Engaging Frontline Staff to Create Interdisciplinary Solutions: A Formative Step toward Shared Governance

Monday, 22 July 2013: 11:05 AM

Ellen B. Buckner, DSN, RN, CNE1
Valorie A. Dearmon, RN, DNP NEA-BC1
Linda Ann Roussel, RN, DSN, NEA, BC1
Lisa Mestas, RN, MSN2
(1)College of Nursing, University of South Alabama, Mobile, AL
(2)University of South Alabama Medical Center, Mobile, AL

Learning Objective 1: 1. The learner will be able to discuss roles of academic, frontline nurses, and administrative partners in collaborative improvement process to improve bedside care.

Learning Objective 2: 2. The learner will be able to synthesize information from organizational theory and evidence-based research that impacts the process on frontline practice improvement.

Understanding the complexities of hospital work environments is a crucial first step to transforming the delivery of nursing care (IOM, 2004).   Frontline workers’ wisdom and their commitment to solutions are essential for improvement (IOM, 2010; Porter O’Grady & Malloch, 2010).  Improvement Science is an emerging science that shares common aspects with other areas of research such as implementation science, translational science, and knowledge translation. The focus of Improvement Science is on translating what is learned from research into actual practice to improve care and outcomes (ISRN, 2011). This quality initiative has global implications for addressing common problems in nursing practice.

University of South Alabama Medical Center and University of South Alabama College of Nursing participated as a first cohort in a national study “Small Troubles, Adaptive Responses (STAR-2):  Frontline Nurse Engagement in Quality Improvement (Stevens & Ferrer, 2011).  Frontline nurses identified operational failures, team vitality and measures of culture of safety.  The data collected reflected significant potential for improvement interventions from multiple disciplines (technology, pharmacy, nursing, medicine, etc.). 

Following the national study, a Frontline Innovations group was formed to identify solutions to address common interruptions of nurses’ work, test these innovations, and determine effects on quality of care.  The formation of interdisciplinary teams promoted understanding of the problems, improved communication and interdepartmental relationships. 

Early results indicate renewed staff enthusiasm, empowerment, and ownership of their practice environment secondary to having a voice. This stage is foundational for shared governance (Kear, Duncan, Fansler, & Hunt, 2012; Newman, 2011).  Meaningful change occurred as problems were solved and new relationships formed. Opportunities for transforming the culture to one of shared decision-making are evident. Participation enabled our team to become active contributors to the priority research studies of the ISRN and initiate a structure for sustained shared governance.