By Debra Wood, RN, contributor
Business and industry discovered self-directed work teams years ago and have successfully employed them in a number of work environments. So has the surgical transitional care unit at York Hospital in York, Pennsylvania, which has found that nurses have a knack for managing themselves.
“It has worked well for us,” said Abigail C. Strouse, MS, RN, a clinical nurse specialist for the surgical service line at York Hospital. “Over the 10 years, we have defined ourselves as a good team that works well together and are able to make decisions for each other. No one has thought about going back to having a nurse manager.”
Lori Heinold, BS, RN; Maria Smith, RNC; Mark Kahler, BS, RN, serve as point people on the surgical transitional care unit at York Hospital.
The 10-bed surgical transitional care unit, with 25 registered nurses, first considered self-directed work teams when a nurse manager resigned to return to bedside nursing and few candidates emerged for the position. The unit already self-scheduled and had active committees.
Nurses from the unit visited other facilities, such as Greater Baltimore Medical Center, which at the time had a unit using self-directed work teams. The York nurses then developed a practice packet, outlining each staff member’s responsibilities and committee expectations. They also taught staff communication and conflict resolution skills.
“We make it a requirement that every staff member be involved in a unit committee,” Strouse said. New members have six months to select a committee, such as education, practice, leadership, performance improvement, and retention and recruitment. Everyone rotates through the various committees every two years.
“It gives you more experience trying different things,” Strouse said.
Three nurses serve as “point persons” to be informal leaders to communicate with other departments and physicians. Staff also can go to one of the point people with work-related issues. One of them handles budget issues and monitors nursing hours per patient day. Monthly, the three point people meet with the financial department to learn how the unit did and look for ways to reduce expenses. A clinical director regularly meets with the point people.
The unit has created a peer review committee, which conducts the annual evaluation for all personnel on the unit, and a six-month review process, which gives nurses an opportunity to improve before the formal hospital review.
The point people receive a small stipend for their extra work and are included in all nursing leadership functions. While a staff nurse, Strouse served as one of the point positions.
“It’s a great opportunity, especially when I did it, to provide the bedside care we love to do but also to develop leadership skills,” Strouse said.
When a point position comes available, nurses on the unit can express interest in filling the role, and the unit will select which nurse will become the point person.
Strouse called hospital support key to the unit’s success. It took awhile for other departments to feel comfortable talking with staff nurses and not a nurse manager. A charge nurse, a regular staff nurse working that day, handles patients’ and families’ concerns.
Staff members are encouraged to resolve their own conflicts with other staff members.
The surgical transitional care unit created a weekend on-call system in which the nurses agreed they would work for one another if one became sick on the weekend. It reduced the number of call offs.
Job satisfaction on the unit remains among the highest in the hospital. On the National Database of Nursing Quality Indicators (NDNQI) survey, the unit exceeds the overall survey mean, the NDNQI critical care mean and the York Hospital average.
“We’ve been able to attract a lot of young nurses to the unit, who like the idea of being autonomous and working as a team,” Strouse said. “We have a lot of new nurses and experienced nurses. It works out well.”
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