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Cultivating Collaboration

5. Share Nursing Resources Far and Wide

Collaborate successfully

Joining forces: Community Clinics Nursing Director Natalie Manolakis and Resource Nurse Manager Karen Nye teamed up to improve patient care and increase operational efficiencies.

Creating one core staff to cover four hospitals, 10 community clinics and hundreds of square miles

The most successful collaborations often start casually. One person has the seed of an idea, another germinates it and together something bigger takes root and grows. That’s how Resource Nursing Manager Karen Nye and Community Clinics Nursing Director Natalie Manolakis transformed the nursing resource pool for our academic medical center: with a single idea, shared over lunch.

“I had a vision for merging our hospital and community clinic resource pools,” says Natalie. “But I didn’t know exactly how it would work, and I didn’t want to overwhelm Karen.” As it turned out, Margaret Pearce, our CNO, had already been discussing an outpatient pool with Karen, because specialty service outpatient areas were using significant inpatient resources trained for acute and critical inpatient services. And so they started with a simple conversation—and a few ambitious what-ifs. By the end of their first lunch date, they were both convinced that an expanded, centralized resource pool was the right thing to do. But doing what’s right isn’t always easy.

Create an environment where everyone wins

1,401 hours covered

In the few months since the new resource pool has been in place, the resource nurses and MAs have already covered 1,401 hours of unfilled shifts for the community clinics.

Karen and Natalie worked together to create a proposal for joining their two teams as one, considering everything from cross-training nurses and medical assistants to centralizing scheduling for them all. And while it was clear that nursing leadership supported the plan and could see the big picture of how it would maximize efficiencies and improve patient care, convincing the hospital and community clinics staff that it would truly work was another challenge altogether. Would resource nurses from the “big house” be interested in the lower acuity patient care and completely different pace of the clinics? And would community clinic nurses be comfortable building the necessary skills to float through specialized units in the hospital?

“We had a very optimistic perspective,” says Natalie. “The challenge was to get everyone to that place of optimism that we felt.” To do this, Natalie and Karen focused not only on how the plan would be better for the organization and patients, but also how it would be better for the staff. With an expanded pool of nurses and MAs, community clinic managers would have more resources to draw from on a day-to-day basis. With centralized scheduling, vacations and family leave needs could be covered proactively, and day-to-day sick calls could be filled. With staffing opportunities on both the clinic and hospital sides, nurses wouldn’t lose hours when one location’s census was low. And with specialty training opportunities for all resource nurses and MAs, everyone would have a clear pathway for career advancement.

“We had an opportunity to bring all staff up to a higher level and really invest in their careers.” —Karen Nye, Nurse Manager, Resource Nursing

Karen and Natalie also gave staff the gift of time. They had meetings, picnics and retreats so that nurses and MAs could get to know each other. They talked over the additional training that all resource nurses and MAs could receive, and they asked for feedback on how to make the process better, so that everyone had a voice before the plan was implemented. “We didn’t just throw a new manual at them,” says Karen. “We created a safe zone for communicating change, and we kept an open mind about how to shift to a larger system.”

Develop a single set of expectations

Once staff bought in to the plan, the next step was to fully prepare them for the transition. With a significant reduction in inpatient agency use from the prior year (see idea 05, 2011 Nursing Report: Transport your float pool into a highly trained SWAT team, Karen was able to expand the inpatient nurse coordinator position to cover community clinics staffing as well. The staffing coordinator created a streamlined, consistent process for resource requests and worked directly with our IT department to ensure that scheduling software was standardized across all clinics and integrated with the hospital system, so that no one made requests via email or phone that could be easily overlooked.

Next, they worked with our nursing educators to create a consistent workflow throughout the system, so that every nurse and medical assistant could follow the same standard of practice, no matter which location they were serving. “We made it seamless,” says Natalie, “so that moving to another clinical setting didn’t feel like moving to a foreign country.” This made it easy for nurses and MAs to get up to speed quickly, and it ensured that patients received the exceptional care they deserved, wherever they were within our system.

Focus on continual improvement

Just nine months after first proposing an integrated inpatient and community clinic resource pool, the project is now up and running. Staff fear and uncertainty have been replaced with a common sense of purpose—with people who once worked with fierce independence coming together as a single, focused entity. “My personal mission was to show that we are really one system,” says Natalie. “After all, our key goals of quality, patient satisfaction and efficiency are the same in every clinical setting.”


But Natalie and Karen aren’t resting on their early wins. Instead, they’re looking forward to the next steps, including further expanding the resource pool to cover a clinical call center, urgent care clinic and specialty clinics, too. “We’ve taken a great step toward thinking like a system,” says Karen. “But we can have an even bigger impact on patient care moving forward,” adds Natalie. “We’ve only begun to chip away at the iceberg.”

How are you combining shared resources in your system? Discuss your experiences in our forum.