The Center of Nursing Excellence Facilitators (CONEF) Team began its journey in 2017. The team is made up of eight volunteers consisting of Chair, Co-Chair, Secretary, Facilitator, Shared Governance Coordinator, Chief Nurse Facilitator, Chief Nurse Advisor, and a Social Work Representative. The team partners to ensure direct care nurses and social workers have participatory decision-making opportunities related to clinical/practice standards, quality improvements, staff and professional development, and research. The CONEF team have mentored, empowered, and supported multiple quality patient care and evidence-based projects. The CONEF developed the reporting structure for all service wide committees. The team volunteers their own time developing newsletters, writing minutes, and planning and organizing agenda items for CONE meetings. Moreover, the team devotes countless hours strategizing on how best to support direct care employee initiatives to generate quick wins. The team generates staff participation through robust marketing strategies to reach all units and disciplines as evidenced by the increase in meeting attendance by an average of 54%. Shared governance initiatives promote excellence in the delivery of patient care and exemplify South Texas Veterans Health Care System I CARE values of Commitment, Advocacy, Excellence, and our mission to serve and care for our veterans. For FY 19 CONEF has guided and mentored Unit-Based Councils (UBCs)/direct care staff in effecting change through the following projects:
1. Parental Nutrition Administration
• Issue: Lacking a defined policy and procedure for the nursing administration of TPN and PPN. Frontline staff identified concerns associated with a lack of knowledge and the absence of a well-defined practice standard for the administration of parental nutrition. Concerns included orders from providers to piggyback other medications with TPN and inconsistencies related to variations in the double verification process.
• Action: CONEF guided the frontline team to conduct a literature review and establish a draft TPN/PPN SOP for nursing administration based on the evidence. CONEF partnered with the proposing nurse on the development of the SOP and presented the recommendations to NEB for approval.
• Outcome: Establishment of an SOP where none existed before outlining the process for the nursing administration of TPN/PPN. Limits deviation and brought nursing practice in line with the latest best practice guidelines noted in the literature, improving patient care.
2. Update to the uniform policy that allows hemodialysis staff to wear hospital-issued scrubs to and from the workplace.
• Issue: staff identified a barrier to having enough space to change into uniform with limited changing room space. This was causing staff to be late or having to be creative in how and where they changed into scrubs.
• Action: CONEF guided frontline staff to conduct an inquiry on practice guidelines in collaboration with infection control and provide recommendations to the CONE.
• Outcome: CONEF presented to NEB and was able to garner support through presenting evidence that resulted in a change in practice and policy and decreased tardiness related to delays is locker room availability/space by 100%.
3. Easy Print
• Issue: Nurses floating to other units that need to have timely access to a printer. Concern raised from employees involving the knowledge deficit related to installing an alternate printer to use when being floated to other units.
• Action: collaborated with CHIO's office to designate a quick access folder for printers located throughout the hospital.
• Outcome: Michael Patterson developed folders identifying all printers with the location on each floor and developed quick instructions on how to install the printer based on the current location. This intervention improved efficiency and employee morale when floating. This efficiency was shared with the medical staff for implementation in their respective areas.
4. The addition of Interprofessional Shared Governance Model
• Issue: lack of defined inter-disciplinary participation within the nursing shared governance model.
• Action: create a model that promotes interprofessional shared governance and brings every professional stakeholder to the table to collaborate with a focus on establishing goals, enhancing teamwork, and improving the lives and care of patients and families in the community.
• Outlined an SG model for Social Workers
• Facilitated development of the Social Worker Charter.
• Provided Education to the Social Worker Supervisors about shared governance.
Outcome: Changes to CONE SG Model; it is expected that Social Work service will continue to grow their governance model resulting in a positive impact on patient care delivered organizationally and in the community. Removed the word Inpatient from the Nurse Practice and Performance Improvement (NPPI) to foster inclusion across the organization. Committees to report to NPPI: Falls/Pain/HAPU/Products Review/Organ Donation/Clinical Emergency Response Committee (CERC)
Interprofessional Shared Governance: Social Worker, Quality, and Nutrition & Food Services, and Sterile Processing
Outpatient Committee reporting directly to CONE
Other Projects Facilitated by CONEF:
• Developed a recognition program for best projects
• Sick Leave Tracker
• Discharge folders
• Hydration station- spread
• Security password
• Provider Hand-off tool
• Read n Sign