MultiCare set out to create a strong and vibrant nursing culture when we created our 10-year nursing strategic plan in 2019. We’ve come a long way since then, with nurses and nursing leaders working together to build a collaborative, accountable and empowering environment where nurses give the best care to every patient, every time.
Structural empowerment and shared leadership have given nurses a voice in designing and improving nursing practice. In addition to the work described in the next few pages, successes and highlights include:
- Supporting six systemwide shared leadership councils and growing the percentage of unit-based councils in hospitals and clinics from 14 to 72 percent.
- Implementing the Navy Seal Extreme Ownership training program in the Inland Northwest region. The program has enhanced leadership skills, decreased burnout and improved workplace culture. With a 43 percent reduction in turnover and over 450 graduates, the program saved $2.7 million and demonstrated significant structural empowerment within the organization.
- Creating a standard response systemwide that uses plain language and eliminates confusion with a similar-sounding code to mobilize the right people — an obstetric and neonatal response team — to imminent births happening outside a Family Birth Center.
- The Mary Bridge Children’s Shared Leadership Council partnering with Cass Bucey, NPD program manager, simulation, to develop a tool for facilitating a clinical debrief, including language to establish psychological safety.
- Frontline nurses helping determine whether changes to oral care kits would increase compliance for independent and dependent non-ventilated patients; whether new peripheral intravenous dressings would eliminate the need for a stat lock for stabilization; and other impacts to nursing practice.
Shared voice, shared impact: A conversation on nurse empowerment at MultiCare
Emily Calabro, PhD, RN, CCRN, CHPN, CLNC, CCISM, Clinical Nurse Scientist and Health Care Researcher
Julie W. Rose, Program Manager, Nursing and Allied Health Resilience & Well-Being
Moderator: We’re joined by Julie, a nurse advocate and wellness champion, and Dr. Em, our system’s clinical nurse scientist and 2023 chair of the system’s Shared Leadership Coordinating Council. We are diving into the Nursing Magnet Model and Pathway to Excellence. Achieving a designation like Magnet involves excellence across all categories, a feat accomplished by only 612 hospitals nationwide. Central to attaining this level of excellence is a collaborative approach between frontline teams and administration. Dr. Em and Julie, we appreciate you joining us!
Rose & Dr. Em: Thanks for having us! We’re excited to discuss how MultiCare prioritizes shared decision making between nurses and administration.
Moderator: That’s the perfect segue! We often hear about programs like shared leadership, but can you share some concrete examples of how nurse input is directly improving patient care or staff well-being at MultiCare?
Rose: Well, I could tell you many stories, but there’s one program that’s had a truly unexpected and profound impact: Echoes for Nursing.
The program began with the physician wellness team, Dr. Tammie Chang and Karen DeLorenzo. A group of senior nurse leaders, especially June Altaras, our chief nursing officer, were excited about the potential of it for nursing — because nurses have so many stories — so we decided to explore it. As it grew, the need to support the events also grew, so we created a subcommittee within the Nursing and Allied Health Shared Leadership Wellness Council. Through that partnership and shared responsibility, we have been able to grow the program.
Moderator: That’s a wonderful example of shared decision making!
Dr. Em: Absolutely! This team was also not afraid to tackle some of the challenges we’ve had. They studied the program’s impact, streamlined and refined the coaching process, and actively sought feedback from frontline nurses.
Rose: The team was empowered to lead some integral aspects of creating these events, and now we have nurses reaching out, wanting to sign up to be a storyteller — and others are excited about attending the events. So now, instead of wondering if we will have an audience, we need formal RSVPs so we can accommodate everyone. We are also building a waitlist of tellers for future events.
Moderator: Wow, that’s powerful! From nurses not really knowing about storytelling and how it can help our communities, to having them proactively wanting to be involved, that speaks volumes about the program’s impact.
Rose: Exactly. It shows how ownership and pride can blossom when nurses have a voice. Plus, our commitment to continuous improvement led to a 50 percent reduction in event costs!
Moderator: Impressive! So you’re not just telling stories, you’re being fiscally responsible, too.
Rose: We are! We also embraced technology to expand our reach. By broadcasting events online alongside in-person gatherings, we’ve connected with more health care professionals than ever before.
Dr. Em: Inclusivity is our goal. We wanted to reinforce the idea of shared wisdom across the entire health care spectrum and even the community. Several times we had our storytellers invite patients or family members that were part of the story they were sharing.
Rose: Absolutely! We invite patients, families and even other departments to attend. It fosters stronger connections and a sense of community.
Dr. Em: And the impact goes beyond just connection. We discovered that storytelling can spark profound growth in nurses.
Moderator: Can you elaborate on that?
