Staff Nurse Medical City Childrens Hospital Dallas, Texas, United States
Abstract: Introduction Shared Governance is a nursing practice model in which bedside staff, leaders, and providers collaborate to use evidence-based practice (EBP) solutions to improve staff satisfaction and patient outcomes. While the implementation of a nursing-based council in a robust Pediatric Cardiac Intensive Care Unit (CICU) is challenging, research shows a shared governance model leads to quality care improvements, cost savings, staff autonomy and a healthier work environment (HWE). The purpose of this process change is to provide a platform for achieving high-quality patient care and outcomes. Interdisciplinary collaboration between bedside nurses, nursing leaders, and providers are crucial to the success of a team. Utilizing a Shared Governance Council (SGC) to identify EBP and creating new policies and protocols enhances team performance by allowing transparent communication promoting a HWE.
Case Description In August 2021, when our SGC was chartered, our new members performed a unit-wide needs assessment and identified gaps in process alignment. Our SGC members researched EBP and in collaboration with our physicians, pharmacists, child life, and nursing leadership, we formulated policies to standardize practice. To promote nurse empowerment, a vote prior to unit education and implementation was instituted. SGC policies created within 12 months of committee initiation included: • Building emergency admission kits for neonates, toddlers, and adolescents with proper size assessment tools • Standardizing our OR to CICU hand off by creating a tool to ensure a safe post-operative admission • Creating a standardized bath protocol, considering their physiology, to reduce clinical instability and cardiac arrest • Coordinating with Child Life to equip nurses with tools to improve end of life care for families • Standardizing intracardiac (IC) line securement allowing parents to safely hold their child • Collaborating with wound care and surgical team for proper sternal wound care • Improving discharge process to reduce readmission and successful graduation from interstage monitoring program
Discussion Twelve months post implementation of the CICU SGC, an anonymous retrospective survey was completed by multidisciplinary staff. Results indicated our SGC has improved team communication, assisted in providing education to enhance patient safety and quality of care, reduced readmissions, and promoted a HWE. Additional findings demonstrate that staff have been more involved in the decision-making process by translating and applying EBP to improve the care provided to pediatric CICU patients. Our experience in implementing SGC is consistent with current literature which demonstrates that shared governance is a professional nursing practice model that reinforces collaboration and shared decision-making. SGC improves quality of care, reduces costs, increases staff autonomy and retention, promotes nurse empowerment, and improves the overall work environment.
