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Nurses Find Ways to Own Their Practice

Conquest - Spring 2011

Monthly meetings of the Nursing Practice Congress allow nurses and their colleagues 
to address issues from social work to infection.
Photo: John Everett

Congress hears, amplifies, channels the nursing voice

By Julie A. Penne

There’s the voice of an MD Anderson nurse, and then there is the voice of nursing at MD Anderson.

To patients navigating their personal cancer journey every day, their nurse’s voice is reassuring, confident, strong and compassionate.

As a collective voice of 2,800 professionals who want to improve, update or challenge clinical nursing practice standards, MD Anderson’s nursing community speaks openly, autonomously, passionately and authoritatively.

The Nursing Practice Congress is their primary platform.

The full story:

Nursing Innovations Improve Patient Care

Good Catch Program Eyes Potential Errors

Established as a formal nursing governance structure in 2006, the Congress is composed of 35 nurses and 21 elected multidisciplinary representatives who are social workers, dietitians, physical therapists, pharmacists, patient advocates, chaplains and infection control specialists.

The Congress began as a nurses-only body but expanded and broadened its representation just two years later.

A PACT team that included Joan Arnim, in Patient 
Advocacy (left), Karen Whitmore-Radford, in 
Nursing (center) and Debbie Wright, with the 
Welcome Center, created packets for patients in 
need of emergency clean clothes.
Photo: John Everett

It takes a village

Nancy Tomczak, chair of the Congress, says the group’s emphasis always will be on nursing practice, but seldom do nurses work in silos.

“The interdisciplinary work of the Congress is a direct reflection of our collaborative work every day in the clinics and units to provide outstanding daily patient care,” says Tomczak, a clinical nurse on the Stem Cell Transplant Unit.

“Nurses are constantly reaching out beyond our ranks, so it’s natural that we would extend that reach when we’re looking at practice issues or procedures.”

For the Congress, the Professional Action Coordinating Teams (PACTs) are the front line of engagement and action.

Though the makeup of the PACTs depends on the specific issue, the staff member who brings an issue forward to the Congress has the opportunity to chair the group and follow through until resolution. A PACT stays open until the issue is resolved. For some groups, it may be as short as six months, or it may be one to two years.

It is rare that the Congress will not take action on an item, though a PACT is not always the answer.

A congress that works

Last year, the Nursing Practice Congress — mainly through the work of its PACTs — resolved 56% of the issues brought to its attention within the fiscal year when they were identified. Since the Congress began five years ago, 73% of issues have been resolved.

The issues, questions and problems assigned to PACTs by the Congress are primarily clinical practice questions, but they also can include educational or environmental matters that affect patients.

Recently, PACTs have:

  • developed a new algorithm and order set for the management of acute chest pain,
  • revised, based on current evidence, a new process for off-unit cardiac monitoring, which spurred a new policy and program for outpatients who require personal care items and
  • developed a more consistent practice for changing dressings.

PACTS in progress are looking at:

  • practices related to diabetes management,
  • delirium assessment,
  • speech pathology services,
  • use of compression stockings and
  • securing crash carts.

The PACTs rely on published outcomes and scientific evidence to come to a clinical solution, and the input and expertise of many staff members to move a policy through the institution. Sometimes an issue requires clinical and administrative acumen.

Nancy Tomczak (left), Mary Lohman (center) and 
Debbie Cline are current, past and first chairs of 
MD Anderson's Nursing Practice Congress.
Photo: John Everett

“Nurses now know to bring a problem, challenge or question forward to the Congress, and they’ll be heard,” says Debbie Cline, oncology nurse and the first chair of the Nursing Practice Congress.

“Congress empowers them to ‘own’ their issue, work through the process and develop a resolution. The experience can teach nurses how to navigate the system and gives them the opportunity to grow professionally, while learning leadership skills.”

Patty Johnston, director of clinical nursing and program director of NPC, supported Cline’s interest in being involved in the Congress when the two worked together in the Stem Cell Transplant Unit.

Johnston had been asked to revamp the former council structure into the current Congress after she had successfully developed a floor council to share in management decisions.

“What’s unique about MD Anderson’s Nursing Practice Congress is that it’s fully home-grown, but based on shared governance research,” Johnston says. “It’s a large body of all frontline nurses who work transparently and independently — on top of their own demanding jobs — to improve patient care and nursing practice.

“It’s the backbone of nursing at MD Anderson because it touches and influences what’s most important to us as nurses. We all can have a hand in it.”

© 2015 The University of Texas MD Anderson Cancer Center