Unit leaders are integral to ensuring a healthy work environment that focuses on the delivery of the best care for patients and families. On the unit

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Category 1: Leadership Structures and Systems –

Unit leaders are integral to ensuring a healthy work environment that focuses on the delivery of the best care for patients and families. On the unit, the best care may be reflected in a commitment to systematically develop and train nurse leaders; ensure accountability; advocate and participate in decision making; and provide meaningful recognition to staff. Creating a sustainable healthy work environment can improve the care delivery environment, thereby improving clinical outcomes, patient and family satisfaction, and staff satisfaction and retention.

The criteria questions in this category are aimed at soliciting information about how your unit leaders support and maintain a healthy work environment. For each question reviewers will evaluate the comprehensiveness of your approach; application and integration across staff and key stakeholders; and evidence of continued evaluation, shared learning and process improvement.

Criteria Questions
1 For unit leaders identified in the Unit Profile:a.      Describe how they are trained to meet and maintain the responsibilities of their role. For example, how are unit leaders held accountable by managers, staff or interdisciplinary stakeholders?

b.      Describe how unit leaders guarantee joint accountability between medical, nursing and other leaders.

c.       Describe how this group works together to ensure integration of patient care within and outside of the unit.

Notes: Unit leaders are defined as anyone who has daily responsibility for unit function and may include managers, supervisors, charge nurses or directors. This may also include physicians and other non-nursing personnel. Some examples of accountability may include formal processes such as peer review, performance evaluation and/or performance against measurements and goals; it may also include informal feedback mechanisms or surveys. Integration of patient care includes the processes and systems used to ensure sustained quality of care between your unit and supporting units (such as dialysis or radiology) and/or outpatient care settings (such as clinics, offices and rehabilitation facilities).

Response The units nursing director is accountable for all unit outcomes and is the formal unit leader for ICU and the emergency room.  The director completed a formal orientation and was partnered with a mentor. The mentor is another nursing director who has been at the hospital for several years. The unit’s nursing director has been a leader for many years in various facilities and several states. She has extensive training in managing employees, difficult situations and providing positive customer experiences. Most importantly she possesses an incredible ability to work closely with her staff and takes the time to listen to staff concerns.  The nursing director is also a board certified nurse executive. She completes  continuing education requirements to maintain her certification.Larkin Community Hospital is a teaching hospital and promotes leadership and staff professional development. Nurse director attends national conferences and maintains Specialty area CEU via webinars and on-line courses.

Staff and director work collaboratively to attain all goals and maintain patient safety. Every shift has a charge nurse that is assigned by the staff on the unit. An ICU unit Chair present at hospital leadership council meetings brings information back to the unit and shares it with staff from all shifts. Director also presents information at staff meeting where ideas are introduced and decisions are often made. Evidence-based practice recommendations are provided via several forums to include: interdisciplinary patient rounds, staff meetings or informally as the need arises based on patient and staff needs. Every hospital inpatient department has a chair. Each department/unit chair meets quarterly. During these meetings the chairs discuss patient care issues, staff concerns and generate suggestions or processes that the staff nurses would like to incorporate into daily practice.

An example is hand-off of communication. The staff in the Intensive Care Unit (ICU) felt that hand-off communication should be verbal where they are afforded the opportunity to ask questions. The staff brought the concern to the director who then collaborated with the director in the medical surgical unit. The joint commission standards on handoff of communication where reviewed collaboratively between the different departments and based on the recommendations from the staff and the evidence-based research from Joint commission; all reports between ICU and medical surgical units are provided verbally staff to staff.

ICU’s medical director is a board certified pulmonary intensivist. The medical director is active in meeting with the units nursing director and the hospital CEO. The director maintains an open door policy, and together with the medical director, promotes collaboration among the various disciplines. The directors provide all staff with their personal phone numbers maintaining themselves highly accessible. Residents play an active role in the collaborative process. Patient care decisions are made as a team.

2 Describe how unit leaders interact with staff to:a.      Build relationships, provide timely feedback and ensure patient-centered care.

b.      Encourage/ensure frank, two-way communication throughout the unit.

c.       Share key hospital decisions and information.

Notes: Your response may include the frequency of interactions and modes of communication, both formal and informal.

Response ICU enjoys an open communication process where leaders are easily accessible and provide their personal number to all staff. Communication occurs via several medians and in both formal and informal methods. Staff report is received from nurse to nurse and then the director huddles with the nurses andunit secretary to share unit plan of action and care for patients. The leader ensures that all staff has report for all the patients on the unit and that all staff agrees on unit plan for the day.

Patients plan of care and unit plans are evaluated three times a week during interdisciplinary rounds. Various departments collaborate on a plan of care for each patient on the unit and goals are set, continued or modified as a result of interdisciplinary collaboration. The interdisciplinary team consists of nursing director, staff nurses, dietary, pharmacy, infection control, patient family members if present, unit secretary, case manager, residents from various disciplines, respiratory therapy, laboratory at least once a week and wound care nurse and physical therapy as needed.

Communication boards also keep all staff and unit visitors informed of unit activities and quality outcomes. The use of emails and monthly staff meetings is yet another form of communication between staff and leadership. All staff meeting minutes are posted so that staff who is unable to attend can read and signoffthat they read minutes. Many times staff will follow-up by calling director to obtain information directly from her.

Quality improvement measures are a continuous process fo

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