Dr. Em: Certainly. Half of our storytellers report a significant shift in how they relate to others and find strength through adversity. A third discover new meaning and appreciation for life, building personal resilience.
Moderator: That’s incredible. It sounds like these stories are helping nurses rediscover their purpose and heal from past experiences.
Rose: They are! Through the coaching process, nurses can remember and reconnect to the positive impact they have, the value they bring, the joy in their work and even why they chose nursing, which is all about staying connected to their purpose. We found this process is integral to ensuring nurses feel supported and skilled in their storytelling. There’s often a serendipitous element where earlier experiences resurface in the stories; with the right kind of support, this can lead to healing and gratitude.
Dr. Em: It is incredibly powerful. Interestingly, we also discovered that while nurses are used to storytelling, a formal event can be very intimidating. And we wondered, how does fear play a role in the healing process?
Rose: Yes, it’s an interesting question. Fear is often underrated. In this case, the fear of public speaking becomes a catalyst for growth. Overcoming that fear is a big part of the healing journey.
Dr. Em: It is a fascinating perspective, Julie. And while we are still studying this, we know this isn’t for everyone and not everyone wants to overcome the fear of public speaking. We do have other programs that help in the healing process too, like Harmony Hill.
Rose: It is so important when we talk about wellness that we really meet nurses and health care teams where they are at. Through listening sessions, nurses expressed the need for support to heal from the stress and trauma of COVID and deal with the ongoing challenges of nurse burnout.
Dr. Em: You’re exactly right, Julie. When we look at the research, the nursing profession faces significant challenges related to mental health, with nearly 30 percent of nurses experiencing post-traumatic stress disorder, or PTSD, during their careers. The work environment exposes nurses to triggers and traumas contributing to PTSD, with rates varying across care settings. And we know that PTSD drives nurses away from the bedside, worsening turnover rates.
Rose: And this shows up in many ways. Nursing leaders may see increased absenteeism and presenteeism, the latter being particularly concerning as it can compromise patient safety. Younger and less experienced nurses are at higher risk of compassion fatigue, which can lead to decreased retention and intentions to leave the profession. Chronic stressors, traumatic patient experiences, workplace incivility and high patient-to-nurse ratios further contribute to compassion fatigue and burnout among nurses. There is an urgent need for systemic support and interventions to address the mental well-being of nurses and ensure the sustainability of the profession.
Moderator: So what is MultiCare doing to address this growing need?
Rose: That is such a great question, and it goes right back to structural empowerment. We are partnering with June, our chief nursing executives, our managers and directors, our nurse scientist, and the MultiCare Foundations to help stand up programs that support nurses. It really ties back to our long-term strategic goal of building a strong and vibrant nursing culture, and the vision and directive from our chief nursing leaders to bring wellness and resiliency resources to our nurses. We’re happy to report that while some of these programs cost money, the return on investment is impressive.
Moderator: I’m not great at math, but can you give an example of the ROI (return on investment) for Harmony Hill?
Rose: Yes, of course! ROI is simply how much you get back from what you put in. If we focus on turnover, for example, we can see that nurses that have attended a Harmony Hill overnight nursing retreat have a 98 percent retention rate compared to the system’s average of 65 percent retention. After the cost of the program, we have shown we can save $1.2 million for every 100 nurses that go through Harmony Hill, which is a 77 percent ROI.
Dr. Em: We would not see this kind of success without a strong partnership with administration. By working together, nurses have a clear voice at the table, and administration understands the challenges and needs on the front lines. This collaboration allows us to develop and implement programs like Harmony Hill and Echoes that directly address nurse well-being and benefit patient care. It’s a win-win for everyone involved.
Moderator: Your point about nurses having a clear voice at the table applies to another success story in 2023, the implementation of The Johns Hopkins Activity & Mobility Promotion.
Dr. Em: It sure does! The mobility program is exciting because it began with our nurses, and it was implemented by our nurses. They saw a need and brought the idea to shared leadership. About 70 nurses — primarily floor nurses — became mobility advocates to champion the program among their peers.
Rose: The #everyBODYmoves program uses research to improve our reliability in getting patients moving more quickly, so you can see why it’s so nurse-driven. One of the registered nurses who helped launch this at MultiCare, Katie Stochosky, had a great quote about why the mobility program is so important. She said: “You have patients winning because they’re able to leave the hospital with less long-lasting health effects. You have nurses winning because they are less relied upon to do activities of daily care for patients, and then the hospital system wins because of shorter length of stay.” That’s powerful stuff!
Moderator: Thank you for sharing these insights into how MultiCare is fostering a culture of shared voice and shared impact. It is a true inspiration for health care institutions everywhere.
Rose & Dr. Em: Thank you for having us! It was a pleasure.
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