R-PATH: Transformational Leadership Empowering Shared Governance

Staff of 13 West

Jennifer Grenier, DNP, RN-BC, Angelique Richard, PhD, RN, CENP, Tim Carrigan, PhD, RN, NEA-BC, FACHE, and Patty Nedved, MSN, RN, CENP

The R-PATH initiative was launched with a three-pronged approach focusing on multidisciplinary daily rounds (MDRs), unit patient population re-aggregation, and care management. The ultimate goal was to improve care coordination and patient flow optimization.

A vision was created to optimize our medical surgical bed complement, which included re-aggregation of patients on several units. This process was completed by February 2018.

Nursing senior leadership created initial plans for the changes and created an R-PATH nursing project coordinator. Jennifer Grenier, DNP, RN-BC, Director of Rehab Services eagerly took on this additional role.

To process physically changing units and patient populations, a tremendous amount of teamwork was required. Major initiatives included preparing nursing staff for changes in their practice workflow, educating large groups of nurses, and ensuring appropriate patient placement within this new structure.

Nursing senior leaders and unit directors utilized town hall meetings and the Professional Nursing Staff (PNS) shared governance structure to hold discussions with frontline nursing staff. The Chief Nursing Officer (CNO) elevated nursing staff concerns to the R-PATH steering committee. Based on clinical nursing feedback, the following changes were made to the initial plans:

  • 9 Kellogg moved to 13 West Tower to care for ortho-spine, neuro-spine, pain, and ENT/plastic surgery patient populations (keeping ENT/plastic surgery). Nurses felt a strong commitment to this complex patient population due to years of developing nursing skill and positive surgeon relationships.
  • 12 East Tower became the Intermediate Care Unit (IMCU) level of care, continuing to care for cardiovascular (CVT) and transitioning to care for the transplant patient population. This team was passionate about maintaining their expertise in caring for CVT patients and receiving only higher acuity general surgery patients.
  • 7 South Atrium staff elected to physically stay on their same unit and continue to care for bariatric and general surgery patients and also to begin caring for medicine acute care patients. In addition to not moving units, this team was able to maintain their expertise and passion to care for the bariatric surgical patient population.

The Clinical Nurse Specialist (CNS)/Educator group worked with Jennifer Grenier to create patient population education. One concept was having experienced RNs train nurses on the unit with the new patient population. For example, two RN3 nurses from 7 South Atrium went to 12 East to help train and care for the transplant patient population.

Nurses on 13 West became train-the-trainers to fine-tune neuro-assessment skills to care for their new ortho-spine and neurosurgery populations. Another educational component completed was utilizing online courses from the American Association of Critical Care Nurses for intermediate care units.

To ensure appropriate patient placement after the moves occurred, nursing worked with the patient placement department to create an algorithm for patient overflow. Clinical nurse input was also encouraged and solicited in this process.

The success of the R-PATH project is attributed to RUMC’s long established shared governance structure where frontline nursing concerns were heard and project plans were altered based on the input, expertise, and feedback of nurses on the frontlines of care.

Transformational leadership and project agility were central to improving patient care and nursing engagement with this initiative.

Optimizing Patient Flow with Increased Observation Beds