The council improves surgical practice on the hospital for special surgery

When perioperative nurses on the Hospital for Special Surgery in New York City encounter a practice or policy that might be improved, they do not just complain about it. They’re fixing it.

Over the past few years, the hospital has had a shared management structure through which staff nurses lead improvements within the operating room. The hospital, recognized as a Magnet facility by the American Nurses Credentialing Center since 2002, has established nursing councils, the oldest and largest of which is the Hospital Council for Perioperative Practice. The council consists of 30 members, including 27 nurses and three surgical technicians, representing the predominant operating room, ambulatory surgery department, central sterilization, nursing education and a number of other other areas of the hospital.

At the guts of the concept of shared governance is the goal of shared responsibility and empowerment of nurses.

Ron Perez, RN

“This gives us a forum where we can address issues that concern us.” explains Tashma Watson, RN, who has been with HSS for two.5 years and has served on the Perioperative Practice Council for a yr. In May, she became considered one of two co-chairs of the council. “It gives us some form of empowerment to engage?” she says. “It gives us the opportunity to connect with nurses from all areas of the perioperative environment, and a chance for all of us to work together to make changes that can benefit us all.”

The Hospital for Special Surgery on Manhattan’s Upper East Side is an independent, nonprofit facility that performed 23,000 surgeries in 2008. The board structure, and the perioperative board specifically, grew out of a recognition that the hospital needed to enhance its surgical preparedness for the reason that number had increased significantly several years ago, says Ron Perez, RN, JD, CNOR, associate vp for perioperative services, who serves on he has been on the council since its inception and until recently co-chaired it.

The council has evolved over time, and Perez says the rotating handover of leadership to staff nurses like Watson is the newest step in handing leadership responsibility to those most involved within the council’s recommendations: staff nurses.

Charlotte Guglielmi, RN

Advice ? considered one of the 4 nursing unit councils and 4 supervisory councils within the hospital? It meets once a month and works with other hospital committees, Perez says. When nursing boards make recommendations about practice or policy that affect physicians, for instance, the changes have to be approved by the suitable service committees. Opening these communication channels has improved relationships between doctors, nurses and managers, say those involved.

“It certainly increases team spirit?” – says Perez. “I think (surgeons) recognize our commitment to this process and that we have the authority to speak up and make recommendations.”

One of the perioperative council’s projects is to create a surgical safety checklist based on the list published by the World Health Organization, but adapted to the needs of the HSS. Board member Elizabeth Goetz, RN, BSN, CNOR, clinical coordinator within the hospital’s predominant operating room, says the checklist project and other similar projects that involve each doctors and nurses help construct relationships between medical and nursing staff. Nurses who control their work environment are also more likely to be more satisfied with their jobs, he says.

Elizabeth Goetz, RN, left, and Tashma Watson, RN, confer outside the operating room at Hospital for Special Surgery. HSS has 28 operating rooms on three floors of the hospital, where over 22,000 surgical procedures were performed last yr. Courtesy of Polina V. Yamshchikov | Hospital for Special Surgery

HSS administrators consider that the activities of the Perioperative Practice Council have contributed to increased patient confidence within the operating room staff. In a hospital patient satisfaction survey, patients? Survey results show that safety perceptions in OR increased steadily from FY 2007 through the primary half of FY 2009.

Other recent developments have included changes to documentation to reflect the “universal protocol”. to stop unsuitable place, unsuitable treatment and operations performed by unsuitable person; implementation of a printed operational consent form, which reduced errors related to illegible handwriting; and onboarding a brand new surgeon who becomes aware of implant specifications prior to surgical implant procedures.

Stephanie Goldberg, RN, MSN, NEA-BC, is vp of patient care and chief nursing officer at Hospital for Special Surgery. Before joining HSS several years ago, she worked at one other Magnet hospital in New Jersey and is currently a Magnet inspector.

“As the chief nursing officer of a Magnet institution, do you know that you have to have some kind of institution or framework that allows nurses to participate in clinical decision-making?” she says. “Nurses caring for patients understand what the problems are and what they need to do to provide better patient care because they live and breathe it every day.”

Shared governance models, comparable to the nursing board structure at HSS, are considered the popular practice model, says Charlotte Guglielmi, RN, BSN, MA, CNOR, president-elect of the PeriOperative Registered Nurses Association and perioperative nurse specialist at Beth Israel Deaconess Medical Center in Boston . In 2000, roughly 1,000 U.S. hospitals implemented some type of shared governance of their nursing departments, in accordance with a July 2000 article within the AORN Journal titled “Implementing a Shared Governance Model in the Perioperative Setting.” It’s harder to find out what number of hospitals across the country have perioperative nurse boards, but Guglielmi says such models have gotten more common.

“I think it helps support the high-performing elements of teams.” she says. High performance teams communicate, high performance teams operate in a learning environment, high performance teams change into truly patient centered. They process care in real time and solve problems in real time.

As health care reform unfolds on a national scale, it’s becoming clear that high-quality, financially responsible and evidence-based care will likely be rewarded, and nurse practice advice will help achieve these goals, Guglielmi says.

“Will these types of structures continue to develop in nursing units?” he says, “because that’s where the solutions will come from.”