After a shared drill that was impacted negatively by obvious fractures in the personal relationships between our Antepartum, Labor & Delivery and Mother Infant Units, we were brought back to our hospital wide model of Relationship Based Care.  One of the three pronged focuses of this care model is our relationship with our colleagues. This was the beginning of the formation of our Divisional Relationship Based Care Team.

Proposed change:

Each unit identified three nurses that expressed specific concerns and invited them to serve on the committee.  These were nurses that weren’t highly involved in other areas of our units, but were interested in improving relationships.  They were felt to be team players and solution seekers who displayed constructive behaviors in the past. We asked them to seek feedback from their peers.   Prior to beginning, we enlisted a facilitator from outside our division and we each read the book, Crucial Conversations.  

Implementation, outcomes and evaluation:

Our first meeting began with a symbolic devotion: each nurse gave a hand massage to another nurse from a different unit.  The message being, “each of our hands impact the birth experience of all of our patients”.  Representatives brought the most pertinent issues they had identified. Our defined objectives were to focus on improvements in relationships, communication, care delivery and workflow processes.  The committee identified five areas of focus:  1). Issues surrounding Family Centered Care  2). Handoffs between all three units 3). Role definition when floating among units  4). Contingency plans during crucial times of diversion or threatened diversion and 5). The Antepartum Unit’s “step child” perception.  We developed an action plan and follow-up person(s). 

 Progress includes:

-  The creation of a “Baby Communication” notepad to facilitate safe transfer

-  The revision of the Couplet Report Tool

-  The Diversion Watch “Stork System” was created and implemented.   

-  The Antepartum/L&D Patient Report Tool revised

-  Meetings were facilitated between APU and physicians to find ways to meet their needs

-  The Antepartum Nurses felt validated by sharing their “step child” perceptions. 

 Implications for nursing practice:

Our initial plan had been for this committee to meet for a finite, focused period of time, but the benefits of this committee had become clear.  This committee is an excellent example of bedside nurses coming together in a professional way to improve relationships and communication between units, thereby increasing job satisfaction, efficiency and patient safety.

 Keywords: Relationships, Communication, Quality, Safety, job satisfaction