Engaging Bedside Nurses in Quality Initiatives
By Anne Moseley, MSN, MBA, RN
Providing high-quality care is engrained in the culture of the Pediatric ICU (PICU). The nursing staff is highly skilled and takes great pride in the care they provide. A critical element in providing such quality care is through zero unsafe events and high satisfaction with pain control. To ensure we are meeting these goals, we continually monitor quality metrics that include central line-associated blood stream infections (CLABSI), catheter-associated urinary tract infections (CAUTI), ventilatorassociated pneumonias (VAP), pressure ulcers, and unplanned extubation and satisfaction with pain control.
While our quality metrics were routinely discussed at staff council, included in staff email updates, discussed informally in the unit and were part of our unit education, we still were not achieving our desired goals. The diligent efforts of Deb Soetenga, MN, RN, CCNS, our clinical nurse specialist, and myself were not enough. We needed to take a different approach to really make a difference. We felt the only way we were going to achieve the results we were striving for was to involve the staff more actively in our efforts.
To create engagement, we developed a quality team structure in which all nurses in the PICU would be expected to participate. All of the nurses were assigned to a team. A care team leader and member of the opposite shift were assigned as team co-leaders. We felt it was crucial to have a team leader from both the day and night shift to help engage all members of the team.
We used Kotter's Change Model as the foundation for the teams. We knew that improving our metrics might require making practice changes and Kotter's model provides practical steps to making a change. We focused much of our attention on small short-term wins. In addition, the hospital's UWHIN tools were a great resource for the teams. A retreat was held for the quality team leaders to help educate them on the process, the tools, and provide inspiration that achieving our goals was possible and their efforts were central to our success.
As a leader, I could not be more proud of our teams! They have embraced this concept and the co-leaders have engaged their team members. They hold meetings and develop the plans they think will work. All members of the team participate in some manner, helping educate their peers, completing audits, or acting as a resource for others.
Deb has been an integral part in helping them problem solve. I have offered consistent guidance and advice, which often has been, "remember small short-term wins!" While sometimes that concept is hard for nurses to accept, to date, all teams have seen an improvement in their metrics. I believe allowing nurses the autonomy to develop plans has been key. They know what will work and their efforts are paying off!