Angela Creta, MS, RN-BC, CNL, Magnet coordinator at The Miriam Hospital, Providence, RI, described how nurses are introduced to the culture of shared governance at her facility, which recently received its third Magnet redesignation.
"The surveyors take a close look to be sure nurses who work overnight or off-site are involved and engaged," she said. "Shared governance is not a separate program here at The Miriam and being engaged is not just a nice thing - it's an essential component of professional nursing practice."
Heart of Shared Governance
That expectation is described during the interview process, and reinforced during orientation and the nurse residency program.
"We challenge them to participate in decision-making, no matter what shift they're on or what their level of experience is," Creta said. "We ask them to become involved as a formal part of their unit-based councils, or to push forward nursing practice issues."
With a year of practice under her belt, night nurse Amy Krajewski, BSN, RN, has joined colleagues from other units to develop a nursing protocol for treating hypoglycemic patients.
"Nurse managers encourage professional development conversations - if you want your voice heard, let us know what topics interest you the most," Creta said.
When she first accepted the position as chief nursing officer and vice president of patient care services at Monmouth Medical Center, Long Branch, NJ, an affiliate of Saint Barnabas Health Care System (SBHCS), Diann Johnston, MSN, RN, NEA-BC, resolved to engage all nurses in the decision-making process.
"Managers struggle with involving nurses from all shifts, but the model unit-based council on our oncology unit has every nurse actively engaged in projects that impact the work environment and patient care," she said. "These projects help them move along our clinical ladder, as well."
Darla Malaspina, MSN, RN, OCN, clinical director of oncology, described the history of the council. "I don't like to hear nurses say, 'I'm just a bedside nurse,' so a couple of years ago, I came up with a way to engage night nurses along with their day-shift colleagues," she said. "Today, 100 percent of my nurses are involved in a nursing committee of their choosing, covering everything from patient safety to patient satisfaction."
In addition to sharing minutes from their councils, the nurses plan and execute initiatives, making sure changes are sustainable. Vilma Palisoc, BSN, RN, the unit rep on the Falls Prevention Committee, developed a unit-specific fall risk assessment, gave a video presentation on fall risks, presented new best practices, and arranged for a representative to demonstrate bed alarms and bed pads. She'll soon present the program at local senior centers and assisted-living facilities.
Geri Tamborelli, MS, BSN, RN, nurse director for the NICU and Family Birth Center at Maine Medical Center, Portland, acknowledged, "While it can be a challenge to keep night and weekend nurses engaged and involved in the organization, the 12-hour shifts most of our nurses work make it a little easier. As a Magnet-designated hospital, we encourage all of our nurses to be part of the meetings, committees, performance improvement teams, tasks forces and other shared governance activities."
The clinical ladder at Maine Medical Center rewards participation in the nursing community.
"During our annual performance reviews, we find out what our nurses are interested in, such as patient satisfaction or quality improvement, and mentor them in that interest," Tamborelli said. "Andrea Farrar, RN, one of our NICU night nurses, has a baby of her own and we provided tuition reimbursement so she could get certified as a lactation counselor. She now offers a breastfeeding support group for our NICU moms once a week."
Maura McQueeney, MPH, BSN, RN, NE-BC, director of professional practice and outcomes, Middlesex Hospital, Middletown, CT, described how night nurses are an integral part of the shared-governance structure at her three-times-designated Magnet facility.
"The greatest opportunity is at the local level, where unit-based councils led by bedside nurses meet monthly to work on relevant improvements in patient care, work environment, nurse-sensitive outcomes and staffing," she said. "These meeting times are rotated so night-shift nurses can participate."
Night nurses may also be designated by their units to serve on the nursing department's Professional Practice Council and its subcommittees. "I'm also a Magnet appraiser, and one of the best examples I've seen of engaging night-shift nurses is a Night Shift Council," McQueeney said.
