Objective: In this paper we describe an intervention designed to enhance nurses’ leadership skills to improve the quality of their work environment and report the experience of nurses who applied the intervention in their practice setting.
Design: An intervention framework was developed based on the work of Nelson, Mohr, Batalden & Plume (1996), systems theory (Nadler & Tuchman, 1980), and participatory action research. Small groups of nurses worked in a team to identify a target for workload improvement. They utilized structured problem-solving and decision-making tools to identify, design and conduct small tests of change.
Setting/Sample: A total of 16 medical or surgical units from 8 randomly selected hospitals participated in the study.
Methods: A nurse facilitator in each hospital was trained in the use of the Intervention Framework. These local facilitators were assisted by a project coordinator who conducted regular site visits. The nurse facilitators worked intensively with the nursing staff for a six month period to design and implement the changes in practice. They met with the “expert trainer” and skilled project coordinators every two months to share progress and problem-solve.
Findings: Fifteen of the sixteen teams piloted a change leading to improvements in nurses’ workload. Projects included improving the supply and access of materials for care, clarification of the roles and responsibilities of unit staff, upgrading nursing skills for technologically intensive care, improving team communication, reducing workload redundancies, and assigning nursing workload based on patient acuity.
Conclusions: Nurses were empowered by the intervention. The role of the local facilitator was critical for success, as was ongoing communication with the expert trainer and coordinators. Successful projects tended to have a clear, circumscribed focus and involved the key individuals affected by the change.
Implications: The study underscores the importance of assisting nurses to chart their own course for change.
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