Culture of Inquiry and Innovation
UWMC Professional Practice Structure | Our Shared Governance
Relationship Based Care is our model of nursing. This model emphasizes the relationship with self, coworkers, and the patient/family, based on work by Mary Koloroutis, MSN, RN
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The Professional Practice Council (PPC), Local Practice Councils (LPCs) and Unit Practice Councils (UPCs) are the central structures by which nurses come together from within and across the medical center campuses to define and guide professional nursing practice. These councils are an example of shared governance, where bedside nurses and leaders collaborate to improve care. The PPC reports to the Nursing Executive Council (NEC). Information flows between these levels of councils in both directions.
- UPC – Focuses on improvement projects for one unit.
- LPC – Focuses on improvement projects for a specialty area in nursing (ICU, Med-Surg, OR, etc.) and support the UPCs.
- PPC – House wide committee (both campuses) that oversees nursing policies and supports the councils. Made up of LPC co-chairs and more.
- NEC – Oversight council for nursing quality & practice with bedside RNs and nursing leaders.
Northwest campus LPCs
- Critical Care/ED
- Med-Surg
- Periop
- Procedural
- Infusion
- CBC
Montlake campus LPCs
- ICU
- Med-Surg
- Perianesthesia
- OR
- Procedural
- Oncology
- MIC
- NICU
Joint Councils
- Education
- Advanced Practice
- Clinical Informatics
- PPC
National Contributions to Research, Evidence-Based Practice and Sharing of Innovation
Nurses play a critical role in disseminating evidence, influencing national best practice guidelines, sharing innovation, and supporting and inspiring nurses across the country. University of Washington Medical Center nurses make an incredible contribution on a national level in a multitude of ways. Some examples include:
Zahra Ali, BSN, RN, TNCC
- Co-author: Ali, Z. et al. (2021). Physician and patient perceptions on randomization of treatment intensity for unfit adults with acute myeloid leukemia and other high-grade myeloid neoplasm. Leukemia, p.1-4
Amadae Breaux, MSN, RN, NPD-BC, CCRN-K
- Author: Breaux, A. (2021). Nurse extender orientation program: Transitioning displaced staff to support acute care nurses in response to COVID-19. Journal for Nurses in Professional Development, 37, 315-316
- Co-speaker, (Breaux, A., Smith, M., Covel, S. & Constantino-Shor, C.) Association for Nursing Professional Development Annual Conference, virtual: Bend but don’t break: The role of the NPD practitioners in a global pandemic, August 2021
Elizabeth Bridges, PhD, RN, CCNS, FCCM, FAAN
- President of the American Association of Critical Care Nurses (AACN), July 1, 2020-June 30, 2021
- Co-author: Cordoza M, Thompson H, Bridges E, Burr R, Carlbom D. (2021). Association between target temperature variability and neurologic outcomes for patients receiving targeted temperature management at 36°C after cardiac arrest: A retrospective cohort study. Therapeutic Hypothermia and Temperature Management, 11, 103-109
Nancy Colobong Smith, MN, ARNP, CNN
- Director, American Nephrology Nurses Association Board of Directors, 2021
- Author, Chapter 47: Assessment of Kidney and Urinary Function.Brunner & Suddarth’s Textbook of Medical-Surgical Nursing, 15th Edition, 2021
- Nephrology Nursing Journal Editorial Board, 2021
Cheri Constantino-Shor, MSN, RN, CRNI, CMSRN
- Speaker, Infusion Nurses Society Annual Conference, Las Vegas, NV: Diffusing healthcare violence, August 2021
- Speaker, American Psychiatric Nurses Association Annual Conference, virtual: Finding meaning and resilience in healthcare amid crisis, October 2021
Sydne Mead-Smith MSN, RN, OCN, Priyanka Devgan, RN, MBA, OCN, Irawati Lam, BSN, RN, OCN, et al.
