Exemplary Professional Practice

In 2025, nurses on Orthopedics W3A used their monthly shared governance meeting as a forum to review and reflect on unit-level quality metrics. During this discussion, nurses caring for the fracture population noted an increase in pressure injuries and shared concerns that some patients were returning from surgery with reddened sacral areas. Through shared decision-making, the team recognized an opportunity to improve patient safety.

To address this, nurses explored current evidence-based literature and identified the “4Eyes,” or two–registered nurse (2-RN), skin assessment as a practical and effective approach. Using the Plan, Do, Check, Act (PDCA) framework, the nursing team worked collaboratively to design a process for implementing the 2-RN skin assessment at the time of admission.

Together, nurses discussed realistic and consistent ways to integrate this practice into daily care. The team determined that the charge nurse or Clinical Support Specialist (CSS) would partner with the primary nurse during admissions from the Emergency Department, Admitting Unit, or Post-Anesthesia Care Unit. During this shared assessment, the two nurses carefully turned the patient onto their fractured side to complete a full skin check of the patient’s back from head to toe. They reviewed findings together, with the primary nurse documenting the assessment. To support prevention efforts, a five-ply Allevyn sacral dressing was applied, and wedges and glide sheets were used to assist with safe repositioning every two hours.

Interprofessional collaboration further strengthened this work. Prior to implementation, the nursing team sought guidance from nurses in the Wound & Ostomy Center (WOC), who shared evidence-based resources on pressure injury prevention, including the “4Eyes” assessment. The WOC also connected the team with the Intermediate Care Unit, where thicker sacral dressings were already being used successfully. These shared insights helped shape the PDCA process and supported confident adoption of best practices.

Since implementing this nurse-driven intervention, the unit has not experienced any additional pressure injuries. This success highlights how nurses, empowered through shared governance and supported by strong interprofessional partnerships, can lead meaningful practice changes that improve patient safety, advance quality excellence, and foster a culture of teamwork and accountability.

Workplace violence remains a significant risk in healthcare, with frontline staff experiencing nonfatal violence at rates far higher than most other professions. These incidents contribute to emotional distress, burnout, and potential impacts on patient care. Recognizing that a safe practice environment is essential to clinical excellence, nursing at The Valley Hospital has taken a leading role in prevention, education, and system-level improvements.

Crisis Prevention Institute (CPI)

While all employees complete annual required virtual workplace violence prevention training, Valley’s Nursing Professional Development and Simulation Center recognized an opportunity to further strengthen frontline preparedness through immersive, hands-on learning

Lora Bognar, PhD, RN, ANP, NE-BC, NPD-BC, Director of the Nursing Professional Development and Simulation Center, led a partnership with the CPI to introduce hands-on training through CPI’s Nonviolent Crisis Intervention® program. This program equips nurses and frontline staff with practical, nonviolent de-escalation and crisis intervention techniques. To date, more than 775 employees have completed CPI training, and ten employees have pursued certification as CPI trainers, strengthening internal expertise and sustainability. Nursing champions Virginia Wydak, BSN,RN, HN-BC, Joseph Ballesteros, BSN, RN, PCCN, and Lauren Piech DNP, MPH, RN, NI-BC, NEA-BC, HN-BC, played key roles in advancing the initiative.

Workplace Violence Algorithm

Nursing leadership also extended into system redesign. After frontline staff raised concerns about disruptive visitor behavior, nurses elevated these issues to leadership, prompting the creation of a multidisciplinary workgroup to improve visitor management. Nurses were active contributors in developing a standardized Workplace Violence Algorithm for non-patients. Based on staff feedback, updates included expanded visitation hours, a streamlined overnight visitor approval process, clear code-of-conduct signage, and the introduction of the algorithm to guide staff when disruptive behavior occurs.

Broset Violence Checklist

Moreover, in 2025, nurses led implementation of the Broset Violence Checklist, an evidence-based tool that identifies patients at risk for aggressive behavior within 24 hours. Piloted in the Emergency Department and implemented across all clinical areas on May 1, 2025, the assessment is completed by nurses at admission and every 12 hours, with results displayed on digital door signage and included in handoff communication to promote team awareness and a safer care environment.

