Abstract:

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Leveraging Shared Governance for Organizational Change: A Grassroots Dress Code Initiative Amanda Bonsutto, BSN, RN, Nurse Clinician I, Medical-Surgical Unit and Johanna Lemke, BSN, MA, RN, Coordinator, RN Residency and Onboarding 9/16/2011: Scrub Color survey results announced 6/2010: Article, “The Color of Caring”, published in In-house journal 4/29/2010: Fashion Show presentation at Nursing Science Symposium 2/18/2010: Presentation to the Clinical Practice Council 8/1 - 8/14: February 23-24, 2011 Scrub Distribution Survey released 3/7/2011: Caregiver Identification program “ go - live ” March 1, 2011: Clinical leadership Reviews and approves new dress code policy drafted By the Uniform Task Force 3/10/2010: December 2011 – 1000 associates complete fitting and ordering of new scrubs 12/2009: Cohort 12 presentation; Open forum for staff representatives Presentation to the Nursing Advisory Council 5/2010: Dress Code Task Force Formed 6/10, 6/23, 7/8, 7/ 29, 8/12: Task Force meetings Abstract: Processes: Outcomes: • Cohort 12’s project focus was determining support and feasibility for implementing a caregiver identification program • The literature review focused on the benefits of a standard dress code and how to provide the structure for the organizational change • Based on the literature, a patient survey was conducted to gauge patient’s ability to differentiate among caregivers • Results from the literature and the survey were presented at the Versant Graduation • Based on the work of both cohorts, AIMMC executive leadership expressed support for moving the Caregiver Identification Dress Code forward as a new organizational policy • RN Resident Amanda Bonsutto emerged as a nursing leader, demonstrating the influence newly licensed registered nurses can have on their peers, leaders and organizations • The project evolved through Shared Governance process without any heavy handed executive mandates • A 15 member multi-disciplinary Task Force formed and met 6 times, each with greater than 80% attendance • The project stimulated healthy debate and discussion at every level and promoted peer coaching and unit culture changes • COMING SOON: Patient, Physician and Associate Satisfaction Outcomes INTRODUCTION A caregiver identification dress code assigns colors by role, allowing patients to differentiate among providers. This is crucial in today’s healthcare environment for patient safety and satisfaction. Historically, nursing uniforms have identified the profession and elicited strong opinions. Dress code modifications pose many organizational challenges. The uniform is a means of non-verbal communication. The geriatric patient with poor eyesight can be confident, “My nurse is the one in blue.” In a code, there is differentiation among care providers, enhancing patient safety. METHODS As part of their RN Residency, newly licensed registered nurses (NLRNs) examined the evidence for a color-based dress code. The organizational culture allowed them to question current practice in a safe environment with support and structure. They conducted a literature review and initiated a performance improvement project utilizing the FOCUS Model. As the project moved forward, our perception is that resistance transformed into enthusiasm and additional groups opted to participate. The project is an example of shared governance as a mechanism for debate, peer influence and dissemination of the best evidence. RESULTS This initiative features direct-care nurses in the spotlight and executive leadership “behind the scenes.” Inspired by the nurses, the Chief Nurse Executive leveraged resources to provide logistical and financial support. Starting March 7, 2011, seven caregiver groups including RNs, NCTs, Respiratory, Lab, Rehab Therapies, Mental Health Counselors and Diagnostic Imaging are now identified with different color scrubs. The outcome measure will be sustained improvement in patient satisfaction. CONCLUSIONS The vision and courage of nurses, strong shared governance and effective leadership facilitation may transform our environment to provide more safety, comfort and confidence for patients and family. Cohort 11 identified the standardization of the nursing uniform as their group project topic and compiled an Evidence Based Fact Sheet – a summary of their literature review. Structures: • Background & Introduction • In 2008, with the seventh cohort, Advocate Illinois Masonic Medical Center implemented an innovation to enhance the Versant RN Residency. The purpose and intended outcome of the RN Residency Group Project was to provide the RN Residents an opportunity to synthesize knowledge and skills for planning, implementing and evaluating practice improvement. • This practice-based teaching method provided a clear framework for the RN Residents to identify and execute an Evidence Based Fact Sheet, Process Improvement Project or Policy Revision. • Support & Curricula • The following classes were developed and integrated into the first 6 weeks of the Residency Didactic: • Project Introduction & Group Assignment • Research Library • Outcomes Driven Practice • Performance Improvement • Policy Development • Change and Evidenced Based Practice • Research Article Critique • The following structures were implemented to provide support and expectations for the Group Project process and outcomes: • Group Project Sponsors –Dedicated nursing leaders to coach each team • Group Project Notebook – A binder with class handouts, worksheets, samples and tabs for literature review and data • Group Project Work Time – 15 hours scheduled during classroom days to work on the Group Projects with sponsor support • Manager/Unit Council Support – Residents present project ideas to Manager and Unit Council in the early stages to ensure the projects are relevant to and supported by their units • Graduation – Residents present their projects on stage at their formal graduation ceremony to an audience of leaders