- Poster, Oncology Nurses Society Annual Conference, virtual: The Development of a Multidisciplinary Care Team to Provide Optimal Patient-Centered Care at an Outpatient Radiation Oncology Clinic, 2021
Tao Zheng, MN, RN, CCRN-CSC-CMC, CHFN, PCCN
- Author, Chapter 12 Electrocardiography and Cardiac Rhythm, Perpetua & Keegan’s Cardiac Nursing 7th edition, 2021
- Author, Chapter 17 Hemodynamic Monitoring, Perpetua & Keegan’s Cardiac Nursing 7th edition, 2021
- Zheng, T. (2021). Sleep disturbance in heart failure: A concept analysis. Nursing Forum, 56 (3), 710-16
- Zheng, T. (2021). Who cares? An existential perspective of caregiving for individuals with a left ventricular assist device. Journal of Gerontological Nursing, 46 (11)
- Award: Ruth L. Kirschstein Predoctoral Individual National Research Service Award – Pre-doctoral fellowship from National Institute of Health/National Institute of Nursing Research
- Award: Magnuson Scholar – from Warren G. Magnuson Institute of Biomedical Research and Health Professions Training
Care Team Model Project
In May 2021, South Lake Union Diabetes Institute recognized an opportunity to review and change their care delivery model based on provider feedback and a request from Dr. DeSantis. Conversations and planning started and the Care Team Model was selected. The MD teams were divided into 4 groups by Dr. DeSantis based on MD time in clinic, complexity of patient panels, and appointment lengths (appendix 1). Teams consisted of MDs, APPs and RNs supported by medical assistants and nutrition staff. Provider staffing levels were reviewed and additional APP and MD positions were approved for recruitment. RN team roles and goals evolved and revised workflows identified nurse staffing requirements needing schedule changes:
Approved RN coverage - Minimum requirements and considerations:
- Clinic hour coverage 7:30-5:00 pm
- Rapid response coverage 8am-5pm for Building F
- Lunch break coverage for RN team members
- Tasks:
- Triage
- MD support
- 1:1 education appointment – with CDCES RN
- Classes/projects/paperwork
Care Team Model:
Each RN performs the duties for the assigned team. Triage and classes rotate between the RN’s.
- MD Support
- In basket
- 1:1 visits (leverage RD/PharmD/APP as much as possible)
The RN schedule changed from 40 hours a week to 80 hours over a 2-week period with a mix of 8- and 9-hour shift lengths and a new self-scheduling system. The pilot project went live on Oct 1st, 2021, with the aim to cover full clinic days from 7:30 to 5 PM and offer each RN scheduled 1 day off per 2-week period. The RNs chose a Monday or Friday rotating day off and thus got a 3-day weekend every other week.
The RN team compiled data starting 10/1/21 on how many “touches” they were having in various categories; MD support, eCare, Triage, etc.
Team feedback May 2022
Overall, the providers have been happy and enthusiastic with the team model and have verbally expressed gratitude for the multidisciplinary support it offers this patient population. The Quality of patient care is amplified through better access, broader perspectives, and point of care support. RNs have expressed a sense of professional satisfaction directly associated with the collaboration between RN and APP teams.
Summary:
The project commenced Oct 1, 2021. The full benefits of this Care Teams model and resulting change of staffing model have not yet been realized as it is still being evaluated and provider recruitment is ongoing. Early assessment has shown that this change has been seamless for the patients and beneficial for team building within the clinic. Team assignments are being monitored and have been adjusted to ensure the workload is evenly distributed among the RN team. The RN team is still evaluating the pros and cons of this model change.
Advantages:
- Better continuity of care with patients, patients know RN
- Good working relationships with providers, better customized support
- Clear delineation of workflow
- RNs learning from providers
Disadvantages:
- RNs managing all roles within the team
- Increased duties/expectations from MDs
- Does not facilitate remote working
- More difficulty in maintaining RN team bonds/goals
Next steps:
We are planning on a 6-month review in May to continue to evaluate whether the goals are met and the teams are evenly distributed.