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History of the PNSO

All RNs employed by the UVA Medical Center, School of Nursing and School of Medicine are automatically members of the Professional Nursing Staff Organization, and have the opportunity to actively engage in the shared governance of the practice of nursing at UVAHS.

Founded in the 1980's

The Professional Nursing Staff Organization has been evolving since the mid-1980's. In the early '80's, UVAHS Nursing followed a traditional administrative structure in which decisionmaking cascaded down through layers of nursing directors. Nurse leaders at UVAHS began to explore alternative models that would facilitate grass-roots participation in decisionmaking and nursing autonomy. A peer-driven Clinical Career Ladder, founded on Patricia Benner's "from novice to expert" principles, was launched in 1987, and between 1988 and 1991, the first phases of a shared governance model for nursing were implemented.


The 1990's: Evolving Leadership and Career Ladder

The first President of the PNSO was elected in 1991. The roles of the President and President-elect became even more important to the shared governance of nursing, in collaboration with the Chief Nursing Officer, as UVAHS reorganized into a "service-center" model which decentralized the previous division of nursing.

To facilitate the decisionmaking representation of so many diverse nursing practice areas, the first Nursing Cabinet was convened in 1996.

Additional opportunities for direct-care nurses and nursing leaders to engage in professional development, networking and shared decisionmaking were offered with the initiation of two semi-annual events in 1999, Leadership Forums and general Nursing Assemblies. While PNSO-sponsored events have changed in theme and structure over the years -- and increased in number --  the intent of empowering the voice of grassroots nurses and nurse leaders is stronger than ever.


The 2000's: Shared Governance Expands

The PNSO Bylaws, codifying the guiding principles for the operation of the PNSO, were first adopted by the membership in 2000, with annual opportunities for members to consider amendments. The Bylaws define the four core missions of the PNSO -- shared governance, clinical practice, professional development, and nursing research -- and provide direct guidance for the key structures and programs through which the PNSO pursues these missions on behalf of UVA nurses.

To further broaden the representative aspects of our shared governance model, the first annual  PNSO Nursing Congress was convened in 2001; fifty-six peer-elected representatives engaged in a day of continuing education and planning, with the intent of defining the agenda for the 2002 Nursing Cabinet/committees to pursue. From 2001 to 2012 Congress Delegates continued to represent their practice areas annually, one delegate elected locally for approximately every 30 nurses.

A re-evaluation and restructuring of the Clinical Career Ladder took place in 2002 to address changes in both the Health System and the state of nursing nationwide, particularly regarding advanced practice roles. Outpatient nurses migrated onto the Ladder in 2004. In 2006 and annually beginning in 2008, robust re-evaluations of the Ladder's parameters took place, addressing the evolving needs of UVAHS nurses and practice settings, based on feedback from direct care nurses. To encourage recruitment and retention, quarterly opportunities to advance along the Ladder were introduced for wage-to-hire (2009). We also took time to celebrate the 20th anniversary of the Clinical Career Ladder in 2008!

In 2003, the Office of Nursing Governance Programs was formed to provide coordination and infrastructure support for nursing-related initiatives, both in the PNSO and in the larger Health System community. A Director and a Manager of Nursing Governance Programs were dedicated to facilitating these infrastructure improvements for nurses across UVAHS; their roles have since grown, from Manager to Director of NGP, and from former Director to Administrator For Workforce Development, in recognition of the broad scope of their influence.

In 2004, the PNSO prioritized the goal to develop and evaluate new models of professional development and continuing education to advance nursing knowledge. One strategy was to design and operationalize a Nursing Research Mentorship Program to enrich nursing knowledge and streamline the research process. The goal of the Research Program is to create an institutional milieu that encourages and supports clinical inquiry and evidence-based nursing practice.

In the winter of 2004-2005, we hosted our first Evidence-Based Practice Day symposium, as a forum for addressing complex nursing practice issues, sharing best practices and improvement ideas, and showcasing nursing research. This has since become a major annual event, with numerous nurses giving poster and podium presentations, the proceedings of which are posted in an online Virtual Gallery for reference throughout the year in implementing the changes they suggest.

In 2006, we proudly received our first designation of ANCC Magnet Recognition!

We began to heavily expand our nurses' use of technological resources for clinical practice and shared governance during this time. In 2007-2008, we switched to an all-electronic nursing procedure manual for Pediatrics and Adult Acute Care, facilitating in-the-moment reference without having to go find the book (in 2011, this expanded to include Critical Care as well). In 2008-2009, PNSO committees started using "UVA Collab", a Sakai-based collaboration and courseware internet tool, to engage in shared governance activities as virtual meetings from wherever they happened to be located, and to weigh in on teamwork tasks whenever it was convenient for them.


