Nursing

News spotlight: Winner of HCPro’s nurse leader best practices contest

Nurse Leader Insider, September 26, 2011

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Editor's note: A few weeks ago, we asked you to submit best practices regarding culture change. Below is the winning entry from Anjie Vickers, RN, BSN, NE-BC, Carolinas Medical Center in Charlotte, NC. Congratulations Anjie and thanks to everyone who submitted best practices!

I am the nurse manager of a 19-bed progressive care unit, which I have managed for almost 11 years. The culture has dramatically changed from that of the one I started with. That was one in which the nurses exhibited horizontal violence, resisted change, and lacked shared ownership. How I changed it to one that is now a healthy work environment that embraces shared decision making, learning, and engagement involved a combination of the following.

I created an expectation of peer accountability. If the employee came to me with a complaint about someone else, I set clear expectations asking if they had spoke to their peer first and foremost. Peer review and accountability has evolved over time and continues to improve even more. We have most recently adopted the practice of bedside report and have expectations that peers will communicate, mentor, and develop each other with peer-to-peer feedback and expectations of each other.

We created our unit-based council (UBC), which has grown over time to now include each of the following:

  • Quality unit-based council
  • Professional development unit-based council
  • Coordinating unit-based council


We have sub-committees off these councils that include our Sunshine Committee, Peer Interviewing team and Self-Scheduling committee. We also empower our staff to be the champions of different goals and areas, such as restraint champion, skin care liaison, and falls champion. This helps to create an engaged workforce where everyone is part of our success.

Our community liaison assists with coordinating and organizing our volunteer events such as volunteering at a men's homeless shelter.

Areas that we have been successful include:

  • Falls champion-Quality UBC: Reduced our falls from a total of 25 in 2010 to eight in first quarter 2011, one in second quarter, and zero in third quarter
  • Skin care champion-Quality UBC: Reduced unit-based pressure ulcers from 18 and 20 in last two quarters respectively of 2009 to zero in first half of 2010
  • Professional Development Council achieved recognition of Hallmarks of a Healthy Work Environment in 2010


The feedback from patients and families speaks highly of the engagement of this department and includes many compliments.



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