Give your nurses a voice
Higher acuity patients. Fewer resources. Increased overcrowding. It’s no wonder that for many ED nurses, morale is at an all-time low. But there is a proven way to boost morale of nursing staff, while improving your ED’s operations, say ED nurse managers. "Committees can boost the morale of ED staff by allowing them a voice in the change and planning processes," says Sandy Fox, RN, ED nurse manager at Avera McKennan Hospital in Sioux Falls, SD.
When developing committees for ED nurses, consider the following benefits:
• ED nurses can play a role in major changes.
If you are implementing major changes at your ED, such as switching to a new triage system or planning a redesign, nursing committees can prevent a host of problems, says Fox. "This prevents nurses from being a victim of the system," she says. "Instead, they are able to brainstorm solutions that will make their position meaningful and satisfying." When a decision was made to update the ED’s triage system, three nurses were selected to assist in the process of planning and implementation, says Fox.
Bonnie Murtha, RN, an ED nurse who serves on the triage committee, says, "To be updated on current trends in triage and be able to share this information with colleagues was a real morale booster in itself." The committee has recommended that the ED switch to a five-level system, she says. "We’ll have a lot of input as to the protocols and how the flow is going to work," she adds.
The committee meets regularly to plan physical changes, write policies, develop staff education, and create all the necessary forms for the new triage system, says Fox. "Committee members are excited about the changes and appreciate the opportunity to function in a new capacity and role," she says.
The nurses attended a three-day triage workshop in Minneapolis at a cost of $499 per person, says Fox. "With hotel and food, it ended up being about $2,600 total," she says. In comparison, Fox estimates that hiring a consultant would have cost $1,500-$2,000 per day, plus expenses. "I would rather send nurses who know our facility to bring back information than to have an outside consultant come in and evaluate the ED," she says. When the ED is redesigned next year, committees will be used to involve nurses with that process, adds Fox.
• Experienced ED nurses can get a change of pace.
Many ED nurses were looking for a new challenge after working in the unit for many years, says Fox. "Committees can move them in a whole new direction, and they may find new interests in the process," she says.
• Improvements are made in a variety of areas.
In March 2003, a six-committee self-governance structure was implemented for ED nurses at Inova Fairfax Hospital in Falls Church, VA, says Karen Peck, RN, patient care director for the ED. The committees are scheduling, quality, peer review, standards, education, and employee satisfaction. The committees are all chaired by an ED nurse, with a leadership team liaison as advisor, says Peck. "Each has had varying levels of success up to this point," she reports. Here are the accomplishments of each committee so far:
— Scheduling: A survey was conducted to examine scheduling satisfaction. The results showed that staff members were happy with the way schedules were done, but had concerns about the departmental policies governing scheduling. The committee is working on refining these practices and has proposed changes to the ED’s use of PRN nurses.
— Quality: The committee is identifying performance improvement opportunities surrounding documentation and orientation.
— Peer Review: This has been the slowest committee to get going, says Peck. "They have had difficulty recruiting membership, but we have started by looking at what peer review is, how it works, what’s acceptable, and what’s not," she says.
— Standards: A grid was developed to monitor what standards were due for review and when they are due, and a system was developed to ensure staff and physician input and follow-through.
— Education: Journal articles are being supplied to staff for review, and committee members are working with the clinical nurse specialist to plan educational offerings for the staff. The committee is developing educational bulletin boards and has revised the competency-based orientation for ED technicians.
— Employee Satisfaction: Collages with staff pictures have been posted around the ED, a welcome board was created for new staff members, a department newsletter was started, and quarterly birthday recognition for staff was implemented.
The committee also is responsible for the customer service award program, which recognizes ED nurses who give exceptional customer service to patients and family members, and cleanup and surveillance of the ED staff lounge, says Peck. A staff satisfaction survey was done in May 2003 to establish a baseline and will be repeated in May 2004 for comparison, says Peck. "Interviews conducted with staff show a higher level of satisfaction than we had previously," she reports.
Sources
For more information on nurse committees, contact:
• Sandy Fox, RN, Nurse Manager, Emergency Department, Avera McKennan Hospital, 800 E. 21st St., P.O. Box 5045, Sioux Falls, SD 57117-5045. Telephone: (605) 322-2077. Fax: (605) 322-2030. E-mail: [email protected].
• Karen Peck, RN, Patient Care Director, Emergency Department, Inova Fairfax Hospital, 3300 Gallows Road, Falls Church, VA 22042-3300. Telephone: (703) 698-2219. E-mail: [email protected].
Higher acuity patients. Fewer resources. Increased overcrowding. Its no wonder that for many ED nurses, morale is at an all-time low. But there is a proven way to boost morale of nursing staff, while improving your EDs operations, say ED nurse managers.
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