During the COVID-19 pandemic, Kathy Van Allen, MSN, RN, administrative director of the Fetal and Neonatal Institute at Children’s Hospital Los Angeles, recognized a growing need for stronger support systems for NICU nurse leaders navigating extraordinary pressures.
The NICU is an intense care environment, with leaders facing unique challenges related to high-acuity care, staffing, regulatory demands and supporting teams in a highly demanding setting.
“CHLA serves as the regional NICU for many local community hospitals, and it was key that we identify ways CHLA could better support the community NICUs, and build relationships and engagement with referring hospitals,” Ms. Van Allen said in a news release.
In response, she launched the Regional NICU Nursing Leadership Roundtable, a collaborative forum where NICU nurse managers, directors and clinical nurse specialists from CHLA and 20 community hospitals come together to share knowledge, address common issues and build confidence.
Since it was formed in 2021, the roundtable has more than doubled in membership and now serves as a hub for peer support and practical problem-solving. In this interview, Ms. Van Allen shares more about how the roundtable is helping to strengthen nurse leadership and improve care for newborns across the region.
Question: How has the roundtable identified and attempted to resolve or alleviate leadership issues, such as dealing with the potential for stress and mental fatigue?
KA: The work of nursing leaders presents challenges daily. They are constantly juggling competing priorities and wearing different hats in their responsibilities of overseeing operational workflow, workforce management, clinical care, coordinating supply chain needs, addressing patient experience and administrative responsibilities. For inpatient leaders, these challenges are 24/7. For those working in critical care, the stress is often more intense.
Leaders shared that they have found a safe, open space with this group and can share issues they are facing with other leaders who understand the challenges. It has helped them to know that others are facing the same challenges, and they are not alone. Several said they value our meetings because the support they receive from peers has had a positive impact on their ability to do their job. One even commented that our time together was better than going to a therapist.
Everyone in the group has asked a question to seek information or resources, and at other times, has contributed by providing feedback or information. Leaders value the support they have received and the things they have learned from their peers. It has helped them spend less time troubleshooting and focus on being more productive and better able to support their team. When they are the one providing the resource, it gives them a sense of value.
When professionals develop a collaborative network during times of non-crisis, it helps to build community and will help to support the group during times of crisis. I sometimes think about how this may have impacted our well-being if this work had launched before the COVID-19 pandemic.
Q: How has the roundtable helped enhance care regionally for our NICU babies and families?
KA: The discussions that have taken place address the key responsibilities of nursing leaders – clinical practice, leadership, regulatory issues, professional development and research/innovation.
The feedback from leaders who responded to a qualitative questionnaire to assess the impact of this leader network on their practice was powerful. One leader who was a new manager said she valued resources she received regarding regulatory guidelines and standards she had not previously known about. It helped her prioritize work to ensure her unit was compliant with regulatory requirements in time for their accreditation survey.
One of the clinical nurse specialists stated that she has made numerous changes to policies and protocols based on the information and resources she has received from this group. She believes this group has significantly enhanced both the caliber of her work and her perception of her responsibilities as a clinical nurse specialist.
A manager from one hospital was in the process of implementing a human milk bank. This was the first big project she was tasked with after becoming a manager. Other leaders in the group were able to share their experience, sample policies, operational workflows and recommended equipment to meet the regulatory requirements. This leader acknowledged that the support and collaboration of her peers were instrumental in the successful implementation of the project, which had a positive impact on her self-worth and confidence as a leader.
Q: Has the network evolved in any way that you didn’t expect when the program got underway in 2021?
KA: When we first started this work, we were unsure if there would be strong interest from the other leaders. We discovered it was the opposite. Multiple NICU leaders faced challenges with practices in their organization that were developed for clinical care in other areas of the hospital that were not always applicable to the NICU. They yearned for a peer group that understood the unique needs and challenges of the NICU. We are grateful for their ongoing participation and contributions. The true impact of how this network contributed to their self-worth, confidence, and leadership has been far beyond what we expected when planning this work.
We were also able to find out how we could be better partners as their regional NICU. In response to their feedback, we have expanded educational offerings, created on-demand access to clinical updates for referring neonatologists, and worked to create a more seamless transfer process.
Q: Can you tell us more about the concept of nurses’ workplace social capital and how it guides the roundtable and the participants?
KA: The concept of nurses’ workplace social capital refers to the relational network, shared values, trust and mutual support that nurses build with their professional interactions that foster collaboration, resilience, and well-being. The nurses’ workplace social capital model includes individual and group social capital – those resources an individual derives from their relational network and the expansion of those resources beyond the person, impacting the work group. Bonding and bridging behaviors create horizontal connections between individuals and groups. Bonding behaviors create a connection between a smaller, closed group with a common identity or bond, which can lead to developing trust, confidence and reciprocity while bridging behaviors create connections or social exchanges with those that may be different or unfamiliar, such as between other departments or teams. One’s vertical relational network across various levels of power such as manager to director and vice versa also contributes to building nurses’ workplace social capital.
It has guided our meeting structure. As we started to see more directors and CNSs participating in the meetings, we had considered doing break-out affinity groups, so each group was able to meet with their peers. The response was a resounding decision to keep everyone together. What we discovered was that having all participants in the discussions together fostered a greater sense of shared understanding of each other’s perspectives on the issue, as well as a greater awareness of the impact of the practice changes on each other’s workflow. Leaders felt it had an impact on their horizontal and vertical communication in the workplace.
When nurses trust one another and feel supported, they are more likely to share knowledge, ask for help and step in to support one another. Our leaders have voiced that this group provides a space with psychological safety where they can bring forward issues without judgment, creating a safety net for them.
Q: Are there any advocacy or policy projects the roundtable is pursuing?
KA: We are not actively engaged in advocacy or policy efforts at this time, although we had discussed and acted upon bed licensing changes a couple of years ago. With the current political climate, we envision profound effects on children’s healthcare due to Medicaid and the Children’s Health Insurance Program funding cuts. Many of the hospitals represented in this leadership network provide neonatal care for a significant percentage of babies on Medicaid.
