Leaders in Neuroscience Nursing
More than 175 registered nurses – and a total of 236 employees – have been recruited in the past three years to keep pace with the rapid expansion of the Memorial Hermann Mischer Neuroscience Institute at the Texas Medical Center. Many of the nurses started at the bedside and quickly moved into leadership positions. Their management style is based on an understanding of the needs of bedside nurses, and they work together across units to provide support and encourage creativity, autonomy and teamwork.
Among them is Odun Atunrase, RN, B.S.N., clinical manager of the Spine Unit, who started as a floor nurse in 2009 and moved up to charge nurse shortly afterward. By 2012 he was a team leader in a pilot project designed to improve the customer experience by rounding on patients and families to ensure that their needs and expectations were met. In February 2014, he was promoted to manager of the Spine Unit, which had opened a few months earlier as a specialized unit in a renovated space. He had a plan in mind.
Atunrase describes himself as a “big believer” in Maslow’s hierarchy of needs, a pyramid with the largest, most fundamental levels of human needs at the bottom and the need for self-actualization forming the peak. “I took the hierarchy beyond the level of the individual and began to apply the principles to my unit,” he says. “To get to a place of self-actualization as a unit, we had to work our way up the pyramid from physiological needs, to safety, then belonging and self-esteem.”
After making sure his unit was adequately staffed and supplied – the physiological needs – he moved on to safety, which he defined as staff education, orientation to the unit and role, and understanding hospital policies and the fundamentals of customer service.
“Safety is also linked to accountability, effective performance and meeting outcome metrics,” Atunrase says. “Then we moved on to the higher level need to belong. I wanted to make sure our team had a cultural identity. We knew our strengths were proactiveness and teamwork. We reviewed and reinforced that in one-on-one meetings so that
everyone felt engaged. We also had weekly staff huddles and made sure every staff member had
input, paying special attention to our new nurses.”
At the same time, Atunrase’s unit started to lead the neuroscience service line in HCAHPS scores and has placed either first or second at Memorial Hermann-Texas Medical Center, among all service lines, since December 2013. In March 2014, his unit received the hospital’s quality award for outstanding customer satisfaction. By that time, seven Spine Unit staff members had received standing ovations at weekly patient experience meetings attended by hospital executives. “We had great scores and knew we had built a team, which met our need for self-esteem,” he says. “Then we moved to the self-actualization part – philanthropy, creativity and fulfillment. We really wanted to set an example as a group and find the meaning in what we’re doing. Managers from units outside the Mischer Neuroscience Institute now ask us if their staff can orient with us. We’re acting from the heart and touching others in the process.”
Shanequa Sostand, RN, B.S.N., worked as staff nurse for five years before starting at the Institute in 2008, where she spent her first four months at the bedside in the Stroke Unit. She was promoted to charge nurse and in January 2014, to manager of the Stroke Unit.
Sostand describes her management style as a mix of engagement, empowerment and teambuilding. “I truly have an open door policy,” she says. “We support our staff members and at the same time are supported by the entire leadership team. If we let them know what we need, they will help us get it. That support from leadership has made a huge difference in the growth of the neuroscience service line.”
Transparency on the units has encouraged accountability and empowerment. “When it comes to performance evaluations, there are no surprises here,” Sostand says. “Our quality metrics and each nurse’s success at meeting them are posted monthly. We’re here to help those who aren’t meeting the metrics improve their performance.”
Daily rounding with attending physicians empowers nurses by allowing them to make decisions about patient care with the doctors, who consider their input on patient condition invaluable. “We’re at the bedside 24/7,” she says. “When nurses round with physicians, they help develop the plan for the day. If patients or family members have questions about the plan, we can answer them because we’re all on the same page.”
Clinical director of patient care Enedra Allen-McBride, RN, M.S.N., started at the bedside at Memorial Hermann-Texas Medical Center in 2003, and worked there for a year and a half before moving to The University of Texas M. D. Anderson Cancer Center, where she climbed the career ladder to associate director, working under Nicole Harrison’s leadership. Harrison recruited her back to the Mischer Neuroscience Institute in 2011.
As clinical director of the neuroscience service line, Allen-McBride is responsible for providing leadership, direction and support to patient care areas. She is heavily involved in the day-to-day operations of the seven units that report to her – mentoring managers and quality coordinators on budgeting, management, quality and leadership skills.
“I meet with each manager once a week to discuss what’s going well and the concerns and challenges they face,” she says. “I round on the units, which gives me the opportunity to get to know our staff. We have over 300 employees and I take pride in being able to recognize each one of them and have conversations with them. I want them to know me, and put a face to a name. Leadership is not just about what we do at work but getting to know them personally. My relationships with my managers keep me connected to the staff and unit.
“It’s especially important to me to know my managers,” Allen-McBride adds. “They’re on the front line and have the hardest job. My door is always open and if they need me after hours, they know I’m always available. The opportunity and support Nicole has given me trickles down. I pay it forward to my managers. It’s exciting to work in an environment that fosters growth among all our colleagues, and it’s just going to get better. We’re dedicated to our patients, our people and the extraordinary work we do each and every day.”
Dong Kim, M.D., director of the Institute and professor and chair of the Vivian L. Smith Department of Neurosurgery at UTHealth Medical School, recognizes the important role nurses play as advocates for neuroscience patients. “Because they’re at the bedside the majority of the day, they ensure that the medical plan stays on course and keep affiliated physicians informed of even the smallest change in patient status,” he says. “Having well-trained, dedicated neuroscience nurses is essential to producing superior outcomes and to realizing our vision for the future
at MNI. We want our nurses – whether they’re at the bedside or in management – to participate fully in creating that vision by sharing their ideas as equal members of the team."