Running Head: QUALITY IMPROVEMENT PROJECT

Quality Improvement Project

Kirsten Poole

Bon Secours Memorial College of Nursing

NUR 4144

Dr. Barbara Ellcessor

I pledge the honor code.

Quality Improvement Project

As a servant leader, it is important to determine policies and processes that do not serve

patients in a way that provides maximum benefits. As a nurse manager, it is important to

implement new policies that fix the problem (Marquis & Houston, 2017, p. 6). In this essay, I

will write from the perspective of a nurse manager, and identify a clinical issue that I need to

solve. I will use evidence-based references to provide rationale for my policy change, and I will

relate my process to the characteristics of a leader, as defined in the book Lead Like Jesus.

Finally, I will give examples of the implications this will have on nursing practice, and evaluate

the outcomes for patients’ and the units’ well-being.

In the February 2013 issue of the Journal of Advanced Nursing, authors Fore & Sculli

define ‘situational awareness’ as, “ an internal factor of primary decision making that plays a

critical role in ways patient care is provided” (p. 2615). As nurse manager of the Labor and

Delivery unit, I have noticed the issue of situational awareness in several staff nurses. I have seen

nurses taking lunch breaks during post-partum hemorrhages, when their knowledge and skill are

desperately needed in the patient’s room as opposed to the staff lounge. All too often nurses

perform with the approach of “not my patient, not my problem.”

On labor and delivery, it is an expectation that nurses stay abreast to the state of the

department throughout their shifts. Due to the unpredictable nature of nursing, and on this unit in

particular, all staff need to be aware and anticipatory of precipitous or sentinel events. In keeping

with this effort, I have decided to implement a staff-wide shift report.

Shift-change report has come into scrutiny in recent years, and there is a plethora of

current literature on the positive outcomes of bedside reporting between two nurses. While this is

helpful to the nurse when caring for just her patients, this report may not be enough in ensuring
QUALITY IMPROVEMENT PROJECT 3

the safety of all of the patients on the unit. My idea is to update each oncoming nurse on the

acuity of the entire unit’s census. The purpose of this practice is to allow nurses to identify the

most acute or critical patients on the floor, and although they may not directly care for these

patients, they will know to make themselves available in the case of urgency or emergency.

Servant Leader Domains

According to Lead Like Jesus (Blanchard & Hodges, 2005, p. 31), the four domains of a

servant leader include heart, head, hands, and habits. The first domain that must be considered is

the heart. Blanchard & Hodges (2005, p. 32) say that a servant leader must have the ones they

are leading’s best interest in mind when making decisions. The implementation of shift board

report benefits both the nurses and the patients. The nurses are aware of each patient’s condition,

therefore, they are able to respond and act in situations quickly and efficiently. The patients

benefit from this protocol by having a whole staff of nurses privy to their status, and will

received more individualized care.

The head is defined as the beliefs of a servant leader (Blanchard & Hodges, 2005, p. 32).

This relates to the heart, as the are both internal domains of a leader (Blanchard & Hodges, 2005,

p. 32). If the motive for this exercise is to benefit the nurses and the patients, thusly my belief as

a nurse leader is that the nurses should be given opportunities to grow into their bests selves, and

the patients should be kept as safe as possible. Through the implementation of a board report

every shift, I hope to develop a culture of involved nurses and safe patients.

The hands of a servant leader are their actions. I believe that it is only through

encouragement and guidance that a person can achieve the level of expert nurse. It is my hope

that by placing the expectation the every nurse is responsible for the safety of every patient, staff
QUALITY IMPROVEMENT PROJECT 4

will work hard to ensure this, and evolve into better nurses because of this. This is the right

amount of guidance leadership can offer while still allowing nurses to maintain their autonomy.

Finally, the habits of a servant leader are perhaps the most difficult on which to elaborate.

Blanchard & Hodges (2005, p. 33) state that, habits “are how you renew your daily commitment

as a leader to serve rather than to be served.” As a nurse manager, my commitment is to my staff

and our patients. I believe that I responsible for fostering the growth of the nurses and ensuring

quality care for the patients. This requires reflection on our performance as a unit. I need to

constantly look at how I am meeting the needs of staff and patients, which is reflected in nurse

performance and staff satisfaction. I then pray for guidance on how I can better serve these

groups.

Practices of Exemplary Leadership

There are five practices of exemplary leaders that I hope to uphold as a nurse manager.

First, I must model the way by asking of the nurses only what I am willing to do myself (Kouzes

& Posner, 2011). This means that I will attend board report every morning and assign a night

shift leadership team member to attend in the evenings. This way, I am just as must “in-the-

know” as the rest of the staff, and therefore, the responsibility of responding to patients

appropriately equally falls on me.

