Sunday December 17th 2017

Frontline change

Building the next generation of leaders, problem-solvers and innovators

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Nurses routinely identify and solve problems large and small, but sometimes they face barriers that prevent their solutions from being fully realized. However, RNs at Vanderbilt University Medical Center who’ve participated in its Frontline Leadership Academy have an edge that can help them overcome obstacles and make changes that benefit patients and health care staff.

Then-assistant nurse manager Shelly Anglin, MBA, RN, for example, successfully took on staff turnover on a med-surg unit. For medical ICU bedside nurse Darlene McCormick, BSN, RN, CCRN, it was all about preventing central line infections. Both credit their participation in the academy for helping them achieve the outcomes they wanted, as well as for enhancing their professional development.

The academy

Along with other organizational leaders, Chris Wilson, MSN, RN-BC, director of Nursing Education and Professional Development at VUMC, had been concerned about the supply of future nursing leaders for some time.

“When we started to do succession planning, we realized that we did not have what we needed in place for leadership development,” said Wilson, a Tennessee Nurses Association member. So in 2007, VUMC started the academy in partnership with the Advisory Board Company.

Although initially focused on ensuring the next generation of nurse leaders, the academy is now open to other health care professionals, including pharmacists, respiratory therapists and lab supervisors. The 11th group of participants started earlier this year, and well over 350 staff members – the vast majority nurses – have completed the program, Wilson noted.

Currently a year in length, the program consists of a series of four, all-day intensive learning sessions, with content ranging from proactive problem solving to strategies on delegating and motivating others to maximizing one’s influence. Participants are assigned to a team and work with a coach who can guide them in the improvement project of their choice.

The program ultimately is designed to provide staff with the skills they need to plan and execute projects that improve their work areas and potentially the facility as a whole, and to empower them to tackle future projects and challenges.

Seeing what’s possible

A bedside nurse at Vanderbilt for 30 years, McCormick had just completed a VUMC fellowship on evidence-based practice when she decided to apply for the academy program in fall 2011.

“That [fellowship] really ignited my passion to make changes that lead to better practice and better patient care based on evidence,” McCormick said. “Things are always changing, so I’m always learning. And I felt the academy would help me sharpen my leadership skills.”

To improve patient care on her unit, McCormick focused her attention on reducing the duration of MICU patients’ central lines, which in turn, would reduce the risk of central line-associated bloodstream infection.

“In my day-to-day-practice, I saw that lines were left in longer because decisions about their ongoing need were not on the radar of doctors and others on the team,” she said.

So McCormick worked with the information technology department to create a computer dashboard indicator that would track how many days each MICU patient’s central line was in place. She then collaborated with the unit’s CLABSI committee to ensure that nurses and physicians would address each patient’s ongoing need for a central line during morning rounds.

“Although the indicator is not a magic cure, there was a downward trend in the number of CLABSIs on my unit because fewer [non-PICC] central lines were left in for more than seven days,” McCormick said.

Anglin, another participant, had just been promoted from a staff nurse to the assistant manager of her med-surg unit when she decided to apply to the leadership academy.

“I felt it could help me to problem solve and perform better in my new role,” Anglin said. “And I wanted to reduce staff turnover.”

One of the first steps in her project involved looking at all the contributors to nurse turnover and identifying the “low-hanging fruit,” or problems that could be addressed more easily through small changes. She also identified key stakeholders, which included a group of staff nurses who were interested in brainstorming solutions with her.

Anglin subsequently reviewed nurses’ comments in exit interviews about why they left the unit and surveyed current nurses about what makes them consider quitting or transferring. In those findings, nurses reported that patient assignments were too heavy based on acuity levels, management was unresponsive to their concerns and did not appreciate their contributions, and inpatient medicine is a “dead-end profession.”

As a way to address heavy workloads, Anglin collaborated with team members to reorganize frontline staff’s priorities, as well as ensured hiring more nurses to align with VUMC’s proscribed staffing model.

