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P41 - Local Shared Governance Model Design and Implementation in Ambulatory Care Setting

Background and purpose: A large ambulatory care center’s nursing and management staff recognized a mutual interest in improving communication and fostering a trusting environment. The overarching goal was to improve relationships and allow nurses to have increased involvement in decision-making. The local shared governance committee concept was proposed to accomplish the goal. Nurses in action (NIA), was developed and implemented.

Design: Committee design was developed around guiding principles, supporting inclusiveness and interprofessional membership, evidence-based practice initiatives, subject matter expert input, and metrics to define measured outcomes.

Methods: Thirteen voting and non-voting positions were created that included registered nurses, medical and nurse assistants, nurse educator, nurse manager, assistant nurse manager, clinical administrative director, and a senior administrative assistant. NIA representatives were nominated and voted onto the committee by their peers. Elected members developed a charter that defined representation, membership mix, responsibilities, and terms of service, as well as subcommittee and meeting structure. Three subcommittees, quality and safety, education, and staffing and retention, were developed to represent areas identified as the underpinning of nursing practice. Committee members are elected annually to allow full participation of all nursing staff.

Results/outcomes: At the one-year committee anniversary, 100% of staff participated in at least one subcommittee during the year. Overall, staff-driven subcommittees demonstrated key project outcomes, including the following examples:
• Quality and safety subcommittee redesigned the telephone triage script for patient calls, resulting in a decrease in the incoming call telephone abandonment rate from 23% to 4%. Other process improvement initiatives included addressing the National Patient Safety Goal NPSG.03.06.01 related to compliance with medication reconciliation and NPSG.15.01.01 related to suicide prevention. The latter project resulted in improved completion rates of a validated patient needs screening tool and appropriate intervention and referral for patients at risk for suicide.
• Education subcommittee used evidence-based practice to organize two interprofessional mock codes. This project resulted in a significant improvement in response time to emergent events and compression fraction rates during a simulated cardiac arrest. Additionally, in collaboration with nursing education, bi-annual nursing skills fairs were conducted to promote oncology nursing staff competencies. Twelve institutional specialists were selected and spoke to nursing staff on relevant nursing practice topics for continuing education credits.
• Staffing and retention subcommittee developed an expanded staffing coverage partnership model to assist with time off requests throughout the year. This staffing model also provides coverage for lunch breaks, meetings, and additional support for each other day to day. Members reviewed and approved staff time-off requests during the holiday period, resulting in 100% approval of requested time. The committee also planned and hosted six interprofessional social activities.

Implications: This progressive, local shared governance model has redistributed the center’s decision-making process. Professional empowerment was accomplished through a commitment by staff and management. Problem-solving through shared governance was shown to be an effective way to improve interprofessional relationships and nursing staff development and identify and respond to patient needs and perspectives. The NIA structure has been expanded to include advanced practice nurse representation in fiscal year 2020.