A shared governance organization is flat, flexible and decentralized. The structure supports innovation, relationship building and strategic planning. Its nurses grow, engage with the community and contribute to the strength of the organization.
Shared governance has been in place at MacNeal Hospital for nine years through our Council Structure with a Coordinating Council, Hospital Councils and Unit Councils.
The governance of nursing at MacNeal is shared between direct-care nurses and nursing leadership. Because the voice of the staff nurse is critical to our success, it made sense for us to elect a Nursing Staff President to oversee this structure. The idea came from a staff nurse, Diane Mahalko, RN, who attended the National Magnet Conference in 2006. The idea resonated with all of us, and we adopted this innovative idea and elected our first Nursing Staff President. Together the President collaborates with the CNO to keep the powerful engine of shared governance running, especially in the areas of practice; education; quality and safety; recruitment, retention, and recognition; research; and evidence-based practice.
At the start of Fiscal Year 2011, we began the two-year term of the fourth Nursing Staff President Deborah Robbins, RN. The President-Elect, Erika Hernandez, RN, BSN, CMSRN, CVRN, will step into her role after working side-by-side with Deb for the next two years. Each of Deb's predecessors has left behind a legacy of accomplishment for the nursing staff.
As the first Nursing Staff President, Christine Carsten, RN, MS, CNOR, blazed the trail and worked with others to develop the bylaws of the nursing staff and began the traditions of quarterly meetings. The second Nursing Staff President Erica Hess-Martinez, RN, BSN developed the Coordinating Council, which brought together the Chairman and Chairman-Elect of each Council for a monthly discussion of Council work which encourages coordination and support. This took the shared governance structure to a more organized and professional level.
Pat Peck just finished her term as the third Nursing Staff President. Pat invested in the quality and development of Council leaders, developed an orientation for staff nurse leaders and was well-known in as a valuable voice for staff nurse leadership. Under Pat's leadership the relationship with the medical staff elected leadership was strengthened. Pat also developed communication guidelines for nurses and physicians and organized preparation classes for board certification exams.
We wish Deb the best as she makes her imprint as the newest Nursing Staff President at MacNeal Hospital.
The Coordinating Council is an integral part of the shared governance structure. It coordinates the efforts of the nursing Councils; provides oversight, support and guidance to the Councils; and serves as a vehicle for communication between Councils. The Nursing Staff President assures that the accountability of the Coordinating Council are fulfilled. The President is the chairperson for the Coordinating Council, represents the Council and nursing staff and acts on its behalf.
The Coordinating Council meets once a month and all Nursing Council Chairpersons attend along with their facilitators to report on the progress of their Councils. The CNO is also present along with the Director of Professional Practice.
The Coordinating Council gives the Nursing Council chairpersons an opportunity to share their successes as well as any obstacles they may have with projects or events, and receive feedback and advice. The Coordinating Council also affords Nursing Councils the opportunity to collaborate on projects or events. The President organizes feedback about the shared governance structure for the report to the nursing staff.
Professional Practice Council
This Council defines, implements and maintains the highest standards of clinical nursing practice consistent with national standards of practice promulgated by the appropriate national organizations. Recent accomplishments include the following:
- Clinical Advancement (CA) is a reward program developed for nurses that choose to remain in direct patient care. Credit is given for professional development activities and contributions towards improving the nursing profession and patient outcomes above and beyond normal job expectations. MacNeal Hospital has had a Clinical Advancement Program since 2006 and in 2010 progressed from an optional three-level program to a five-level ladder that includes all nurses from the moment of employment throughout their career at MacNeal Hospital. The highest level includes specialty board certification. The Professional Practice Council provides leadership to this program.
- Nurses are supported in the CA process through workshops for resume writing, development of Power Point presentations, assistance in writing exemplars, Microsoft Word training and poster presentation development.
- Direct care nurses on the Professional Practice Council review approximately eight nursing policies a month to assure that their practice is evidence based, efficient and effective that result in the best patient outcomes.
- Discussion about and recommendations for prevention of needle sticks resulted in a new product trial and product change.
- Professional Practice was instrumental in the selection process of the outstanding Physician of the Year Award, based on staff nominations in collaboration with the Nursing Staff President.