To address concerns over management, Anglin helped institute “stoplight reporting,” in which staff bring their complaints or ideas and they are addressed in a standardized way. For example, if managers receive a “red” complaint, they will discuss with staff why they are not addressing it.  If it is a “green” issue, managers will agree to fix it right away and work with staff to determine how it will be done.

Solutions also were implemented regarding career development and staff appreciation.

Overall, Anglin said she received a great deal of feedback during this project that led to positive changes.

“People felt listened to, and some of the ideas we implemented really helped to build our unit’s identity,” Anglin said. “Now nurses see med-surg as a specialty. And the project made a difference in turnover and satisfaction levels.”

The other side of the coin

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A key part of the leadership academy is coaching, and VUMC turns to its staff to fill that need. Barbara Shultz, MSN, RN, NEA-BC, has been one of those major contributors.

“I’m very interested in succession planning, and believe that all nurses need to share every bit of their knowledge [with] at least two people who they think could replace them,” said Shultz, administrative director of Surgical Services, Monroe Carell Jr. Children’s Hospital at Vanderbilt and member of the Association of periOperative Registered Nurses, an organizational affiliate of the American Nurses Association. “I also wanted the opportunity to mentor people who wanted to be mentored.”

She estimated that she has coached nearly 40 nurses, along with a few staff from other disciplines, from all around the organization between 2009 and 2014. Some of the projects she helped facilitate include: educating families about the importance of following isolation precautions; reducing hospital-acquired infections at the burn center; creating a charge nurse resource manual to help onboard nurses who are new to that role; addressing the distribution of IV poles; and ensuring better stocked linen carts on the weekends.

As a coach, Shultz met with participants initially every two weeks then monthly to help them shape their project, keep it on track and share her knowledge and support. She also worked with them to introduce their projects and convey their impact within their cohort and beyond.

“It’s been amazing to see how all the projects have been beneficial to patient care, and also in terms of financial savings,” she said. “Many have been adopted on other like-units, and I’ve learned so much too.”

Katie Brennan, MSN, RN, NE-BC, CDE, administrative director for Internal Medicine, Primary Care and a TNA member, is currently coaching her second group of academy participants.

“The leadership academy is a great way to help nurses and others develop their leadership skills, which also can help them move into other positions that have more responsibility.

“I really see my role as helping them keep the work moving, especially when they come up against barriers,” she said. For example, if someone opposes a proposed solution, Brennan helps the participant work through it and hopefully gain a champion in the process. She also helps participants set up their problem statement, oversee their root-cause analysis and review data.

As a coach, she worked with a nurse on standardizing shift reporting.

“Many nurses were approaching it in different ways, with some forgetting details that were needed,” Brennan said. “So the nurse worked on creating a one-page tool that has helped to streamline and standardize the report, which has made patient hand-offs safer and reduced overtime.”

Another nurse’s project focused on developing protocols and checklists so nurses can be better prepared to take care of pediatric, suicidal patients who must remain on their units until they can be transferred to behavioral health.

Lessons learned

Both Anglin and McCormick believe that the knowledge they gained from participating in the academy has helped them improve care and grow professionally.

“The program has helped me take a systems approach to problems and consider the potential downstream effects of decisions I make,” Anglin said. “It also was interesting to meet people who I may never have crossed paths with otherwise that I can still talk to and learn from, and hopefully they feel the same.”

McCormick added, “For me, it really helped increase my critical thinking skills as a leader, and to look at system and process weaknesses. It also helped me appreciate teamwork more. You can’t always solve a problem on your own, so it’s important to bring in other people to get their insight and advice.”

In closing, Brennan said, “The academy is a great opportunity for anyone to grow and develop, and it’s a great investment for an organization.”

— Susan Trossman is a writer-editor for ANA.

Resources

Vanderbilt University Medical Center’s Frontline Leadership Academy
www.mc.vanderbilt.edu/root/vumc.php?site=fla

ANA Leadership Institute

ANA developed the ANA Leadership Institute with you in mind — a nurse interested in excelling in a career path, a leader within a health care organization who represents the interests of the nursing profession, a seasoned nurse or health care administrator interested in refining skills to differentiate them from the competition or to advance to the next level of leadership.
https://learn.ana-nursingknowledge.org

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