Barbour, L., Bellaire, S., DiBiase, R., Wynn, V., Marchand, M., McCann, K., & Simanovski, J. (2010, December 1-3). We're all in this together: A collaborative approach to enhancing nursing leadership skills. A concurrent presentation at the Workplace Integration of New Nurses-Nursing the Future (WINN-NTF) annual conference, Toronto, ON.

1. We’re all in this Together:
A Collaborative Approach to Enhancing
Nursing Leadership
Rita DiBiase, MSN, NP-Adult, RN(EC)
Lisa Barbour, BScN, RN
Shannon Bellaire, MN, NP-PHC, RN(EC)
Jane Simanovski, MScN, NP-PHC, RN(EC)

2. Background
Culture changes included…
• Elimination of the designated Charge Nurse on the inpatient
oncology unit
• Nurses now responsible for every aspect of the patient’s care
• Addition of novice nurses to the Oncology unit
• Seasoned nurses new to the Oncology unit
• Bed Utilization Nurse assigned to help with patient flow from
admission to discharge
• Physician expectations of the nurse’s role

3. Goals & Objectives
• Improve collaboration, communication and knowledge
among disciplines on the inpatient oncology unit
• Expand nurse leadership roles related to facilitation of
patient care
• Increase nurse expertise in disease management and
patient advocacy
• Increase nurse confidence in presenting patient issues in a
Multidisciplinary Round (MDR) setting

4. Defining Multidisciplinary Rounds
Patient-centered model of care:
• Emphasis on safety and efficiency
• Multiple members of the team come together to discuss
care of a patient in real time
• Coordinate patient care, determine priorities, establish
goals, and plan for transfer/discharge
• Formal mechanism for communication and collaboration
Improvement Map. Getting Started Kit: Multidisciplinary Rounds How-to-Guide. Cambridge, MA: Institute for
Healthcare Improvement; 2010. (Available at www.IHI.org.)

5. Best Practice / Literature Review
Research has demonstrated that Multidisciplinary Rounds:
• Foster nurse –physician collaboration
• Improve satisfaction for patients, physician and nurses
• Improve quality of care
• Reduce health care cost (decreases length of stay)
• Improve team communication
Improvement Map. Getting Started Kit: Multidisciplinary Rounds How-to-Guide. Cambridge, MA: Institute for Healthcare
Improvement; 2010. (Available at www.IHI.org.)
Natalie Moroney, & Charles Knowles. (2006, April). Innovation and teamwork: introducing multidisciplinary team ward
rounds. Nursing Management, 13(1), 28-31. Retrieved October 19, 2010, from ProQuest Health and Medical
Complete. (Document ID: 1017573421).
Vazirani S; Hays RD; Shapiro MF; Cowan M (2005). American Journal Of Critical Care: An Official Publication, American
Association Of Critical-Care Nurses [Am J Crit Care] 2005 Jan; Vol. 14 (1), pp. 71-7.

6. Pre-Implementation Survey Results
• Majority thought all disciplines needed to participate or be
available for collaboration
• Benefits of MDRs
– improved communication, care priorities, establishment of
daily goals, planning for transfers & discharges, improving
patient & family satisfaction
• Barriers to Implementing, Participating & Sustaining MDRs
– lack of time, inconsistent scheduling of rounds,
interruption of routine
• Template beneficial for preparation & involving midnight staff
• Timing: weekly & in the am

7. Strategies for Success of MDR
Strategies
Staff
Education
Tools &
Templates
Mentoring
Physician
Team

8. Staff Education
• MDR presentations to staff
• Potential impact of MDRs
• Improved communication and teamwork across
caregivers
• Reduction in errors, length of stay and central line days
• Improved flow of patients through levels of care
• Expedited discharge planning
• Increased collaboration and satisfaction among all
members of the multidisciplinary team
Improvement Map. Getting Started Kit: Multidisciplinary Rounds How-to-Guide. Cambridge, MA: Institute for
Healthcare Improvement; 2010. (Available at www.IHI.org.)

9. Tools & Templates
• Survey utilized to gather
information
• Template developed as a
tool for nurses to use for
presentation of patients
during MDRs

11. Mentoring
• Role modeling / coaching
• Expertise & guidance
• Promote understanding of the plan of care
• Facilitate communication among disciplines
• Validate nursing knowledge
• Novice nurse

12. Physician Team
• Lead MD to champion (buy-in)
• Evidence presented
• Accountability

13. Inaugural MDRs

14. Feedback
“Ideal for the team to come together in a non-threatening learning
environment” (Physician)
“There is variation in the approach to rounds among physicians. Our goal
is to standardize the rounds so nurses are aware of expectations” (NP)
“I found it helpful to go over the template prior to rounds” (Novice Nurse)
“Template helps keep rounds focused…” (Experienced Nurse)
“An opportunity for nurses to expand their knowledge regarding the plan of
care and become less task oriented” (Physician)
“Template is useful for reminder about details that are relevant during
rounds” (Experienced Nurse)
“I learned a lot about the disease process and treatment plan from the
physician” (Novice Nurse)

15. Next Steps
• Maintaining Rounds
• Post-survey 6 months / 1 year
• Template revisions based on RN feedback
• Evaluate metrics
• LOS
• Discharge Planning process
• Reduced errors

16. Questions?
Contacts:
Lisa Barbour: lisa_barbour@wrh.on.ca
Shannon Bellaire: shannon_bellaire@wrh.on.ca
Rita DiBiase: rita_dibiase@wrh.on.ca
Jane Simanovski: jane_simanovski@wrh.on.ca