Culture of Inquiry and Innovation

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Shared Governance Across Two Campuses

2020 brought significant change in our world, and one of the first changes was our integration between two campuses, Montlake and Northwest. Work started in 2019, as work groups set out to align all of our nursing policies. As a result of intentional work 4 years ago, the Northwest campus had a very similar professional practice structure to the Montlake campus. This was fortuitous for the integration work.

Local Practice Councils, Clinical Nurse Specialists and others communicated regularly during 2019 to combine policies. When the integration became official on January 1, 2020, it was time to start living into our new world as one medical center with two campuses. An important undertaking was the joining of the two Professional Practice Councils. We updated our bylaws to reflect new agreements and a new structure and began meeting as a larger group in the summer of 2020. We now have staff RN co-chairs from each campus, and fluidly plan agendas and rotate the chair position.

The discussions have been robust, especially as we worked through the challenges of COVID. Some projects that the PPC worked on included Healthy Work Environment, supporting resilience during a pandemic, and preparing for the Epic rollout in early 2021. We look forward to working together for many years to come.

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Committee Leadership: "What it Takes" Workshop

Shared governance structures empower nurses to step into leadership roles. However, clinical nurses are seldom prepared for leadership positions and often feel inadequately trained to succeed and lead meetings, fellow members and successors. Therefore, a workshop (pdf) was designed by two bedside nurses who sought outside training to develop and teach the content.

The workshop's goal was to enhance clinical nurses’ leadership skills and prepare them to be proficient, knowledgeable and empowered in their leadership roles. Effective meetings allow nurses the space to evaluate current nursing policies and procedures to improve practice at the bedside. The workshop taught strategies to prepare for a meeting, lead a productive meeting and which specific tasks to complete after a meeting. Participants learned best methods to take meeting minutes and notes and how to communicate during meetings effectively.

The 4-hour workshop was attended by nurses (n=37) with varying levels of expertise and comfort in their leadership roles. Surveys were administered to assess how knowledgeable and prepared they felt in their role before, immediately after, and 6 months after the workshop. Survey results immediately post-workshop demonstrated a statistically significant difference, showing increased confidence in skills to lead a productive meeting (p<0.001), confidence in skills to take meeting minutes and notes (p<0.001), confidence in effectively communicating during meetings (p=0.004) and confidence in current leadership skills (p=0.001). The survey results at 6 months are still in progress.

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Research and Evidence Based Practice

UWMC nurses remain leaders in our community in advancing the care of patients and supporting care providers through ongoing research and evidence-based practice initiatives. What is most exciting about this extraordinary work is that it is being led by direct care nurses with the support of our Clinical Nurse Specialists, Educators Researchers, and senior leaders.

UWMC Nurses are Advancing Care for Our Most Vulnerable Patients:

• Carri Gest, MN, RN, Assistant Nurse Manager of the Neonatal Intensive Care Unit, completed an education project targeting the prevention of low body temperature in neonates less than 32 weeks of age. This multidisciplinary project aims to optimize temperature management from the time of delivery to transfer to the NICU. Additionally, the clinical nurses supported by the Clinical Nurse Specialist have begun a staged intervention with evidence-based environmental stimulation for neonates to enhance their development.
• In the Post-Anesthesia Care Unit, a team of clinical nurses, led by Dana Scharfenberg MN RN, OCN evaluated the effectiveness of an ice pack to the back of the neck to mitigate post-operative nausea. This work (see poster below) found that this seemingly simple (and inexpensive) strategy was associated with decreased nausea. The team has shared this work across UWMC and our community and have written a manuscript that is under review in a national journal.
• The Intravenous (IV) Access team created an innovative teaching tool to enhance confidence and success with placing peripheral IVs (see their poster below). The team of expert clinical nurses, led by Kelly Gardner, BSN RN conducted a hospital wide survey to assess the need for this intervention and created a training tool (accessible using a QR code) that takes the nurse directly to step-by-step procedures and a video on techniques used by expert nurses. Consistent with our culture of inquiry and constantly asking the question “are we making a difference?”, the team is planning a follow-up survey to describe the effect of the training tool on nurse confidence with inserting peripheral IVs. As nurses become more confident, they can contribute their own perspectives to this nurse driven resource and continue to help the next generation of nurses with this skill and enhance patient care.
• In 2020, Nathan Dreesman, PhD, RN, a clinical nurse, completed his PhD in nursing science. During his doctoral program Nate completed a study exploring the pain experience in four individuals who donated a kidney (living kidney donor). In addition to their descriptions of their pain experience, these individuals also talked about what motivated them to donate, their expectations, as well as the impact of social support on their experience. This study provides insight into this unique experience and may inform future research to optimize the experience for these individuals as well as develop strategies to motivate others to give this gift of life.

UWMC nurses – Enhancing Well-Being and a Healthy Work Environment

The onset of the pandemic brought new challenges and new opportunities. A major emphasis has been on the well-being of the entire care team. The ongoing work at UWMC to maintain resilience and mitigate the risk of burnout in care providers has taken on even greater importance. This work, which based on a large body of research and evidence, is led by Marie Cockerham MN RN, CCRN (Support Specialist/CARE4U Program Director) and Mia Baumgartner, MDiv, MNPL-BCC, Director, Spiritual Care who collaborate with teams of nurses across UWMC. Nursing units throughout the hospital have actively engaged in the “Three Good Things” initiative under the direction of Mia Baumgartner. This evidence-based innovation asks individuals to daily recall 3 Good Things that occurred during the day and their role in the event. The nurses have integrated this activity into daily huddles, where they call out 3 Good Things, they see their colleagues doing. The teams have studied the effects of this meaningful recognition and outcomes of this initiative include increased professional fulfillment and increased empathy towards patients and coworkers.