Continuing to Evolve after 2010

We celebrated the 10th Anniversary of the Nursing Congress in 2010 - and in 2012, disbanded the concept of a representative "Congress of Delegates" in favor of a "Summit on the State of UVA Nursing", open to all nurses, just as they are each empowered to actively participate on their local and central PNSO committees.

Further changes to the Clinical Career Ladder process continued in 2010-2011. In 2011, we expanded opportunities for general nurse advancement to twice a year. Our Revalidation requirements for Clinician IVs and APNs were significantly restructured in 2010, including changing the revalidation timeframe to a quarterly rotation every two years, responding to feedback to enable credentialed staff to align their preparation of both Career Ladder portfolios and Recredentialing materials in the same timeframe. The peer-driven Advancement Panels were also restructured for the 2011 season to align more clearly with the distinction between Clinician and Advanced Practice roles, with both groups governed by a new advisory group combining leaders from both arms with other strategic PNSO leaders, including the Dean of the UVA School of Nursing.

The Advanced Practice arm of the Career Ladder evolved further in 2010 to grow all Medical Center NP and CNS roles, enhancing their relationship with regional administrators and aligning each with specific region-wide outcomes goals. Separate from the Career Ladder process, an APN Committee was created through a grass-roots effort, to address the unique practice and professional development needs of the NP and CNS roles. The CNO created a Director of Advanced Practice Nursing role in 2012 to further provide supportive operational infrastructure, based in part on the input of the continuing shared governance APN Committee.

Our Research Mentorship Program also changed, supporting the growing demand for structured APN-driven outcomes improvement projects by introducing the option of "RM Pairs", coupling an APN with a clinician as they began the training process as Research Mentors.

The PNSO President, together with other interdisciplinary leaders, advocated for UVAHS to host onsite Schwartz Center Rounds  bimonthly beginning in 2011; each of these emotional discussions on patient safety and ethical issues, held in the largest onsite venue we have, has been standing-room-only. 

In 2011, Nursing Cabinet's membership composition evolved to include more key members of nursing administration, as well as continuing the tradition of many grass-roots clinician representatives, to closely align the decisionmaking of our formal and informal leadership structures for UVA Nursing.

To emphasize a renewed focus on excellent quality of care, 2010-2011 saw the creation of several new workgroups, including the Nursing-Sensitive Quality Indicator team and the Nursing Quality Council. The PNSO membership approved the addition of Quality as the fifth core mission of the PNSO, codified in our Bylaws after the 2011 elections. The Medical Center's quality metrics became easily available to every staffmember. Examples of the gains instituted by the NSQI team include the development of a Post-Fall Huddle debrief to analyze commonalities across fall events. New outcomes-driven nursing recognition opportunities also emerged from these groups: some new peer-to-peer recognition, and some personal recognition from the CNO for individual and team-based accomplishments.

In 2011, the PNSO (with the CNO's active involvement) hosted a historic Shared Governance Redesign Summit, convening all Past Presidents and other key nursing leaders, to reevaluate the fundamental structures of the PNSO against the changing backdrop of nursing practice at UVAHS: were we still efficiently meeting needs? What changes were needed? A special referendum vote by the PNSO membership in 2012 adopted substantial changes to our Bylaws and committee structure. It has become an explicit expectation that every RN actively participates in PNSO activities annually, either at the local or central level. A robust network of Local PNSO Committees was formed, so that each unit/clinic has the infrastructure to systematically address local issues of nursing practice, quality, research, and professional development; these funnel their local decisions and multi-area challenges to the corresponding Central PNSO Committee for house-wide nursing consistency. A central Management Committee was also formed, whose administrative and direct-care representatives ensure sustainable implementation planning to further support house-wide consistency and accountability for change initiatives raised through shared governance, tightly aligning the PNSO's informal leadership and UVAHS operational leadership.

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The PNSO continues to be a vital, growing entity at UVAHS, always pursuing better ways to address the needs of our members and our patients. We continue on our Magnet journey. Direct care nurses provide improvement suggestions anytime by contacting the CNO, the  PNSO Office, their Nursing Cabinet member, or their network of representatives on our various committees. Nurses also provide essential feedback via the Nursing Satisfaction Survey and Employee Engagement Survey; trends from this data are closely analyzed and shared with all nurses, and Cabinet uses this data to guide and prioritize their activities.


Reference: For more information on the history and evolution of UVA's Professional Nursing Staff Organization, please see "Sharing Governance" by Pamela F. Cipriano, PhD, RN, FAAN, and Terry Lucas, MSN, RN, Advance For Nurses  (Maryland/DC/Virginia edition), May 26, 2003.

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