International Practice Development Journal


Title of ArticleTransforming culture in the critical care environment – The building block of the journey
Type of ArticleOriginal practice development and research
Author/sSuzanne Murray, Jonathan Magill and Megan Pinfold
ReferenceVolume 2, Issue 1, Article 5
Date of PublicationMay 2012
KeywordsFacilitation, shared governance, values and beliefs, workplace culture

Purpose: External facilitators were approached by a newly appointed acting nurse unit manager (A/NUM) to provide support and facilitation expertise, in her quest to engage with her new critical care nursing team. The intent was to work towards creating an effective workplace culture in a cardio thoracic intensive care unit (CTICU).

Background: The A/NUM position of the CTICU is based on a four bedded unit with 19 full time equivalent (FTE) staff at a major metropolitan teaching hospital in Sydney, Australia. The hospital has, over the past seven years, been working towards the development of an emancipatory culture of nursing. The hospital nursing shared vision statement being; ‘ for nurses to embrace a culture that enables all persons to flourish’. This programme of work has focused on developing key groups of staff (mainly leadership groups) to adopt ways of working that enable staff participation, facilitate critical conversations and promote collaborative action towards improved person centred outcomes. Shared governance principles of engagement are critical to the development of an emancipatory culture. The new A/NUM was keen to inspire a sense of team spirit in the unique shared environment of public and private healthcare. She had the vision to look beyond the barriers and insular ways of working and advocated a model of shared governance, providing nurses with a voice within the wider organisation that allowed and encouraged them to participate in the decision-making processes that affect their professional practice.

Process: The external facilitation provided opportunity for the A/NUM and now permanent NUM to be part of the values clarification and shared values process, this occurred over a number of facilitated sessions. As no adult intensive care unit in New South Wales, had commenced the Essentials of Care (EOC) Programme, it provided an opportunity to introduce the framework and propose the potential for further work.

Discussion: Using the values clarification process, the external facilitators were able to progress to an action planning phase of work. The CTICU teamwork has significantly improved overall as they have a sense of belonging to the unit. They shared how they felt the working environment had already improved half way through the process. The external facilitators used various tools and practice development principles to engage the unit, working inclusively and participatively. Circles of concern were reduced and influences increased throughout the action planning phase.

Future scope: The action planning phase continues. The future vision to commence the EOC Programme in CTICU in 2011 has been realised; they continue to work collaboratively with the general intensive care unit to refine the critical care domains of EOC. CTICU have reengaged with the Nursing Person Centred Shared Governance Framework, having representation on Nursing Councils and the specialities Community of Practice.

This article by Suzanne Murray, Jonathan Magill and Megan Pinfold is licensed under a Creative Commons Attribution Non-Commercial 3.0 License.

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