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Driving Change

Sep 15, 2017

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Aberdeen Hospital’s Nurses Piloting a First in Nova Scotia

Carla MacDonald was looking for an opportunity for her department’s nursing team, one that would challenge them to play more of a leadership role on the inter-professional care teams on which they serve.
MacDonald is the clinical nurse specialist for the Aberdeen Hospital’s busy medical inpatient unit. The unit cares for all patients in the hospital, other than surgery and maternity/pediatrics. It requires a large team of nursing professionals who are skilled in nearly every area of patient care.
The opportunity MacDonald was looking for arrived in the form of a pilot project that is a first in Nova Scotia. When implemented, it will represent a transformation not only in care but also culture.
The Aberdeen Hospital has been invited to partner with the StFX Rankin School of Nursing to become a Best Practice Spotlight Organization. This designation is a health care innovation developed by the Registered Nurses’ Association of Ontario (RNAO) and deployed internationally.
“This pilot represents a planned system change that will be led by our nurses. It’s about how nurses build on the knowledge they graduated with. It’s a process through which that knowledge is continually updated and put into practice,” says MacDonald. “This is about breaking the mould of doing a thing because that’s how it’s always been done.”
The program represents a shift in culture because the nursing team is leading the introduction of the latest best practice at the bedside. They learn how to gather evidence, develop a rationale, and facilitate conversations that help the entire team adjust and adapt its approach based on new information. In this way, nurses become patient care innovators.
“We are ever so thankful to StFX and in particular Dr. Jo-Anne MacDonald, associate professor in the university’s faculty of nursing, for inviting the Aberdeen Hospital to be their partner in this pilot and for the extensive work that was done by many people both at StFX and here within the Nova Scotia Health Authority over the last two years to make this possible,” adds MacDonald.
During the one-year pilot project, the team will be implementing best practice guidelines in two areas: pressure ulcers and managing transitions in care that occur at shift changes. These are areas of patient care and safety that nurses can directly impact. How they communicate, make decisions, and collaborate with other health professionals are key aspects the program addresses.
To help prepare the nursing staff and managers of the hospital’s medical inpatient unit, a small team travelled to Ontario to see best practice implementation in action. This was followed by a three-day training symposium hosted in New Glasgow to prepare a number of “best-practice champions” to lead the transformation within the department.
The Aberdeen Health Foundation provided funding for these activities. “We are very pleased to play a role in making this pilot possible at our hospital,” says Susan Malcolm of the Aberdeen Health Foundation. “It’s a patient care strategy that is improving patient and organizational outcomes wherever it is implemented, and we’re excited to see our nurses driving those changes. It’s such an exemplary use of the Foundation’s resources.”
MacDonald has already noticed a marked change in her team. “The symposium was very in-depth. By the final day, our language had already shifted. We learned an overall process, which can be applied to all aspects of care. We talked a lot about change management and understand the expectations of what this means to take this back to the unit.”

“We are really pleased that the Aberdeen Hospital has been given the opportunity to participate in this pilot, which is the first time the Registered Nurses’ Association of Ontario Best Practice Program has been implemented in Nova Scotia and the first time an academic institution and service provider are collaborating on implementation.
RNAO’s approach to nursing innovation has transformed patient care in Ontario and we look forward to seeing how it will impact outcomes in our medical inpatient unit and to applying what we learn when it comes to expanding this approach throughout the Nova Scotia Health Authority.”
Nancy MacConnell-Maxner, Interprofessional Practice & Learning Director

“From a patient perspective, my overall goal is to be able to walk into a patient’s room and ask if they know their care plan and to have them say they know the plan. To have the patient and family involved in making the plan means we’ll reduce gaps in communication. Because they’ve played a role in creating the plan, it will mean better patient outcomes. Patients will be much more informed and motivated.
From a nursing perspective alone, the leadership capability that this will bring to staff will pay dividends beyond measure. Just in the time we’ve started talking about this, you can see that flip in the team already. It’s phenomenal. There’s such a feeling of positivity. They feel supported and with it, satisfaction has increased.”
Carla MacDonald, Clinical Nurse Specialist

“The timing for this pilot couldn’t have been better. The unit needed some fresh ideas and something for staff to be excited about. Satisfaction and pride have spiked and we’re working better as a team. Everyone is keen to play a role in changing things for the better. I think our patients sense this too. Communication is a really important part of this program, so we’re educating them on the changes, talking to them a lot more, explaining their meds in more detail, and involving them in their care plan. The changes have been very positive. I really look forward to going to work every day now.”
Sandi Kennedy, RN

“It’s really exciting to work with StFX and RNAO on this pilot. The initial phase was about getting the word out to other staff. Everyone understands that the goal is to improve patient outcomes and they all want to be involved. Our staff seems more engaged and more responsible for the role they play. Even participation at staff meetings has increased. We’ve already begun to implement some changes and they’ve definitely improved how we’re operating and communicating.”
Brittany Heighton, RN