As part of its efforts to achieve Magnet status — the gold standard for nursing excellence — from the American Nurses Credentialing Center, Northwell Health’s Cohen Children’s Medical Center in New Hyde Park, N.Y., began to shift its culture toward patient-centered care with the highest possible outcomes. Patient safety was a major focus of these efforts. As staff began to explore ways to improve, they uncovered an unexpected opportunity: staff uniforms. Cari Quinn, R.N., MSN, NEA-BC, deputy executive director at Cohen Children’s, facilitated the cultural transformation behind the initiative’s implementation. Following her presentation on this initiative at a reception during the American Organization of Nurse Executives (AONE) 2017 annual meeting, H&HN spoke with Quinn about why and how the uniform change occurred.
What drove Cohen Children’s search for new replacement uniforms?
Quinn: We had a lot of energy and stellar work from nursing leaders around patient safety. Along the way, we did some self-awareness activities and recognized that from an identification perspective, it was a struggle for our patients to understand the roles of our team members — who was their nurse, who was their nursing assistant, etc. Also, we had changed our health system’s name, and we wanted to make sure that the new brand would give patients a sense of trust in our care across the whole care team.
We looked at how the clinical staff dressed every day. Around four years ago, we converted the nurses from colorful and playful scrubs to white tops and gray bottoms. To clearly identify nurses, we displayed a very, very large R.N. logo opposite our health system logo. The nurses told me how much they didn’t like it — so much so that they drifted back into scrubs that were mismatched or from a previous hospital employer.
I took pause and assessed how I’d been implementing change in the organization. To vet the decisions around another new uniform change, I chose to utilize our organization’s shared governance structure. I was very deliberate not to have decisions made only at the top and asked for unit-based champions who believed they could help unify their peers behind a uniform change.
What individuals or teams led the initiative’s implementation?
Quinn: The unit-based champions joined our monthly nurse professional practice meeting, where our agenda included talking about safety concerns and best practices. We also had ad hoc meetings around the uniform initiative. It started with a focus on giving safe patient care, but it turned into enhancing the practice environment for them by minimizing the risks associated with accidental and unexpected body fluid exposure.
That’s when we began to explore available products. In addition to offering staff a choice of uniform color, we decided to offer a choice between a standard Cherokee product many were already purchasing, and VESTEX®, a new option that repelled fluid and limited the risks associated with body fluid exposure.
Our hematology-oncology nurses were the first to sign up to evaluate this new active barrier technology. They knew they were at the highest risk from a touch perspective. When a child reacts to chemotherapy, they get extraordinarily nauseous. The nurses are alongside the children supporting them through their nausea and vomiting, steadying the emesis basin while managing to hold them through what for them is a very scary experience.
There was a lot of energy around oncology trying the new uniforms. They became the trusted leaders regarding the uniform choice. That was important because this was not just a nursing initiative; we had to decide on a uniform that branded our entire organization and reflected in our staff the care we were offering to our patients. We had patient care assistants, a unit receptionist and even physicians saying, “We’re in. Whatever you guys decide, we want to be a part of it.”
Why did you feel it was important to engage hospital staff members in deciding on new uniforms?
Quinn: I think it was about allowing the people to feel like they were an integral part of owning their practice and owning their practice environment. Giving them this critical decision of what to wear, it was powerful to see the transformation from begrudging compliance with a current uniform policy to a whole-hearted embracing of a new policy where they recognized “something was in it for me.”
We engaged patients’ families in the decision, also. Our parent family advisory council members were excited to learn about this new uniform technology and how it would impact their children. They reacted favorably to the likelihood that body fluids, and related germs, would be less likely to be on their children’s caregiver uniforms. We sought their input on color choices, how our staff looked and whether the uniforms helped them identify clinical team members by discipline and scope of responsibility.
What results have you seen from the uniform initiative?
Quinn: I think it’s a combination of a lot of things. We’re forward thinking in analyzing our outcomes, but we’re careful not to apply a single intervention when measuring success.
One favorable byproduct of this initiative I’d say would be less distraction — distraction caused by a nurse being exposed to blood, thinking about whether she or he must change clothes and wash whatever body part got exposed by the fluid contact. Less distraction can mean more focus on patient care and safety.
Also, we had an uptick in staff engagement scores across disciplines. Not only were staff involved but they took the opportunity to change the color of the uniform bottoms from gray to royal blue. Engagement in the product selection, and overall engagement in the organization’s safety work, led to positive trends in our engagement scores — rising from 81 to 96 percent participation. Our staff looks sharper and, I am told, feels more professional. Not to mention, the occasional coffee spill does not stain the uniforms, so they tend to look better longer, which also makes our team happy in the pocketbook.
Plus, the initiative’s been so successful at Cohen Children’s that we’ve expanded use of the new uniforms to our physicians and our housekeeping department. Right now, about 70 percent of our point-of-care employees are wearing uniforms with this protective barrier.
As hospitals undergo transformation, how important do you feel it is for nurse leadership to have a driving role in culture change management?
Quinn: Within hospitals, nurses occupy the largest full-time employee footprint. We represent greater than 60 percent of the workforce at Cohen Children’s Medical Center. What better than a nursing leader to help drive innovative transformation? As technology rapidly outpaces our traditional thinking, I think it takes our innovation push and drive. Nurses aren’t afraid of change; if it’s led right, you can have some incredible success.
VESTEX® Active Barrier apparel has earned the endorsement of the American Hospital Association. To learn more about VESTEX from Vestagen Protective Technologies, Inc., visit vestex.com.