We recognized two years ago that our nursing structure was not getting us the results we wanted. We found that we had inconsistencies in how key policies were being implemented on different nursing units. Our measurement outcomes were not consistently well defined, and our employee surveys indicated that our front-line staff felt their opinions didn’t count.
So, beginning in 2014 we began implementing a multi-level particpatory model we call Core Leadership, with the aim to provide a consistent, standard framework for the way we organize nursing in our organization. We also have sought for a structure that allows nursing leaders to focus on their most important responsibilities by delegating some tasks to other team members.
Our model includes three committees on each nursing unit, each with a designated lead: 1.) Practice; 2.) Leadership and 3.) Engagement. As part of identifying which nurses would serve as the leads for these committees, we standardized nursing descriptions across our five hospitals – in essence, creating 3 levels of nursing:
Level 1 – RNs
Level 2—Charge Nurses and Nurse Clinical Specialists
Level 3 – Core Leaders, Nurse Clinical Leads and Nurse Educators
We also defined key responsibilities for all Core Leaders and made sure that expectations were clear.
Each Core Leader sits on a hospitalwide committee to coordinate care and policies and programs across the facility. So, for instance, the nurse who chairs the Engagement Council on Labor & Delivery also participates in a hospitalwide Engagement Council with the core leaders from the other units. We also have representatives from each hospital sit on a regional council, so issues can be coordinated from hospital to hospital.
Since adopting the model and implementing it in 75 nursing departments, we have seen many positive changes. We have hired and trained 200 core leaders. We have seen improvement in our engagement scores as measured by an annual employee survey. Engagement was notably higher among the Core Leaders.
We have also improved communication. Core Leaders have become an important partner with the nursing manager in each department to make sure employees understand the key objectives and performance for their unit. Likewise, the Core Leaders have been effective at collecting and sharing feedback and issues with their peers and leadership.The final benefit of our model has come in the form of succession planning. Since implementing our new approach, several Core Leaders have been moved into department manager roles when vacancies have occurred. And these managers have had a much better onboarding experience because of the leadership skills they acquired as core leaders.