‘Knowing why we do what we do’ – Establishing a Unit Practice Council to Improve Evidence Based Nursing Practice in Acute Medicine using Appreciative Inquiry

Nottingham University Hospitals NHS Trust (NUH) has undertaken extensive work identifying that one of the main concerns of newly qualified nurses, during their preceptorship period, was competence in caring for acutely ill ward patients, or those at risk of deterioration. In January 2012, the Trust’s Medical Admissions Unit (MAU) had a complement of 90 whole time equivalent (WTE) registered nurses (16 of whom had been qualified for less than a year) and 20 non-registered nurses. This indicated a large number of newly qualified nurses in post with minimal experience of caring for acutely ill patients.

There was a keen desire within all levels of the nursing team on the MAU to take a leading role in decisions affecting nursing practice, including the development of all staff in order to enhance the care they provide for acutely ill patients. Supported by the Foundation of Nursing Studies, key stakeholders developed a Unit Practice Council to implement change using a shared governance approach. Shared governance is a style of nursing management which empowers frontline staff to be involved in the decisions made about their practice.  It breaks from the traditions of hierarchical management models, and aims to involve the direct care-givers, who are experts in their area, and therefore in the best position to inform changes to practice.

Appreciative Inquiry was chosen as a guiding framework for the project as it provided a foundation on which to study, explore and actively search out, “the best and focussing on what is good, strong, already working and being achieved”, rather than taking a traditional problem-solving approach (Carter, 2006). It has been described as transformative in its approach to facilitating change management.

The project identified how utilising the skills and knowledge of a group of frontline staff to implement and change practice at ward level through the development of a Unit Practice Council, can enhance the patient experience and be an effective way of developing and empowering frontline staff. It has been an invaluable learning experience for all involved, and will now form the basis of implementing shared governance throughout the whole Trust.

This project was supported by the FoNS Practice Based Development and Research Programme in partnership with the General Nursing Council for England and Wales Trust.