As White Plains Hospital Center embarked on its Magnet journey, Joan Kelly, BSN, RN, a night staff nurse in the White Plains, NY, ICU, championed a Night Council and today serves as recording secretary. Eighteen months later, the group has already tackled a number of issues specific to off-shift nurses.
"It's given us a phenomenal voice we've never had before," she said. "We've worked with staff development to provide educational roundups and inservices immediately before or after our shifts. We're gathering information from all nursing units about issues with the pharmacy and will collate those findings and present them."
Breaking Down Silos
Suzanne Courtwright, MS, RN, CPNP, director of patient care services for pediatric units at the Children's Hospital of New Jersey at Newark Beth Israel Medical Center, a SBHCS affiliate, is particularly proud of the way PICU night- and day-shift nurses collaborate around patient presentations during rounds.
"Night nurses communicate any questions and concerns to their day colleagues," she said. "The day-shift nurses take the input to rounds and then share outcomes from those rounds with night nurses. When Maryjean Kelly, BSN, RN, pediatric nursing staff educator, presented this initiative in a poster presentation during SBHCS Quality Week, the team was the overall winner for Best Poster Presentation."
Courtwright described a number of initiatives that engage night and weekend nurses. "Yvonne Tecson, BSN, RN, volunteered to chair our Wall of Fame Committee as part of our employee satisfaction committee," she said. "The wall highlights pediatric nurses certified through AACN, and also has a large area to publicly acknowledge nurses who have received accolades from patients and families.
"The night nurse carries out the protocol, including a CPAP trial, and informs the day nurse of the results," Courtwright said. "This initiative moves the patient toward extubation quicker and reduces the risk of complications."
As a former night-shift supervisor and staff educator, Barbara Popkin, MA, RN, is well aware nurses on nights and weekends can feel isolated at times. Currently associate executive director of patient care services at Franklin Hospital in Valley Stream, NY, an affiliate of North Shore-Long Island Jewish Health System, Popkin joins the hospital's executive director in quarterly town hall meetings around the clock and monthly night shift rounds.
"We inform the staff about our metrics - patient satisfaction, operations and quality," she said. "This is an opportunity for the staff to speak directly with senior leadership. In addition, all nurse managers and directors work one night per month . to share information and concerns and develop relationships."
Assistant director of nursing Veronica Lopez, BSN, RN, mentors a group of assistant nurse managers who work the night and evening shifts, hosting a monthly meeting. Evening and night-shift nurse educator Peggy Mosono, MSN, RN, facilitates staff committees for those shifts and is responsible for real-time education. Twice a month, a nurse educator presents Saturday programs for weekend staff.
Director of nursing education Lisa Chung, MA, RN, described how RNs on the Collaborative Care Council keep their colleagues in the loop. "Each nurse goes back to communicate outcomes and minutes to nurses on all shifts," she said.
Nicole Walsh, BSN, RN, a clinical leader on the surgical floor at Mount Auburn Hospital, Cambridge, MA, rotates between the night and day shifts. "We have a unit-based council which includes two day/night rotators," she said. "Our meetings are scheduled midday so they work for everyone, and staff meetings are scheduled at 7 a.m. and again at 3 p.m. for everyone's convenience."
Walsh chairs the nursing department's Research Council, bringing some unique perspectives from her off-shift experience and serving as a role model to other night nurses. "They notice [what I do] and know they can advance within the organization, as well," she said.
Walsh appreciates the night-shift supervisors and senior leaders who have a strong presence on her shift. Deborah Baker, MBA, BSN, RN, vice president of patient care services and chief nurse executive, collaborates with Michael O'Connell, vice president of marketing and strategic planning, to schedule free meals once a month on the night shift.
"[That] gives us a great opportunity to interact with nurses and other staff on that shift," she said. "We also award a candy-filled trophy to the night staff on the nursing unit with the most-improved noise scores. We talk with them about their improvements, learn what strategies are working and share those ideas with other nursing units."
Sandy Keefe is a frequent contributor to ADVANCE.