Brennan Lewis (Host 1): ​Welcome to Nurses Connect, a podcast from Children's Health dedicated to exploring critical issues and dynamic topics that shape the nursing profession today. I'm Brennan Lewis, Senior Vice President of Nursing Excellence, Innovation, and Patient Experience.

Christi Welter (Host 2): And I'm Christi Welter, Program Manager of Nursing Communications. We are your co-hosts for Nurses Connect, and we're so happy you have decided to spend some time with us today. On this episode, we're continuing our discussion about how nurses can make a difference in decisions that shape their practice through nursing professional governance.

Host 1: Last episode, we discussed why we transitioned to nursing professional governance or NPG for short, and how this shift aligned with our nursing strategic priorities. Today, our program Director of Nursing Professional Governance, Misty Daugherty, is joining us to discuss how we operationalized NPG and established a new supporting structure. Thank you for joining us today, Misty.

Misty Daugherty: Thank you for inviting me.

Host 1: All right. So, tell me a little bit about what NPG is specifically at Children's Health.

Misty Daugherty: So, our structure is really to provide clinical nurses and nurse leaders accountability, autonomy, and authority in decision-making to achieve empirical outcomes and promote the wellbeing of the nurse and team environment. It's really changing the culture.

Host 2: Misty, you just mentioned structure. How did you and your team build out that structure? What does it look like?

Misty Daugherty: A couple of years ago, we started a gap analysis and we leveraged the strengths of our 10-year history of shared governance, and we began to build what we wanted this new structure to look like. We had five solid core councils with bursting full agendas and really had great leadership from our chairs.

We had a great departmental council, the acute care council and the ambulatory structure was really starting to progress. We knew we were missing a coordinating council. We needed a few more departmental councils to connect, and then we knew that our unit practice councils really needed support. We were very lucky because we got to hire two program managers for nursing professional governance that helped support the unit practice councils, creating that foundation that they needed.

Host 1: And I'd like to add that we developed a visual model to illustrate how the structure comes together, including integrating the Magnet components. This model helps our nurses and interprofessional partners understand the NPG structure.

Host 2: So with this model, there's an illustration, but how do you provide guidelines to NPG members? I know that we've talked about bylaws in the past. Maybe you can tell us a little bit about that and what's inside them.

Misty Daugherty: Absolutely. In the past with shared governance, we did have guidelines. But during our analysis, we knew we needed bylaws to really guide the processes for nomination and election of members and chairs. We needed the term limits defined, role responsibilities, and decision-making. The bylaws really provide a foundation for how the NPG structure is operationalized. We reviewed multiple examples from other organization and partnered with our legal team to really refine our bylaws. And for the first time in over our 110-year history, the Children's Health Board ratified the NPG bylaws and we are extremely proud of that.

Host 2: Yeah, that's really exciting. And over the last year, another exciting development was your team started NPG Council Day. What is the purpose of that and how does it help contribute to the work of NPG?

Misty Daugherty: Absolutely. We started Council Day to really make it simple, to make it more simple for clinical nurses to participate at their councils or to lead their councils. We made an NPG placeholder for their schedule. And the core council chairs were given 12 hours to work on Council Tuesday in place of one of their shifts. This was big.

One of the biggest barriers that clinical nurses have has always been scheduling meetings around their shifts. So since clinical nurses work shifts, it's really difficult. They can't come away from the bedside for an hour or two for a meeting, so it's always around their shifts. If a nurse is on more than one council, it's really difficult. And then, our new structure. If a nurse is a chair actually leading a council, they're expected to attend at least one other NPG meeting.

Therefore, this one-day council meeting has really helped clinical nurses get to the meetings they need to attend because it's on one day. So, it really has increased attendance and participation. And then, one outcome that we really weren't expecting, I didn't even see coming, was that our council day really increases the clinical nurses' understanding of the structure. And so, when I was a council chair many years ago, the meetings were really all over the month. And so, there was no progression and you couldn't really tell that these meetings connected. And so, with this new structure, we believe that it has really helped the collaboration and understanding for clinical nurses.

For example, the unit practice council meets at 8:00 AM in the morning on Council Day. And then, a couple hours later, those unit practice council members bring feedback from that 8:00 AM meeting to the core councils. And then, the core council chairs are able to bring information and bring barriers to the coordinating council that our CNE is the chair of. So, that Council Day really fosters the connection, collaboration, and gives us momentum throughout our structure. Also, on Council Day, all nurses are invited to the virtual NPG general session that starts at 9:30. It's about a 45-minute session. We review professional development opportunities, our CNE Tammy Webb speaks, and we get our NPG members to share current accomplishments and ongoing initiatives. It has really been a great addition.

Host 1: So Misty, tell us a little more about how Children's Health has benefited from NPG and what are some of our successes.

Misty Daugherty: So, increasing decision-making leads to accountability. And our structure allows clinical nurses to make decisions related to their practice. If the clinical nurse has buy-in about a change, a new process, a new policy, implementation is easier, and they help sustain the change. Overall, this has really increased our engagement. Twenty-six clinical departments are represented by clinical nurses on each core council, and we have less than a 10% membership vacancy. Also, we have maintained almost 90% attendance each month for all core councils, so that has been exciting. Over 400 nurses attend general session each month, nurses connect across the system with each other and nursing leadership. Having our chief nursing executive and other nurse executives present increases visibility with clinical nurses and provides time to recognize nurse excellence, teams and individual nurses amongst our peers.

Host 2: So, it sounds like NPG has been extremely successful over the past year. And this question is for both of you, because I know you've both been heavily involved in NPG. What is something that you would want our listeners to know about that I've not already asked you?

Misty Daugherty: So, I would say a couple of things. One has been when we have presented this new structure and our new mindset that we have had multiple hospitals across the nation reach out for more information. So, that has been an amazing thing to be part of.

As we enter year two of NPG, last Friday, we had over 150 nurses attend our annual NPG leader training. It was a really great thing for me to see. I have never seen that many people in one place, that many nurses in one place for a training like this. We had all unit practice departmental forum, and core council leaders invited and the majority came. There was such great energy. And to see the mindset shift is very exciting.

Host 1: A couple of things I was thinking about is really seeing the nurses embrace professional governance. When we first started out, we were talking about our professional practice model and how it has accountability, autonomy, and authority as a part of our model. And really that equates to own your practice. And that is a phrase that our clinical practice council has really taken and run with and really implementing across our organization.

Another experience that I've had serving as an executive sponsor for the Quality Safety Council is really watching the clinical nurses embrace their roles as professional nurses, as they get to make decisions that impact the care of our patients. And how they're learning to lead quality improvement projects is truly incredible to watch. Our chair of the Quality Safety Council, she continues to lead a large interprofessional project in our system and is actually joining us on to be a panelist in an upcoming conference. So, these nurses are really growing in their leadership, and when we say they lead from the bedside, they truly are. And NPG has provided that mode for them to participate.

Host 2: Well, I have to say I'm so impressed by all of the work, Misty, that your team has done, and Brenna, the way you and Tammy have led nurses across our organization and just how successful this has been in getting nurses involved in decision-making across the organization. So with that, we are out of time, so we'll wrap up this episode of Nurses Connect. Thank you so much, Misty, for joining us today.

Misty Daugherty: Thank you, Christi.

Host 1: If you want to know more about nursing at Children's Health, we encourage you to visit childrens.com\nursingannualreport. Here you'll find a variety of information that summarizes some of our initiatives, including nursing professional governance. Thank you to our listeners for joining us today. We'll talk to you next time on Nurses Connect.