- Professional Practice worked closely with the Emergency department to improve the hand-off process and bed availability with the goal of improving customer service and staff satisfaction and relationships.
This Council devises measurement tools, previews and compiles data and makes recommendations for improvement in patient care. Recent accomplishments include the following:
- Streamlined the on-going quarterly tracking and reporting of nurse-sensitive quality indicators by individual clinical areas with a schedule for National Database of Nursing Quality Indicators (NDNQI) and Non-NDNQI units alternating.
- Hosted a successful Quality and Safety Fair featuring unit-based performance improvement projects in November 2009.
- Quality Day is a monthly meeting established for the Quality Council members that included guest speakers, networking between Council members, Council member time on the individual units for data collection, action plans and communication to the unit staff. The day ends with the Quality Council Meeting. Quality Day has been a valued addition to the operations of the Council and has evolved our quality work exponentially. Some of the speakers this year included dietician Jill Whitney, MS, RD, LDN, CNSD who discussed dietary screening, chart audits and the nutrition consult process. Maureen Gardner, RN, MSN, APN, was also a guest and discussed her role on MacNeal's discharge improvement team. This team is addressing readmission of patients with congestive heart failure and pneumonia in less than 30 days. Maureen outlined what the team of nursing, medicine, social service and case management had uncovered to this point and the plan going forward to create a smooth transition to home.
- The nursing clinical peer review project was launched as a pilot in three areas BHS, Birth Center and ICU. These groups review clinical cases and provide feedback to their peers to improve practice and make system changes. The members were nominated by their peers, and were given a day of education to prepare them for their new role.
- In January 2010 the Council worked as a team to work on noise control to improve the patient experience.
- Although patient falls that occur at MacNeal hospital are below the national benchmark, an increase in falls with injury prompted a Council effort to look again at falls, specifically the patient population with alcohol or substance withdrawal. Practice changes were made to reduce falls amongst this patient group.
This Council defines educational needs on a division and departmental basis and plans an annual education calendar. Recent accomplishments include the following:
- Holding an Annual Skills Fair for RNs and Patient Care Technicians with more than 600 caregivers in attendance. The booths are interdisciplinary and interactive.
- Hosting an all-day seminar on topics that are chosen by the direct care nurses 1-2 times a year.
- Revising the Direct-Care Nurse Educational Assessment Survey.
- Distributing the Educational Assessment Survey to direct-care nurses to determine educational needs for the coming fiscal year. Used the assessment to select the all-day seminars.
- Assisting the Recruitment, Retention and Recognition Council with Nurses' Week activities.
Recruitment, Retention and Recognition Council
This Council focuses on attracting, retaining and rewarding nurses. Recent accomplishments include the following:
- The DAISY Program awarding outstanding nurses continued to grow and strengthen. Each quarter, nurses were recognized for their outstanding and compassionate care by peers, patients and patients' families. During Fiscal Year 2010 more than 100 nurses were nominated and 12 nurses received the honorable award. To learn more about the DAISY program go to: http://www.daisyfoundation.org/
- Barb Schuch, RN, BSN, C-EFM, (co-chair at the time) participated in MacNeal's Nurses' Week task force and incorporated many of the ideas into MacNeal's own Nurses' Week celebration, including hosting a guest speaker. Using Evidence to Shape Public Policy: How Health-Related Research Saves Lives was presented by Dr. Diana Hackbarth, RN, PhD, FAAN, who spearheaded the policy changes that made Illinois smoke-free.
- Celebrating our Patient Care Technicians (PCT) by hosting an annual PCT Day. This year it occurred on September 25 and was well attended. PCTs were treated to gifts, games, education and, of course, lots of food.
- The Council spearheaded a "Unit of the Month" program which included a banner for the honored unit, pictures of the unit displayed by the cafeteria and a meal delivered to the unit for all to enjoy.
- Helping promote NDNQI nurse survey participation through our members.
- Hosting the Barnes Family (founders of the DAISY Award).
Evidence-Based Practice Council
This Council encourages and facilitates evidence-based work. Recent accomplishments include the following:
- Hosting multiple Journal Clubs where nurses read current research journal articles and discuss practice at MacNeal Hospital.
