Empowering Nurses: How Professional Governance Transformed a Culture

This is a special AOML podcast as we speak with session presenters from the AOML 2023 conference. With me is Christina Scheminauer, Chief Operating and Chief Nursing Officer at IU Health J and Parker May Nursing Professional Development Generalist at IU Health J. As we talk about empowering nurses how professional governance transformed a culture. This is today a nursing leadership, a podcast from the American Organization for Nursing Leadership. I'm Bill Klapperoff, Christina and Parker, welcome. Thanks for having us, Bill. Yep, thanks for inviting us. Yeah, you bet. The great to talk with you about this. So Christina, when it comes to empowering nurses and talking about professional governance, what did your session address specifically when talking about this? I think the importance of nurses having a voice about their practice, being able to advocate for themselves and their patients, really transforming the culture at IUJ from a physician-driven top-down approach to an approach where it's interdisciplinary. The work is done together and nurses are empowered to make decisions about their practice and become solution-oriented when it comes to their practice. So instead of the traditional top-down leadership you're encouraging the nursing department to speak up if they see something that they think should be changed or give feedback. Absolutely, that's very important as we look at what the needs of our patients are. If our nurses aren't comfortable talking about it and bringing it to the forefront, then we're not going to have good quality outcomes for our patients and team member engagement is going to be poor. Right, so this really covers both ends, better outcomes for patients, and the actual satisfaction of the nurse as well. Absolutely. Yeah, so this is really important. And Parker, for a nurse leader who wants to follow what you have done at IUHealthJ, what are some things to remember? I think it's important to first give them the why behind needing to change, bringing an awareness to the problem before you're going to be able to get any desire from them to actually implement the change. So explaining what you're doing, how is it going to improve their workflow, and how is it going to better patient care and outcomes for quality. And then finding your informal leaders or your change agents on each unit, making sure that you're helping coach them on the next steps in implementing that professional governance, whether that is through a unit-based council or a professional nursing council for the hospital, giving them a platform in which to submit access forms or bring up changes that they want to be made to each other, have an interdisciplinary work group where the nurses are able to come together and discuss the changes that need to be made with their manager, their C&O, or even like the quality nurse being able to give them a voice to ask questions. So Christina, can you talk about some of the specifics of this, and thank you for that answer, Parker, the specifics of exactly what you learned and the programs you initiated to address this? One of the things that we did when I first came to IU Health J was really take the time to get to know the team and the staff, build the relationships so that you built the trust because before there was no trust, it was a culture of fear. We preached that we wanted to implement a just culture where team members could bring up problems without the fear of retaliation, and to do that we felt like the most important thing was really to take the time to build the trust in the relationship. So in my first 30 days I just really worked at the unit level with the team letting them know that I was there to learn from them. When we brought Parker on board as a manager we did the same with him so that we could build those relationships and then implementing a shared governance or professional governance approach where we had unit-based councils from each of our departments that then filtered into our J nursing council. So two reps from each unit-based council comprised our J nursing council. At the J nursing council level we really looked at more organizational high-level things that we could improve upon patient experience, healthy work environments, and then those then went down into the unit-based council levels and they did that on their department. I found it was very important to bring in the multidisciplinary approach when we were doing this. You wanted not just nurses because we have PCAs on our units in our clinics. We have MAs and LPNs that are important as those processes rolled out. So we wanted to open it up so that it wasn't just for nurses but building a charter so that you had voting members from each of the departments. It was a two-year term then that you held these positions and then it would open up so that it gave the other team members an opportunity as they learned more about it and became engaged in the process to then be part of that practice. You really dug in. You really dug a lot, my goodness. It must have been a breath of fresh air for the staff to have somebody like you say, "I want to hear from you. I want to recognize you. I want you to feel comfortable with talking to me about things you see or suggestions you may have or share with us troubles or problems that you're going through without fear of retaliation or somebody saying just do your job." When I came to J it was a top-down approach. Like I said earlier, a culture of fear, I felt like I was walking into a time warp. To be honest with you, I would go to