In 2019, the UWMC nursing team implemented a 21-day “Choose Happiness” challenge in for all hospital staff. Research demonstrates that this innovation is associated with increased professional fulfillment, decreased work exhaustion, interpersonal disengagement, and burnout by rewiring the brain to see and think the positive around us. The challenge involves performing an activity for 21-days.

Pre- and post-surveys demonstrated a significant decrease in emotional exhaustion, interpersonal disengagement, and burnout and a significant increase in professional fulfillment in those who participated in the challenge. Based on positive feedback from staff, the “Choose Happiness” is now a yearly challenge with boosters offered throughout the year.

Unit 6SE (the acute care unit caring for patients with COVID-19) has taken lessons learned from an innovative team staffing model used to care for patients in isolation and applied it to support new graduate nurses as they begin their careers. In the COVID19 area, a unit-based nurse was paired with an RN extender (a nurse from another area of the hospital) to increase nursing availability to patients by allowing the team members to split nursing care. For our new grads caring for other patients on the unit, an experienced RN was paired with the new grad to support them as they develop their skills in prioritization, critical thinking, collaboration, resource finding and developing healthy work habits (e.g., taking breaks). Under the direction of Nichole Gogna MN RN – Nurse Manager the nurses on the unit created a self-assessment for RN extenders (pdf) related to the care being provided on the unit, crafted Purple/Gold team assignments and through repeated assessment refined the ideal flow for care and created practice pearls specific to the care setting (COVID19 area/new grads). The team has followed up with all of the nursed involved to continually refine the process. They are also exploring the impact of this innovation on RN satisfaction and intent to stay and patient outcomes. This remarkable team of nurses took on the challenges associated with the pandemic and have turned it into a strategy to enhance our healthy work environment for nurses and patients.

Sharing Innovation Across Our Community

UWMC nurses share their research, evidence-based practice, and innovations not only within the hospital, but across the community. Each year, teams of UWMC nurses present at the Seattle Nursing Research Consortium conference. The strong quality and importance of their work was reflected in UWMC receiving awards for the Best Research Poster and the highly sought after “People’s Choice Award”, which is selected by peers. These awards are based on the quality of the science, innovation, impact, and presentation.

• Best Clinical Research Poster: Managing Post-Operative Nausea with Application of Ice to the Neck (pdf) - Dana Scharfenberg MN RN, OCN, CPAN
• People’s Choice Award - Poster: Peripheral IV insertion demystified: A Training Tool to Improve Nursing Confidence with Peripheral IV Insertions (pdf) - Kelly Gardner, BSN RN

In 2020, the 31 posters and presentations from UWMC nurses demonstrated the strong mentorship and growth of UWMC nurses in using evidence to drive forward exceptional practice – ensuring that we are providing the highest quality care. Examples of this work, includes optimizing the patient experience, enhancing communication across the continuum of care, optimizing life-saving interventions, decreasing the risk of infections, and advancing a culture of shared governance. Additionally, this work reflects innovative strategies to create a healthy work environment to where our nurses receive meaningful recognition and enhance their own well-being. This work demonstrates the extraordinary commitment of teams of nurses across UWMC.

From direct care at the bedside to care across our community, UWMC nurses exemplify our mission: “World Class Healthcare by World Class Nurses.”

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Hester-Davis Go-live

UW Medical Center is passionate about preventing falls. Falls in the hospital are serious safety events that can cause injuries, increased length of stay, disability or even death. UWMC collaborates with UW Medicine hospitals to standardize the fall prevention risk assessment tools, interventions and outcome goals. The goal for acute care is to have a fall with injury rate less than the NDNQI (National Database of Nursing Quality Indicators) quarterly mean. To achieve this goal, each unit may have no more than one fall with injury per quarter. Although UWMC is uniquely challenged to prevent falls due to an increasingly complex patient population, assessing fall risk and preventing falls with injury protects our very vulnerable patient population and is our priority.

In early 2020, as part of the work of the Falls Prevention Committee, UWMC adopted the Hester Davis Fall Prevention Scale & Program (HDS). HDS is an evidence-based risk assessment and care planning tool and education package that engages staff members to individualize interventions to prevent falls. The program has five distinct elements:

• Training
• Signage
• Tools
• Auditing performance
• Evaluating performance and sustaining gains

Super users were recruited, new whiteboard templates were created and installed, and by go-live, more than 90% of all nurses and nursing assistants had completed the program-specific training.

In addition to the new whiteboard templates, other tools developed include role-specific LMS training modules, interdisciplinary team training, and a new post-fall huddle and process.

Our bedside nursing staff and leadership continue to support fall prevention efforts and patient safety. Monthly auditing of HDS scoring accuracy and completeness of interventions continue to shape educational opportunities, and areas of fall prevention focus on the unit level. We’re very proud of the impact of professional nurses in fall prevention.