On Jan. 24, it was standing room only in the 55 Park St. auditorium as many of the nurses who are participating on the committees and clusters of YNHH's new structure of shared governance were present for its official kick-off. The enthusiasm reflected the participation and buy-in of nurses throughout YNHH, including the significant work of the 55 design team members.
Even before Yale-New Haven Hospital integrated with the Hospital of Saint Raphael in September 2012, nurses on both campuses were working on a variety of important issues. One of the most important of those issues to staff nurses was the creation of a new structure of shared governance for the nearly 4,500 nurses who serve on both campuses, the Yale-New Haven Children's Hospital pediatric units on the Bridgeport Hospital campus, the Shoreline Medical Center in Guilford, Smilow Cancer Care Centers throughout Connecticut and more.
"We had simply outgrown the capacity of the shared governance structures that existed on the York Street and Saint Raphael campuses," explained Judith Hahn, RN, MSN, director, Office of Nursing Excellence. "We have created a modern structure that will serve us in today's rapidly changing healthcare environment. This new framework will help nurses make decisions about quality, competence, evidence-based practice and accountability."
The new structure is composed of 12 cluster-level councils and five hospital-level councils. Patient service managers and assistant patient service managers, service line educators and advanced practice nurses serve on the committees and clusters but at least 51 percent of each cluster and committee must be made up of clinical nurses.
"Decision-making is central to effective shared governance and decisions are best made by those closest to the patient," said Cory Kroon, RN, Surgical Intensive Care Unit and co-chair of the Coordinating Council. "They need to be made by the right person in the right place at the right time and staff nurses are now adequately represented in our new framework.
"You own the decisions you make and this structure gives nurses the ability to make decisions — based on evidence — regarding practice," Kroon pointed out. "When nursing practice decisions are owned by nurses, patient outcomes improve."
The new governance structure is designed to elicit ideas for consideration from nurses and streamline the approval process. Many levels of nurses sit at the decision-making table to ensure that potential best practices are researched thoroughly, aired properly and then upon acceptance, disseminated as a best practice to the right nurses.
For example, members of the critical care cluster are examining a pain assessment tool for critical patients who are unable to report their pain. The cluster expects to make a recommendation on the tool this spring.
Marin Karsmarski, RN, General Surgery/Thoracic Unit, had chaired the staff nurse council on the Saint Raphael Campus prior to integration. With Kroon, she was elected co-chair of the new Coordinating Council and is very optimistic about how well the new framework will serve not only nurses' needs but patients' needs, as well.
"This structure allows us to make decisions on our nursing practice faster and more efficiently," she said. "Our practice will be up-to-date and at the highest levels of quality among peer hospitals in the U.S. Patients demand and deserve safe, high-quality care and that's what makes Yale-New Haven a destination hospital. Empowering nurses to constantly find and develop best practices will help us continue to be a destination hospital."
Kroon agrees with Karsmarski that effective shared governance impacts the entire hospital — not just its nurses. "We are one of the few hospitals in the United States that has a budget for shared governance activities so that units can use their budgets for the items they need for patient care," said Kroon. "We are all concerned with cost/value but investing in shared governance helps nurses continuously develop the best and safest ways to care for our patients."