Shared governance, the engagement of frontline nurses in the decisions that impact the work environment and patient care, is a critical component of nursing excellence. Involving frontline workers in the decisions that impact their work started in the automotive industry and is definitively recognized as the best methodology to enhance the work environment and improve outcomes. UAMS has had a shared-governance structure since around 2010. It has had several iterations, but nursing has had a venue for bringing things forward and working on issues for around 15 years. Currently, we have 2 nursing shared governance councils: Inpatient and Ambulatory NQUEST (Nursing Quality Experience and Safety).
Historically, the nursing shared governance councils have been impactful in decisions at the organizational level. For example, a few years ago, cost-savings decisions led to changing to a less expensive PIV catheter. The catheter was trialed on a few units and superusers were trained and education was rolled out to all the units and ambulatory care areas where IVs are common. Reports of concerns quickly began to surface. The catheters were the topic of discussion at several council meetings. Nurses began to gather data, make reports, and voice concerns about the inadequacies of the new PIV catheters. The members of the council made recommendations to change back to the former PIV catheter. With the data and the resounding voice of nursing calling for changes, the decision was made to change back to the previous PIV catheter. This is what is possible with a shared governance structure firmly established in an organization.
Over the last few years, we have seen a dramatic decrease in engagement and participation in the Inpatient NQUEST council. It lingered long after the impact of COVID and was in direct opposition to the Ambulatory Council, which has engaged in very meaningful work to improve emergencies/code response in ambulatory areas, developed a schedule and process for mock codes in the service lines, and implemented bar code medication and patient scanning in several clinics. The nursing leadership recognized that a reinvigoration of the council was in order and put a call out to the units, announcing a special session of the Inpatient NQUEST for just clinical RNs and nursing leaders. This week, we had our 2nd special session for reinvigoration of the Inpatient NQUEST council, and the response was overwhelming. We had over 20 frontline RNs at the roundtable representing nearly every inpatient unit and the inpatient nursing directors and Tammy Jones, Chief Nursing Officer in attendance. Every RN brought forward one question, concern, or topic to the council. Topics included:
Smaller, Easier
- Controlled substance monitoring/counting
- Access to Consent Forms
- Unit Access/Visitation-cutting through the E units
- Training deficiencies and Training Tracker
- Correct/available lab tubes
- Calling rapid response after a fall
Bigger, Moderate
- Continuity of Care/Pre-procedure, Pre-op
- Unit Access/Visitation – wandering visitors into units after hours
- SANE support on the units
- Delegation of Tasks/PCT
- Bulk room changes/standardization
- USGPIV versus Vein Finder
Biggest, Long-term
- Mobility tech trial
- AI technology
- Environmental consciousness
- Patient flow – transferring patients from ED and PACU to floor
- Workplace Violence/Hostile Work Environment
Updates or resolutions will be presented at the next council meeting in September on several of these topics. Your nursing leadership is committed to addressing your concerns and improving system/organizational challenges that make your work complicated. We can’t address what we don’t know about. Have an issue you want addressed? Ask your leader about who your unit/clinic/service line representative is to the Inpatient and Ambulatory NQUEST councils. Shared governance is your opportunity to be heard, informed and empowered.