the unit and if a physician came up, a nurse would get out of their chair and give it to the physician and then they would stand and do their work. I've been a nurse for 21 years and I had never experienced anything like that. Wow. Yeah. Wow. So the team really was thankful when we were able to get them to buy into what we were trying to do. Yeah. How did the physicians feel about this? It's still sometimes a barrier, especially in our primary care practices. The hospital physician leadership is bought in and they do a lot of really good work side-by-side with our nursing team. But like I said, there's still some barriers within the primary care clinics but I think we're gaining momentum. It's a process. It is. It's a process. So Parker, can you talk about the results so far? You both have made these important changes. What are the results you've seen to this point? Yeah. So we've seen positive results and pretty much across the board. So we've had decreased harm events over the last four years since implementing the professional governance model. Our patient experience has gone up every year. This last year, going up almost 10% in patient experience, we've seen an increase in nurse engagement starting at 34% engagement in 2019 and ending in the mid 50% of nurse engagement, which is great. Which everybody's looking for improvements in those metrics. Absolutely. And one of the things that has helped the most with that was we do an engagement survey every year and after each engagement survey results come out. We take our lowest scoring questions and we go back to the unit-based councils and they work on their own unit scores. So the lowest scoring questions, they come up with countermeasures, action items, go out and implement those things. And so it's really putting that ownership back on the units themselves so that they can implement their own work and become more engaged. You guys are doing the work, which is great. You guys are really putting the time in and it shows. Well, thank you. So congratulations to you too. This is great. So overall for a nurse leader listening to this podcast, Christina, what is the main takeaway for you? What is the main thing you want to say to that person? I think the main thing that I would say is be willing to let your team fail. That's very important. And be willing to pivot. That is something that we took back to our team is we're never going to go back to the way we were, but we're going to pivot and move forward. Also, it doesn't happen overnight. I am not a patient person, which Parker will tell you. So I wanted this change to occur very quickly. But I mean, four years seems like a long time, but if you think about it to make the changes and everything that we've done is tremendous. Yeah. So when Christina said pivot, Parker, you were shaking your head up and down. Yeah. So obviously that's you've learned that and that's important to you. Can you talk about that? Yes. We would come out with a plan in a month later or two months later or a year later. We had to quickly change our plan. So we would have to pivot. We thought we had everything figured out as a leadership team and quickly learned even as leaders that we don't get it right on the first try or the second try, but like Christina said, we refused to go back to the way things were. So yes, we might have gotten it wrong, but we're not just going to take a step back. We're going to pivot and try it this way. And I'm sure the staff appreciates that because they see the openness and the transparency in you two saying, okay, maybe we didn't get this one right, but we're going to adjust and try to do this right. I mean, that builds trust in leadership when they're transparent like that. So final thoughts from you as well, Parker, what's a key takeaway that you've learned that you want to share? Yeah. Like Christina said, I think I just want to echo that you have to be patient. It's not going to happen overnight. And also to continue to hold your team accountable, everyone's not going to be on board. And if you allow a couple to go back to the way things were and not really hold them accountable, the rest of the team does see that. So it's important to equally hold everybody accountable, but also be willing to pivot yourself like I just mentioned when they may challenge you to try it a different way. So definitely need to hear the voice of the people doing the work have an interdisciplinary approach on that and just make sure that you're viewing it from all sides and when implementing these changes. And Christina, if we could just have you wrap everything up for us as a CNO from your perspective, how important is this and what final things do you want to add? Because this sounds like an issue that is happening across the industry and we need more people like you to address it. What would you say to that? I can say that I've been with Jay since 2019. We did not meet any of our goals in 2019, 2020 and 2021. But as we developed this professional governance structure, that is really what got us to be able to exceed all of our goals in 2022. Without the trust and the voice of the people doing the work, you're never going to get where you need to be. Yeah, very well said. Christina, thank you so much and Parker, thank you so much for your time. We really appreciate it. Great job. Thank you very much. You bet. And for more information, please visit aonl.org and if you found this podcast helpful, please share it on your social channels and check out the full podcast library for topics of interest to you. This is today a nursing leadership. Thanks for listening.