In 2025, Valley was proud to welcome two international nurses to the nursing staff – Michelle Samontanez, BSN, RN, and Gladys Barcelona, MSN, RN.

In response to the national nursing shortage, Valley partnered with Connetics USA, an international nurse recruitment agency, to search for qualified nurses to join the organization. After an extensive interview process, Valley hired and onboarded Michelle to the CSICU team in June and Gladys to the W4A Cardiac team in August.

Michelle, who is from the UK, and Gladys, who joined from the Philippines, attended Valley’s comprehensive nursing orientation program. They also received additional one-on-one training to learn how to use various technologies, including Meditech and specific hospital equipment.

Michelle and Gladys have been wonderful additions to the nursing teams, and we look forward to continuing our recruitment efforts to hire more international nurses in the future!

In 2025, nurses from the Wound and Ostomy Center (WOC) identified a hospital-acquired pressure injury (HAPI) and, through shared governance, came together to conduct a comprehensive root cause analysis. This nurse-led review revealed that the patient was clinically malnourished, increasing their vulnerability to skin breakdown.

Rather than addressing the issue in isolation, the WOC nurses partnered with the Clinical and Community Nutrition Department to identify opportunities to improve care and prevent future harm. This nursing-initiated collaboration led to meaningful practice changes that strengthened patient safety and quality outcomes across the organization.

Through this partnership, new interdisciplinary workflows were developed to support earlier identification and intervention for at-risk patients. Nutrition now reviews the WOC team’s SV Pressure Injury Prevention (PIP) Surveillance Board daily as part of its high-risk nutrition-leveling process. This shared visibility allows the Nutrition Department providers to proactively identify patients who may be experiencing nutritional deficiencies and intervene sooner. At the same time, the WOC team reviews the Nutrition Department’s malnutrition tracking boards and the nutritional supplements provided to patients, creating a two-way flow of information that supports more coordinated, effective care.

Both disciplines now consult with one another when patients may benefit from specialized wound or nutritional interventions, reinforcing a team-based approach to care planning. To further strengthen this collaboration, the Nutrition Department began attending the Pressure Injury Task Force meetings, supporting ongoing communication, shared learning, and continuous improvement focused on patient safety.

Building on this success, the Nutrition Department has also begun meeting with critical care providers to discuss nutrition needs for high-risk patients and further coordinate care across settings.

This initiative highlights how nurses, empowered through shared governance, lead meaningful system-level improvements. By fostering open communication and strong interprofessional partnerships, this work underscores the essential role of collaborative care in preventing harm and promoting safe, high-quality patient outcomes.

The Valley Hospital’s Shared Governance councils and committees had a busy year! Below are a few highlights from 2025:

Reorganization and Name Changes

In a concerted effort to strengthen our shared governance councils, Valley’s nurse scientist, Joya Kabel, PhD, RN, ACM-RN, was named chair of the Interprofessional Shared Governance Council. The role, previously held by the Chief Nursing Officer (CNO), was transitioned to the nurse scientist position to better support the council’s work, with the CNO now serving as executive sponsor.

The Interprofessional Shared Governance Council, which has representation from the other five councils, voted to make the following changes last year:

• The Patient Experience Council previously had separate sub-committees that represented the inpatient units and the Emergency Department (ED). Since they both had shared goals and patients typically come to the ED before they are admitted to an inpatient unit, the two sub-committees were combined into one.
• To more accurately reflect the nature of their work, the unit-based shared governance councils were changed to committees.
• The Professional Recognition and Development Council was renamed the Professional Development and Recognition Council to reinforce the importance of developing our professional talent at Valley. There has been so much success recognizing our nurses through Service Star, DAISY and Nurse of the Year awards, and the Interprofessional Shared Governance Council felt there was an opportunity to further our professional development efforts as well.

The Shared Governance logo was also updated last year to reflect these changes.