About eight months into her nursing career at the University of North Carolina Hospitals in Chapel Hill, Tracy J. Carroll, RN, BSN, PCCN, was asked by her supervisor if she would represent her unit on a skin-and-wound-care committee. Carroll, now a patient services manager in surgery services, had no particular interest in the topic and wondered how she would fit a monthly committee meeting into her busy schedule. Truthfully, I joined because no one else volunteered, she said.
As part of the committee, Carroll learned and shared information about the latest skin-and-wound-care products and helped gather information for an audit of wound-care outcomes. She met nurses from other units who became resources for her on topics that had nothing to do with wound care, such as renal and orthopedic issues. The hospitals skin-and-wound-care quality outcomes rapidly improved, and so did the popularity of the committee, Carroll said. Meetings once attended by 10 or 15 nurses became standing-room only, and eventually moved to an auditorium, where it drew more than 100 members, who were inspired by the committees visible successes.
It was a great first committee for me, said Carroll, who has since served on many other committees, including being chairwoman of one of UNCs hospitalwide nursing councils. The hospital really bought into the work we were doing. There are now five main nursing councils with various committees falling under them.
Committees tied to Magnet
As healthcare facilities create and develop structures for shared governance often as Magnet hospitals or with Magnet status in mind they look for ways to involve and empower staff nurses through councils and committees through which they can share ideas, voice concerns and learn new things. But for many staff nurses, the idea of listening to one more presentation or attending yet another meeting can be overwhelming and if they see no results from their efforts disheartening. Committee leaders find themselves begging for volunteers among colleagues already stressed for time. But some facilities have created systems of committees and councils that staff nurses clamor to join.
Were at the point where people vie to be on the councils, said Catherine K. Madigan, RN, MSN, NEA-BC, associate CNO and Magnet initiative co-chairwoman at UNC Healthcare. I think its a fabulous example of how when you give your staff the resources and support, they can achieve some remarkable things.
The benefits of shared governance involving nurses in their own practice long have been promoted by nursing organizations, and more recently appreciated by administrators looking at ways to improve quality and safety. When staff nurses serve on committees, they not only bring information back to their units, but they bring the concerns of bedside nurses to administrators.
Nurses who serve on committees say they understand sometimes for the first time hospitalwide goals and visions. What I do at the bedside really affects the major goals that the hospital has, said Mary Muse Shields, RN, BSN, a staff nurse on the post-anesthesia-care unit at Northwestern Memorial Hospital in Chicago and chairwoman of the hospitals pre- and postoperative-professional-practice committee.
Though shared governance is an important part of being recognized as a Magnet hospital, the Magnet program does not offer specifics on how individual facilities should structure shared governance or achieve staff participation, said Jan Moran, RN, BSN, MPA, assistant director for Magnet operations for the American Nurses Association. Facilities can share ideas online, she suggested.
Barriers to participation
Several years ago, the nursing council at the Dana Farber Cancer Institute in Boston looked at data indicating about 10% of its nurses actively participated in committees. The facilitys evidence-based-practice committee interviewed staff nurses to discover what motivated or impeded them from joining committees. Motivations included a desire to make a difference, to learn more about the hospital and professional enrichment. Barriers were mainly time and scheduling related.
Most employers dont want to pay overtime for nurses to attend meetings, and many nurses are reluctant to come in on their days off, even if they are compensated, said Kathleen Burke, RN-BC, BSN, who serves on several committees, including as chairwoman of Patient Safety Fellows, a group of staff nurses devoted to patient safety issues at the University of California San Francisco Medical Center. It doesnt seem like [taking time for meetings]would be a huge barrier, but it is, she said, especially when commute time, bridge tolls and parking fees add up. Her hospital is trying to get nursing councils up and running, but having difficulty getting enough members, she said.
Even when meetings are part of the workday, the time it takes to hand off patients to colleagues and get to a meeting on another campus or across the facility can turn a one-hour meeting into almost two hours, said Karen Schulte, RN, MSN, ANP-BC, OCN, a nurse practitioner at Dana Farber and co-chairwoman of the nursing council. Nurses may also feel reluctant to leave their unit at a busy time, or managers may be unwilling to pay for meeting time out of a tight unit budget, Burke said. Plus members often must spend additional time on projects, such as researching, gathering data and creating presentations. Its not just about getting to the meetings, its about being there to do the work after the fact, Schulte said.
Shields said she created a PowerPoint presentation for her committee at home on her own time on her own computer because there were no computers or workspaces available for her at the hospital. Though about a quarter of staff nurses at Northwestern are involved in committee work, Shields said it remains a tough sell. We just really need support, support, support from our management, she said.
At UNC, it used to be hard to get nurses to join committees or find time to meet, Carroll said. Most committees met at lunch not a huge incentive for staff nurses to join. But around the time she joined the skin-and-wound-care committee, leadership at her hospital was changing. New nursing leaders brought a strong focus to involving staff nurses in shared governance, and the hospital backed them up by paying for classes, giving nurses resources to prepare presentations and conduct audits, and working committee roles into the clinical ladder. All committee and staff meetings are scheduled for the first Wednesday of each month during a single 12-hour shift, Carroll said. All the managers are good about working with the schedule.
At UNC, new graduates generally do not participate in committee work during their first year because they need to focus on clinical training, Madigan said. But they know they are expected to eventually take on leadership roles.
Carroll said she steers nurses toward particular committees or other leadership roles, such as mentoring, based on their interests. Everybodys got something theyre good at, she said. Knowing what that is helps to get people more involved.
Based on the results of its participation study, Schulte said, the Dana Farber nursing council worked to make meetings more accessible by using teleconferencing, keeping committee documents in an accessible web folder and opening membership to anyone who could attend, rather than designated representatives only. The council is looking at using web-conferencing and holding quarterly meetings in four-hour blocks, allowing time for discussion and work on projects. The council also has learned about the importance of communicating meeting times and places to the nursing staff in a number of different ways and plans to start posting meeting times on a large bulletin board calendar, as well as on its website and through email reminders.
At Northwestern, administrators attend meetings to facilitate and offer resources such as clerical support to take some of the burden off staff nurses, said Jill Rogers, RN, director of professional practice and development at the hospital. Northwestern also blocks out a monthly shift of same-day meetings for leadership committee chairmen and chairwomen, and sets a two-year term limit for committee membership, which can make a commitment seem more manageable and provide a constant flow of new faces and ideas, she said.
Some organizations create separate funds to pay for nurses to attend committee meetings so that does not come out of bedside care budgets.
Perhaps the greatest incentive for staff nurses to join committees is a sense of working with colleagues to make real improvements to patient care, committee leaders say. To this end, Schulte recommends heavily publicizing committee studies, initiatives, educational efforts and other projects that motivate nurses throughout the hospital to think, I want to be a part of this.
When Carroll saw her hospitals scores on wound care improve as a direct result of her committees work, she realized the hours spent in discussions with colleagues were a crucial part of her nursing duties. This is just as important as giving out medications, she said, because we are truly making a difference in patient care.
Cathryn Domrose is a staff writer.