Unit Councils Help with Communications ... and More
People talking to people. The goal of Unit Council is for nurses to communicate and collaborate identifying strategies to improve nursing practice in the unit, hospital, and even across the health system.
Unit Councils have been set up on individual units in each hospital to bring together issues, news and rules that pertain to the unit and that should be discussed by the entire group. The councils don’t have to just involve nurses, either. On the 3 South Telemetry Unit at Crozer, for example, the Unit Council also includes the patient care secretary, patient care technicians and housekeeping.
Gabe DeCicco, BSN, RN, on the merged 3 South Telemetry Unit, coordinates the Unit Council. She is the chair and shares her responsibilities with Kathy Miller, RN, co-chair. Across CKHS, each Unit Council is encouraged to elect a Chair and Co-Chair — who will each receive two hours’ pay.
Modeled after Vision Day, DeCicco explains, they begin their meetings with a safety story which is of interest to everyone. She also writes a newsletter for her unit to provide a review of the Unit Council discussions. Some of the questions in a recent discussion were: "Should the intermediate nurses have ACLS certification?" and "How do we implement best practices related to Medication Administration Checking (MAK) system?"
A Work in Progress
“People are starting to bring ideas up to me to bring to Council. Our Unit Council is a work in progress,” DeCicco says.
To make the meeting more appealing, staff on 3 South Telemetry have been scheduling them off location. The last one was at Casa Prego in Aston. Anyone from the unit who attends on their birthday month also receives a small gift.
At DCMH, on 5 West, which is also a result of a merger of two specialty units (orthopedic/surgical and oncology), Celeste Quigley, BS, R.N., from the orthopedic side, is the chair of the Unit Council and Linda DeGothseir MSN, RN, OCN, from the oncology side, is the co-chair. The Unit Council is open to everyone and meets at various times to accommodate all shifts, Quigley says. “Each unit already had a Unit Council so we merged them, too,” she says.
Since all nurses have to be able to care for all patients on 5 West, it was suggested at a Unit Council meeting that a Sim (simulation) Lab be created. It is open for use in a room on 5 East, which is no longer being used for patients. (5 East is also used by Nursing Education.) Self teaching, with posters and other learning materials, the Sim Lab helps nurses practice and review before being officially signed off on a particular competency. “For example,” Quigley explains, “there are instructions for accessing and de-accessing a port and how to drain a pleurx-cath (chest tube). The Unit Council also created a buddy list where oncology nurses and ortho/surgical nurses are teamed up to help with these competencies.”
Quigley notes that the 5 West Unit Council is also considering moving their meetings off site.
Alisha Hartunian, MSN, RN, NEA-BC, clinical nurse director at the Taylor Regional Rehab Center, explains that their Unit Council ihas also been successful. “It is an open meeting for anyone to attend. People also attend when they are off duty and come in from home,” she says. The Unit Council is co-chaired by Allie Milnes and Heather Magee, two nurses on the unit.
The last meeting, at the beginning of March, was a lively one. Some of the suggestions that came out of it were: a suggestion box that staff can use; a PCT (patient care tech) shift checklist (a shift timeline with which tasks should occur when) and a welcome to rehab worksheet for nurses who are new to the unit and may be unfamiliar with the environment and workflow. Both of these tools were put into use and will be brought to Vision Day. The council also set up a Sunshine Club and designated a nurse volunteer to run it. There was also a change in distribution of emails to staff. Now a daily newsletter is put together at the end of the day and sent to all staff via e-mail. It is also printed out and kept at the nurse’s desk in a communications binder.
Six Taylor Rehab nurses will be going to a rehab nurses conference. “This is a result of discussion at the Unit Council,” Hartunian says. “If they hadn’t brought it up I never would have known about it!”
Shared Decision Making
In the Emergency Department at Springfield Hospital, Amy Meehan, BSN, RN, engages her staff in shared decision making. “I go to my staff, tell them this is what we need to accomplish and they figure it out. They are working on the front line and they should be accountable for their work.”
This is not a new concept. “When we moved into the new ER five years ago,” she says, “they designed the work and patient flow. The staff put together a task force. We kind of run a Unit Council all the time. The staff identifies issues; they then talk among themselves to solve them.”
This type of governance works well in the Springfield ED. “Amy leaves a lot of the issues for us to decide among ourselves,” says Diane Neary, BSN, R.N. “And if we go to her with a problem, she listens but also asks how we would fix it.”
In their introduction of the Unit Council to the staff, DeCicco and Lorraine McGlade on 3 South Telemetry wrote this explanation:
The Unit Council’s role is to plan, improve and maintain quality patient care through specific work surrounding nurse and patient experience, quality and safety Initiatives, patient and professional caregiver experience and evidence-based practice. Accountabilities include unit satisfaction and RN survey scores as well as patient satisfaction, including results of department specific score and quality nursing indicator scores. Council tasks include identifying practice needs of the department and increasing staff awareness and soliciting input regarding quality improvement activities. The council allows staff to bring input and ideas from department to Vision Day. All staff are welcome and encouraged to participate (i.e., RN’s, LPN’s, PCT’s and PCS’s).