- Literature searches are often conducted by the Council: Comparing Traditional and Disposable Bed Baths in Critically Ill Patients; Preoperative Fasting Duration and Medication Instruction: Are we Improving and Reducing Sitters in the Hospital for Confused Patients?
- The Council developed a new educational tutorial on evidence-based practice which was rolled out in Fiscal Year 2011.
- 42S held a Journal Club in December 2009 on Bedside Report.
- In addition, literature searches were conducted by the Council: Comparing Traditional and Disposable Bed Baths in Critically Ill Patients; Preoperative Fasting Duration and Medication Instruction: Are we Improving and Reducing Sitters in the Hospital for Confused Patients?
- The Council developed an educational tutorial on evidence-based practice to be rolled out in Fiscal Year 2011.
- The "Did You Know?" boards continue to be updated with articles on the individual units.
- Ebsco/CINAHL classes were offered twice each month for nurses in coordination with the health resources librarians.
- A new online journal club was created to increase nurses' ability to take part at a time convenient to them.
This Council encourages and facilitates research. Recent accomplishments include the following:
- Research studies done by Council members are presented quarterly at the Nursing Quarterly Meeting.
- In July 2009, a tutorial on What Research Is For Nurses at MacNeal was presented. Using Power Point and visits to unit meetings, this tutorial exposed nurses to the purpose of the Research Council and an overview of the Institutional Review Board.
- The Research Fellows Program was redesigned to ensure that all researchers have successfully completed Ethics Training for Human Subjects.
- InQuest newsletters were distributed explaining how historical research is valuable in evaluating pandemics such as H1N1; describing the AMSN Failure to Rescue project; data collection strategies and expanding on the data analysis strategies used in the BP research project by Afrodita Salievska, RN, MSN, APN.
- MacNeal Hospital hosted the Regional Research Consortium on October 29, 2009. The Research Committee and Fellows presented and helped facilitate the meeting.
- A research tutorial for all nursing staff was distributed via an e-learning tool. The tutorial used the story of Cinderella to convey key terms and strategies in conducting nursing research.
The Magnet Council supports activities to achieve the Magnet accreditation. Fiscal Year 2010 accomplishments included the following:
- Hold a recognition day to honor all board certified MacNeal nurses and encourage new certifications on National Certification Day, March 19.
- Assisted and encouraged staff to become board certified in their specialty area, as well as promoted higher education, specialty certification and participation in professional organizations.
- Helped promote and educate our peers about Career Tracker, a database that helps nurses track their professional development.
- Promoted participation in the Q12 survey that measures nursing engagement at MacNeal.
- Did a SWOT analysis for the nursing strategic plan.
- Magnet champions encouraged participation in NDNQI nurse satisfaction and increased participation from 86 percent to 92 percent.
- Did poster presentations for staff nurses on the Image of Nursing, Scope and Standards for Nursing Practice and the Nursing Practice Act.
- Updated staff regularly through bulletin boards and presentations.
- Developed each unit's unique story with a scrap book and each nursing unit developed a "welcome" theme for patients and families.
- Collected stories and began writing the Magnet document.
This Council is a Shared Governance Council for leaders to develop projects and set the agenda for human, fiscal and material resources as well as operational systems. Fiscal Year 2010 accomplishments included the following:
- Performed unit-based SWOT analyses in each nursing area.
- Created the Fiscal Year 2011 nursing strategic plan based on the unit and the Council SWOT analyses.
- In collaboration with the Professional Practice Council, the Council on Leadership worked to evolve the Clinical Advancement Program.
- Advocated for and achieved funding of continued BSN cohorts and the MSN cohort.
- Supported and educated the new emerging leaders for 2010 which helped develop talent internally.
Advanced Degree Council
This is a new Council composed of MacNeal nurses with master's degrees in nursing. Fiscal Year 2010 accomplishments included the following:
- Expanded the scope of the Advanced Practice Nurse at MacNeal Hospital.
- Coordinated Council member participation in nursing professional practice development projects.
- Engaged Council members as providers of education (clinical instructors, educational offerings, community).