Next, I must inspire a shared vision (Kouzes & Posner, 2011). My vision is that all

oncoming nurses will attend this report every shift they work. The inspiration can be instill

through creating personal investment in the procedure. This can be achieved by presenting the

scenario of their own patient in an emergency with no back up available because no one was

anticipating such an event. That alone should be enough to encourage attendance. However,
QUALITY IMPROVEMENT PROJECT 5

nurses will also receive a letter of recognition if they attend the report for six consecutive months

that they will be able to use for professional advancement purposes.

I must challenge the process (Kouzes & Posner, 2011). As previously mentioned, I have

been witness to incidence where nurses have not been aware of urgent need of the unit because

they didn’t know patient’s conditions. I have seen nurses refuse to watch the strips of other

rooms because they hadn’t care for the patient, and were not comfortable providing care in this

situation. The goal of this new directive is to change that. I hope to equip nurses with the

information they need to feel comfortable caring for any patient in any situation.

The purpose of this change is to enable others to act (Kouzes & Posner, 2011). I hope that

this will create an environment of teamwork and collaboration. I will also enable others to act by

letting each shift decide when they will receive board report, and who will conduct the report.

My hope is that everyone will want to contribute about their own patient in a round-robin style

huddle.

Finally, I will encourage the hearts of these nurses by providing recognition during these

reports (Kouzes & Posner, 2011). I will address the nurses whose work deserves a spotlight after

the board report is over. As stated before, nurses who attend these meetings consistently will

receive a letter of recognition as a symbol of my gratitude. I will also open the lines of

communication for feedback on how the process is working and how it can be improved. This is

to evaluate efficiency and correct any possible issues.

Implications

While this is a seemingly simple change, a few barriers exist to achieving my goal of

implementing this process. Two of which include the demand nurses may feel from setting this

expectation, as well as the ability of nurses to provide measurable and sufficient follow-through.
QUALITY IMPROVEMENT PROJECT 6

These may seem insurmountable, however, the rationale behind the process change

circumnavigates these issues.

Nurses already feel so much pressure from leadership to provide direct care, collaborate

with an inter professional team, and meet standards set by leadership, the hospital, and its

governing bodies. I do not wish to increase to workload of my nurses by placing unrealistic

expectations on their shoulders; rather I hope to make them feel supported by providing an

efficient way to “have each others’ backs”. With this new process, nurses will have to become

motivated to act as a team member and recognize the assets they bring to every shift.

I want to make clear that I do not expect every nurse on the floor to respond to a situation

if they are unable to do so. If a nurse is providing direct care that requires one-to-one attention,

then the best action is to stay with their patient. It is not my intention to pull nurses away from

their responsibilities. I hope that this process will inspire nurses who are unmotivated to act as a

team by giving them the necessary information and tools to respond in an emergent situation.

Evaluation

Upon evaluation of implementation of this process, the staff has improved several

outcomes on the unit. Nurses have responded favorably to the change and have participated in

ensuring board report takes place every shift. There has been 100 percent attendance at all

reports, with each nurse making an effort to free herself for ten minutes to come to the nurses

station and report on her patients. Nurses suggested that if anyone was unable to attend the

huddle report, they could receive report from the charge nurse at the most convenient time for

them. This idea was taken into consideration and approved, as we wish to be as flexible as

possible when implementing change.

Overall, there has been one major event that has occurred since this process started, and

every nurse that was available to respond, did so. During the debriefing all of these nurses noted

that they were able to act so quickly because they knew what was going on with the patient and

anticipated such an event. They were all recognized for their efforts. In addition to this event,

nurses have noted that they are more comfortable caring for other nurses’ patients, and they seem

to have more situational awareness than in the history of the unit. This process change has had a

positive effect on the unit, and I plan to keep this implemented until further notice.
QUALITY IMPROVEMENT PROJECT 8

References

Blanchard, K. & Hodges, P. (2005). Lead like Jesus. Nashville, TN: Thomas Nelson.

Fore AM, Sculli GL. A concept analysis of situational awareness in nursing. J Adv Nurs

2013;69(12):2613–2621.

Kouzes, J. M., & Posner, B. Z. (2011). The five practices of exemplary leadership. San

Francisco, CA: Leadership Challenge.

Marquis, B. L. & Huston, C. J. (2017). Leadership roles and management functions in nursing:

Theory and application. (9 th ed). Philadelphia, PA: Wolters Kluwer