Best Practice: How Find a New Normal with the Pandemic By Using Shared Governance
Nemours Delaware Valley has had a shared governance structure in place since 2005. The combined Congress and Council structures were designed with consultative support from Drs. Tim Porter-O’Grady and Vicki George. The structure includes a Nursing Executive Council with oversight, a Congress with two representatives from each practice environment, and seven councils that focus on practice, informatics, quality, management, research, education, and advanced practice. Approximately 300 nurses have formal roles within the shared governance structure, as either Congress or Council leadership or representatives. Each group within the structure has bylaws that govern leadership, membership, goals, and function. In 2016 Nemours Delaware Valley scored within the range of shared governance using the Index of Professional Nursing Governance developed by Robert Hess, PhD, RN, FAAN, resulting in this organization becoming the first pediatric faculty to be accredited in shared governance by the Forum for Shared Governance.
Nursing shared governance at Nemours Delaware Valley did not skip a beat during the current pandemic. As information about COVID-19 spread across the county, an internally Incident Command and the labor pool were activated. The hospital census dipped as surgical cases were limited to those that were emergent. Nurses were deployed to roles, such as Personal Protective Equipment (PPE) coaches and entrance screeners. A sense of urgency pervaded the organization. Communication was essential, and the steps required to keep patients, families, and our teams safe were changing daily. Severe restrictions were placed on in-person meetings; shared governance forums were too large to meet in-person. In early March, the Council Chairs that comprise the Executive Council met to figure out how to proceed. The Chair of the Congress, Aimee Taylor, BSN, RN, CPN, (photo above) quickly pivoted to WebEx for the Congress and Executive Council meetings, and the Council Chairs followed. Throughout the spring and into the summer, nursing shared governance meetings continued virtually, and agendas included messages from the Chief Nursing Officers (CNO) and Chief Executive Officers, rounding with leadership; information about PPE; the availability of coaches, as a second set of eyes for donning and doffing PPE; and techniques to help manage stress and build resilience. The Practice and Education Council approved and educated about new practices required to maintain a safe environment. The Informatics Council helped the other councils maximize their effectiveness by hosting virtual meetings. As the Congress and Council Chairs became comfortable with the virtual meeting platform, attendance soared.
Shared governance has provided normalcy during the pandemic. Our monthly meetings have continued on as planned despite the unforeseen circumstances 2020 has brought us. Each month we have brought speakers to discuss current topics, such as PPE, COVID exposure, and equity, to our Congress. Our nursing leadership has been present and active each meeting to offer updates on changing policies. The practice area representatives serve as voices for all other associates and disseminate the information received to the necessary individuals.
The Executive Council worked together to move Nurses Week from May to Pediatric Nurses Week in October. One of the treats that our teams look forward to during Nurses Week is Sundaes on Sunday, delivered by the nursing shared governance leadership. A local news organization interviewed our emergency department team during the early days of the pandemic, and a nurse mentioned on-air that the ice-cream was her favorite part of Nurses Week. While we knew that the shared governance leadership team could not travel en mass from unit to unit, scooping ice-cream; the executive council did not want to let go of this tradition. The team decided to deliver individually wrapped ice cream treats with thank you notes to the entire healthcare team. The Nursing Research Council conducted our usual annual poster fair with carefully marked six-foot spaces between the posters. The Education Council offered a well-attended virtual panel discussion with nurses across generations talking about their shared experiences in recognition of the Year of the Nurse. The Nursing Excellence Awards program moved to a virtual presentation, in which more than 200 nominations for these awards were entered, at least 10% more than ever before. Patient care areas live-streamed the awards and hundreds attended. These awards gave the CNO and CEO an opportunity to recognize all teams for their amazing work. Only an engaged and functioning shared governance structure that “led-through” a pandemic was able to create these activities that energized the entire system.