Who’s ‘the Hospital’? Shared Governance Requires Transparent Organizational Decision-Making

When ‘the hospital’ speaks as a single, unified entity.

Many nurses working in hospitals do not know the decision-makers who affect their job. To patients, visitors, donors, accreditors, and other external constituents, hospital systems benefit from being personified as a single, unilateral-appearing brand.

Photo by Erik Mclean on Unsplash

However, when a decision is said to have been made by ‘the hospital,’ rather than by a specific person in the hospital, such language obscures who made the decision and why it was made. Lack of transparency around decision-making processes may be one reason some nurses feel shared governance models are more ‘lip service’ than genuine shared decision-making.

A common health care structure is a large system in which one main ‘flagship’ hospital serves as a central hub, with smaller branch hospitals/clinics with the same name and branding serving patients in other locations that may not be able to support a large hospital or multiple medical specialties.

For example, imagine a 20-bed rural hospital that is affiliated with Higher Education University, a hospital system with their main urban campus in a city one-hour away. The rural hospital’s affiliation with Higher Education University’s hospital system is important for external constituents. A patient may perceive that they […]

2024-12-09T11:17:04-05:00December 9th, 2024|Nursing|1 Comment
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Implementation Science: Systematic, Sustainable, Evidence-Based Change

By Cagkan/Adobe Stock

Reading the article by Russell-Babin and colleagues in the December 2023 issue of AJN made me grateful for all the work that went into developing the nursing implementation science (IS) program at Inova. As a nurse working at this health care system, I’d like to share how I benefited from being in the first cohort of nurses trained and engaged in IS over the last three years.

For the past eight years, I’ve been a clinical coordinator of two different disease-specific programs—first stroke and now sepsis. In these roles, I’ve been engaged in many different quality improvement (QI) projects and have become familiar with the tools and processes used to improve patient care and outcomes.

Towards more comprehensive and systematic evidence-based change.

However, as I was invited to step into the world of IS, I began to realize that a strict QI approach cannot alone bring about all the changes we desire within the complex systems of health care. The fact is that clinicians, […]

2024-01-11T10:06:42-05:00January 11th, 2024|Nursing, nursing roles, Quality improvement|1 Comment
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Black Boxes in the Operating Room: Improving Quality of Care and Patient Safety

What’s covered in this post?

  • Black boxes record video, audio, and data from multiple sources in the operating room (OR), such as cameras, microphones, patient monitoring equipment, and medical devices.
  • By offering transparency on the multiple simultaneous processes in the OR, black box data can be used to improve safety and efficiency, train staff, and onboard new nurses.
  • The data can be used for retrospective analysis of specific events or aggregate analysis to detect patterns and variations in practice over time.
  • Black box data has been used to improve and standardize OR processes such as handling tissue samples, handoff communication during shift changes, and pre-surgical patient positioning.
  • The data is de-identified and is normally deleted within 30 days.
  • Finding what went right and learning from it is the goal, not pointing fingers.

Figures in the OR as recorded and de-identified by an OR Black Box. Image courtesy Surgical Safety Technologies.

Rebecca McKenzie, DNP, MBA, MSN, RN, assistant vice president of perioperative services at Duke University Hospital, recently spoke with AJN about her hospital’s use of black boxes in operating rooms (ORs) to standardize key processes to improve safety and efficiency, train current […]

2023-05-26T15:01:50-04:00May 5th, 2023|Nursing, patient safety, Quality improvement, Technology|1 Comment
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Loss from Nurse Attrition Goes Deeper than Numbers

On watching familiar colleagues leave your unit. 

Photo by Javier Allegue/ Unsplash

It feels as though every week, I hear of yet another one to two colleagues who are leaving our pediatric ICU (PICU).

Reasons colleagues leave.

They’ve been at all kinds of experience levels. Some have only been in our unit for a couple of years, and some have been with us for anywhere from eight to 15 years. Some leave because they realize as young nurses that they don’t want to be around so much pediatric death and dying in the long-term, so they move on to other positions where they can care for healthier populations. Some leave because they’ve already been around so much pediatric death and dying for so long by now that it’s time to practice in different kinds of spaces for their own mental and emotional well-being. Some leave for the significantly higher pay offered by travel nurse positions, and some leave to be closer to family in other states. A smaller percentage leave quietly without ever really disclosing the reasons why.

Every departure hurts on a numbers level.

In a time when nurse staffing seems to be at critically low levels everywhere, raising our workload and stress levels to new all-time highs, every departure hurts on a sheer numbers […]

2022-06-29T10:48:07-04:00June 29th, 2022|Nursing|2 Comments
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A Nursing Perspective on Addressing Racism and Health Inequities

Editor’s note: We’ve all witnessed the recent public outcry against instances of racist behavior and brutality. As nurses, we also witness the toll racism takes on health as well as the racial inequities in access to care and within health care institutions. In the below blog post, AJN senior editor Corinne McSpedon excerpts her recent conversation about these topics with Monica McLemore. I also encourage you to listen to the recent webinar, Nursing’s Role in Addressing Racism, in which a panel of nurses address structural racism, how it prevents health equity, and what actions one can take to change or influence change. You can earn one contact hour of CNE credit.—Maureen Shawn Kennedy, AJN editor-in-chief

Confronting racism during the pandemic.

Over the summer, I spoke with Monica McLemore, PhD, MPH, RN, FAAN, to discuss antiracism efforts amid the COVID-19 crisis and the nationwide demonstrations against police brutality. McLemore is an associate professor in the Department of Family Health Care Nursing at the University of California, San Francisco, where she is also affiliated with the Bixby Center for Global Reproductive Health. She previously worked for nearly three decades as a public health and staff nurse.

Below are highlights of this discussion. The full article, A Conversation with Monica R. McLemore, is […]

2020-09-24T08:55:03-04:00September 24th, 2020|Nursing|0 Comments
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Views expressed on the blog are solely those of the authors or persons quoted. They do not necessarily reflect AJN’s views or those of Wolters Kluwer Health/Lippincott Williams and Wilkins.
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