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5 Tips for Building Nurse Excellence, Outcomes

Meryl Montgomery, RN, for HealthLeaders Media, November 16, 2010

2. Establish structural empowerment

You have a range of choices here. You can focus on professional development, striving to increase the certification, continuing and formal education, and membership in professional organizations. You can emphasize nursing's role in the community toward improvement and partnership. Or, you can take the long view and establish shared governance.

If you already have education, quality, and/or practice committees in place, you can pay attention to membership issues and ensure bedside nurses comprise more than 50% of members and that a bedside nurse is being groomed to assume the chair. Over time, managers should shift to advisory vs. membership roles as nurses accept fundamental decision making roles related to patient care and nursing practice.

There are excellent resources available online and in the literature to help you establish governance. Robert Hess and Tim Porter-O'Grady are two big-name authors with extremely useful books. Again, calling a couple of MRP hospitals to discuss shared governance's effect, barriers, key enablers, and infrastructure can be very helpful. I would recommend picking hospitals that have been re-designated at least once, since they will be able to discuss maturation of shared governance.

3. Maintain an exemplary professional practice

A great way to start is by defining your professional practice and care delivery models. While you can begin by selecting a theorist to model, I personally favor the approach of observation, experience, and dialogue with nurses in your facility. That way, you can find out what is currently being practiced. This may require group meetings or workdays to truly dig deep into all elements of your models, but it's a super way to engage your nurses while engendering excitement and pride.

For example in our hospital, leaders initially created a model with overlapping and concentric circles to describe our model.

Nurses asked, "Why can't the model be easier to understand and be more relevant?" So, we asked the nurses to draw what they had in mind. They came up with a house. Since our hospital is located in the South, it is an antebellum house. They configured meaningful construction for the rooms, steps, pillars, windows, and doors that made sense to them.

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