Shared governance councils are an opportunity to identify excellence as well as process breaks that result in risks to patient safety in hospital settings. How those councils are operationalized is different based on the nurses in the organization. Issues identified may come to light in nursing practice councils, whereas others are data driven and discovered in nursing shared governance quality councils. Although the councils are driven by nursing staff, senior leadership and/or management teams are also in attendance. During these councils, educational opportunities emerge. Many large organizations “drop the ball” or “fall short” when it comes to disseminating frontline staff education that ultimately requires the valuable information to change an outcome. The purpose of this article is to describe how one hospital educates a large, diverse nursing staff about quality process breaks.
It becomes a challenge to take the vital education from a group of 20 shared governance nurses and attempt to educate over 500 staff members. Many obstacles arise due to different shift times, varied schedules, and individual workflows among the in-patient settings; therefore, in-person training sessions are almost impossible to schedule to accommodate all staff (Rosenthal et al., 2018) To provide effective education to mitigate process breaks, one must consider several key concepts. There are two areas to address when educating a diverse nursing staff: knowing the intended audience; and key points in educating a large, diverse audience (Table 1).
Key Points in Educating a Large, Diverse Audience
The first area to address begins with knowing the nursing staff that you want to educate. In our facility, our goal was to provide quality education measures to the frontline staff in several different departments of a large teaching hospital. We had to ask ourselves three main questions: What do the staff need to know? How do the staff learn? How do we get the information to the nursing staff? The largest challenge is that there is no single answer for each of these questions.
Our staff is diverse; they range in ages from 20 to 70 years and over and come from multiple countries and cultures. What works for a 20-year-old American staff member may not work for a 40-year-old African staff member or a 60-year-old Philippine staff member. One constant that we identified was the importance of providing the information in the way that honors staff learning styles and their perspectives—learning strategies had to be relevant to each of them. This, too, can prove to be a difficult obstacle to overcome: What may be significant to what leaders think nursing staff needs to know may seem trivial or irrelevant to the staff member. Many novice nurses are focused on time management to perform necessary tasks while adhering to policies and procedures, whereas the more experienced nurses focus on prioritizing patient needs by using critical thinking skills they have developed over the years (Anderson et al., 2015). Health care today is no longer about just taking care of your patients. Quality measures must be met, and financial reimbursement is directly related to patient outcomes.
What do the staff need to know? Identifying the educational topic is always the first step (Table 1). This information typically comes out of the smaller group meeting. In our facility, this topic is usually identified during our Nursing Shared Governance Quality Council meetings, where a vast array of quality measures and outcomes are discussed and shared. We focus on topics that are relevant to all inpatient departments throughout our facility, including Critical Care, Acuity Adaptable, Family Beginnings, and burn units. Some topics are also geared toward outpatient departments, such as the Perioperative Department, Emergency Department, Cardiac Diagnostics, Interventional Radiology, and Specialty Clinics.
After the educational topic is identified, supporting documentation must be gathered and reviewed. The information being presented must align with and be consistent with evidence-based practice and organizational policies. These are crucial elements to ensure staff are always utilizing best practice as established through policy and to ensure all regulatory standards (both state and federal) are being followed.
It is also imperative to identify what is occurring throughout the departments. Throughout our facility, the nurses are intelligent and creative. Many have mastered the art of finding a “work around” to save valuable time during their shift. These shortcuts can create huge deficiencies in meeting the established quality measures and could ultimately impact patient outcomes. Identifying what the nurses are doing that results in the process breaks is the driving force in determining what education needs to be provided to create improvement.
After these areas are identified, it is time to focus on the main points (Table 1). The expectation of the educational intervention is two-fold. The goals are to provide valuable staff education and to change their practice for improved patient safety and outcomes. The next step is to go back to the second question: How do the staff learn? In our facility, we know that time is valuable. Our staff tend to learn more if provided the information in shorter time frames. Long, lengthy classroom settings do not typically provide the best learning environment. Many are distracted by their personal cellphones and/or watching the clock to calculate how much longer the class will last. We quickly recognized that we needed to incorporate blended learning methods, as not all staff read their emails and/or attend staff meetings— whether the meetings are conducted in person or virtually (Nedder et al., 2017). As a result, we began using educational flyers that are short and to the point, but also contain a vast amount of information.
The educational flyers include all the information—the Dos and Don'ts of the topic. The Dos focus on the main points and the supporting documentation collected from the policies and best practices. The Don'ts include the elements identified from the workarounds and short cuts. It is important that the flyer is a single page, typically a PowerPoint® slide. It is imperative that it is eye catching to grab the interest of the intended reader. We do this by making them colorful and including clip art and images—some cartoons and some reality, depending on the topic. Studies have shown that flyer usage has proven to significantly increase adherence regarding specific education (Anderson et al., 2015).
The final question is how do we get the information to the intended learners? The goal is to get the information out in multiple ways. Throughout our facility, we do this in a vast number of avenues that also aligns with the different types of learners (e.g., written, verbal, visual, kinesthetic) among our diverse staff (Anderson et al., 2015). We include the information in emails, weekly newsletters, and monthly staff meetings. We know that not everyone reads their emails or attends staff meetings, but hopefully everyone makes at least one trip to the bathroom or breakroom during their shift. Therefore, we also post the educational flyers in high-traffic areas for the intended audience: bathrooms—eye level from the commode and the sinks, breakrooms (especially on the door as they are exiting, as no one is in a hurry to end their break), information boards throughout the units, and near the time clocks.
In conclusion, we determined that using numerous strategies for educational topics has increased adherence, improved compliance, and resulted in better patient outcomes. Examples include correctly labeling blood specimens, hospital required shift documentation, correct documentation for restraints, fall risk assessments, Influenza screening, skin assessments, and blood product transfusions. Education using multiple strategies is essential in educating a large, diverse workforce, and effective distribution is a key element to ensure all learning styles are incorporated into the educational process (Anderson et al., 2015). In today's nursing society, a great deal of emphasis is placed on advanced degrees. However, the value of continued education and professional development in the workplace should not be overlooked (Nedder et al., 2017).
- Anderson, N., Johnson, D. & Wendt, L. (2015). Use of a novel teaching method to increase knowledge and adherence to isolation procedures. Medsurg Nursing, 24(3), 159–164 PMID:26285370
- Nedder, M. M., Levine, S. A., Galligan, C., Avery, K. R., Eagan-Bengston, E. & Reilly, K. M. (2017). Blogging as an innovative method of peer-to-peer educational sharing. Critical Care Nurse, 37(1), e1–e9 doi:10.4037/ccn2017642 [CrossRef] PMID:28148625
- Rosenthal, L. D., Barnes, C., Aagaard, L., Cook, P. & Weber, M. (2018). Initiating SBIRT, alcohol, and opioid training for nurses employed on an inpatient medical-surgical unit: A quality improvement project. Medsurg Nursing, 27(4), 227–230.
Key Points in Educating a Large, Diverse Audience
Identify the educational topic
Gather supporting documentation
Must align with evidence-based practice
Must align with organizational policy
Identify what is occurring
Focus on the main points
Identify high traffic areas for the intended audience