Establishing a Shared Governance, Unit Based Council for the Hematology/Hematopoietic Cell Transplantation (Hem/HCT) Nurse Coordinator (NC) and Clinical Trial Nurse (CTN)

Background The role of the NC/CTN is an intricate and integral part of the patient care experience. The NC/CTN provides extensive patient education, advocacy, coordinates diagnostic testing, clinical trial participation and follow-up care in collaboration with a multidisciplinary team; however, current workflow processes for the NC/CTN role are not clearly defined.  We established shared governance via Unit Based Council (UBC) to provide structure and context to organize deliverable goals.  

Purpose:  Define the structure and standard of the NC/CTN role, in line with Hem/HCT department and nursing leadership goals.  Improve patient outcomes through evidence based practice and collaboration with multidisciplinary team throughout the decision making process.  Maintain autonomous professional nursing role while providing empowerment and role satisfaction.

Intervention:  Shared governance education was provided to staff followed by an electronic survey to gauge interest in creating and participating in a unit based council.  A subset of volunteers was selected to serve on the newly created UBC.  Through an evidence based approach, a charter was established.  Members serve as representatives of our NC/CTN staff within which members rotate leadership positions.

Evaluation/Discussion:  Once the charter was developed and approved, per quorum, work commenced on the initiatives:  1) Ownership of ‘the patient and family transplant education class’ was returned to the NC staff.  This opportunity for change resulted from an issue identified in a “management of daily improvement” (MDI) huddle.  2) The material taught was reviewed and updated to current practice, utilizing input from a non-UBC sub-committee.  To date, we have seen an overall increase in attendance and have established measurable units.  It is too early to determine degree of success, however this initiative will help better serve our patients, improve outcomes and allow us to address future concerns with measurable targets.  3) A staff satisfaction survey was developed, implemented, analyzed and presented.  Ideas to improve overall satisfaction are currently underway.  4) Creation of a standard orientation work flow process, role specific checklists and central orientation binder for reference of the defined standards, is work in progress.  Each group in the NC/CTN office has their own orientation model without a universal process between groups.  To address this need, a structured framework was applied to the existing process in attempt to streamline the comprehensive orientation process and centralize references for new employees joining the group.

Future and on-going projects include: 1) Standardize documentation; 2) Collect professional articles that represent current ‘best’ evidence based practices for implementation; 3) Create reward and recognition program within NC/CTN group; and 4) Update annual review evaluation forms.