YEAR REVAMPED MEDICAITON ADMINISTRATION SIDE EVECTS WORKSHEEPT, THIS SHEET HELPS PATIENTS TO BETTER UNDRESTAND MEDICATION SIDE EFFECTS. REVAMPED FALL PRECUATION MEASURES TO ENSURE PATIENT SAFETY Medical/ surgical units: 6 FLOOR REVAMPED THE ORIENTATION PROCESS FOR NEW HIRES, CREATED A BOOK AND IMPLEMENTED ROUNDING WITH DIFFERENT DISCIPLINES EX: A DAY WITH LAB, A DAY IN THE ER, AND A DAY WITH TRANSPORTATION. ACCUITEY SCALE FOR HELPING TO ESTABLISH PATIENT ASSIGNMENTS 4north: WORKING ON NEW HIRE ORIENTATION PROCESS FOCUS ON PREVENTING FATIENT FALLS 2018 :YEAR FOUR CHANGE IN ADMINISTRATIVE LEADERSHIP NEW CHAIR DISCUSS CODE IDENTIFICATION BRACELETS VOTE ON NURSE WEEK AGENDA, CREATE NURSING TSHIRT DESIGN DISCUSS PROJECTS FOR 2018 DISCUSS CREATING NEWSLETTER TO HIGHLIGHT COUNCILS FOCUS AND AGENDA SUPPLY CHAIR PRESENTED ON STRATEGIES TO INCREASE SCAN RATE THROUGH OUT THE HOSPITAL COUNCIL FOCUS IS ON HELPING UNITS COUNCILS OVTAIN UNIT OF DISTINCTION Labor & Delivery UPDATE BEREVEMENT CART Practice Consensus Decision Making Demonstrate efforts toward Improved Outcomes Illustrate how EVERYONE has a Voice, Give nursing staff and others in patient care services a greater voice in patient care The committees focus on improvements in care and patient/family satisfaction for that specific area. Clinical decisions are made at the level that they are performed. Progressive care: ESTABLISH SHIFT HUDDLES CREATED NEW WHITE BOARDS CREAED NEW BEDSIDE HANDOFF SHEET BETWEEN CATH LAB AND FLOOR FOCUS ON EDUCATION AND CREATING NEW CRITERIA FOR PCU PATIENTS Critical care: SHARED GOVERNANCE COUNCIL UNIT BASED COUNCIL ESTABLISH BEDSIDE DAILY INTERDICIPLINARE ROUNDING TO INCLUDE CASE MANAGEMENT, PHARMACY, THERAPY, DIATITION, NURSE, FAMILY AND PATIENT. CREATED COMPASSION CART FOUCS ON CAUTI IMPROVEMENTS OPEN VISITATION HOURS ER: FOCUS ON THROUGHPUT LAMINATED PICTURE EXAMPLE OFR LAB SAMPLES -FACILITATE IN CREATING SBART PROCESS FOR BEDSIDE HANDOFF WITH CNO KAREN WHITE TERVINO Cath lab: One administrative Lead (manager, director, or administrator) Unit Based council lead CREATE RECOGNITION BOX THIS ALLOWS COWORKKERS TO RECOGNIZE EACH OTHER. REHABILITATION: WORKED WITH THERAPY AND FRONTLINE NURSES TO DEVELOP INTERDISCIPLINARY CARE PLANS FOR PATIENTS One front line nurse representative from every department(ideally the unit chair) Frontline nurse lead Chair and co-chair (2yr term) Unit leader (Manager or Director), leaders provide mentorship and support to council One representative from each ancillary service departments (Education, Case management, Quality, and Supply chain) Comprised of frontline nurses ideally 10% of the unit, these nurse attend different hospital councils and report back to unit council Lessons Learned Managers need guidance on their role in Shared Governance. This will ensure the success of the Unit councils.managers are often conflicted as to how do they provide support to Unit councils without influencing the agenda Bedside nurses need clear direction and support on how to start a unit council. After council is established, the council needs consistent support from leadership Bedside nurses need small victories in order to keep the momentum and by in going of the Unit councils The organization must be committed to supporting a Shared governance model in order to succeed Important to maintain consistent policies and procedures Future Continue to mentor manager and directors to help foster Unit based council Continue to become more collaborative council with other disciplines of the hospital Continue on the Pathway to Excellence and Unit of Distinctions