Structural Empowerment: A Framework For Change in Cork University Hospital

By ​Annmarie Galvin (Nurse Practice Development Co-Ordinator, CUH) & Susan Jacob (Clinical Nurse Manager 2, CUH)

In CUH, a lot of work has been done to embed the Magnet model in the hospital. The model aims to ensure that the organization’s policies, procedures, structures and supports promote staff wellbeing and empower staff to achieve excellence in patient care.
CUH Magnet Model has 4 key components: Transformational Leadership, Structural Empowerment, Exemplary Professional Practice and  New Knowledge, Innovation and Improvement. To begin with, CUH developed a structural empowerment framework governed under the Magnet Executive Council.
The structural empowerment component focuses on ensuring nurses are supported to be involved in the decisions which affect their day-to-day work. This is done through having a clinical nursing voice on hospital committees and working groups but primarily through the establishment of nursing councils for different grades.

RGN council
The Registered General Nurse (RGN) council was the first to be embedded and is already having a positive impact in the hospital. The members are from across the hospital; their dedication and enthusiasm to patient care is integral to achieving outcomes. Our RGN council members were empowered to chair and lead this council further enabling development of their confidence, advocacy and project management skills. Some of their achievements to date are as follows;

• Magnet champions from each unit/department
• Developed interdepartmental handover on specific wards
• Nurse led information sessions were launched in 2024
• Monthly lunch and learn sessions which  incorporate wellbeing sessions
• Involvement in cultural celebration
• Nursing values and Professional Practice Model

Clinical Nurse Manager (CNM) council
CNM Council ensures optimization of communication and offers opportunities for sharing ideas and peer support along with the achievement of goals. The CNM council has worked hard to achieve the following during their tenure:

• Development of CNM orientation booklets for newly appointed CNMs
• CNM Workshops conducted for CNMs on topics selected by CNMs eg: Rostering & managing sick leave
• Staff acknowledgement incorporated in work eg: local awards to acknowledge values
• Regular ward meetings were conducted.
• Source of support and learning 

Clinical Nurse Specialist (CNS) Council
The CNS council has the largest membership of the existing councils in CUH. They have worked collectively to achieve the following outcomes to date:

• CNSs Unique uniform colour vote to retain as Lilac
• Advanced Nurse Practitioners (ANP) & CNS conference held in 2022 and another one scheduled for August 2024 entitled “Nursing in the age of diversity, inclusion and equality”.
• CNS council supports mentorship which is available to all nursing grades. CUH celebrated “March” as the month of mentorship awareness

Advanced Nurse Practitioner (ANP) Council
The ANP council is the council which has grown the most over the past 3.5 years to execute the following goals:

• Development of CUH ANP twitter page which is an excellent source of communication & profiling the great work done by the ANPs.
• An agreement developed to pilot alternative approach to nurse medicinal prescribing
• ANP grand rounds launched in 2024 and completed 4 to date and plan for 9 per year
• ANPs referral for radiological procedures within scope of practice

Recognition and other achievements
Magnet implementation won CUH One Team Award in the Staff Wellbeing Category
Magnet communication boards in each unit/department
Posters evidencing work by our staff are displayed in the designated display area in the hospital (MEDIA)
CUH Staff Wellbeing Committee in conjunction with the CNM Council organized Indian cultural day on March 2024 which was a huge success. On International Nurses Day, managers hand delivered cupcakes to wards and units. All of the above initiatives assist a culture of diversity, acknowledgement and inclusion within the organization.
CUH invests in staff wellbeing through the provision of an outdoor exercise area available to all staff amongst other initiatives.

2024 Plan
In 2024, CUH plans to strengthen shared governance through the support of the above councils. Our vision is that structural empowerment will assist in the retention, recruitment, and wellbeing of our nurses in CUH. Nurses who feel supported, valued and have autonomy over practice decisions provide an excellent standard quality care to patients. Our institution encourages education and career development at all stages, resulting in greater autonomy at the bedside. It brings job satisfaction with improved patient care by nurses who are supported to be the very best they can be.