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O C T O B E R 2 0 1 5 W W W . N A T I O N A L N U R S E S U N I T E D . O R G N A T I O N A L N U R S E 9 We continue our explorations of the life and career of Kay McVay, a longtime intensive care unit RN at Kaiser Permanente and president emeritus of the California Nurses Association (CNA). In this installment, McVay discusses the Quality Liaison program, a unique nursing position within the Kaiser Permanente system dedicated to identifying and solving systemic practice issues Kaiser RNs face in their work. How did the Kaiser quality liaison (QL) program get started? Well, it was spring of 1998 and the Kaiser nurses were in contract bargaining. This was after a series of massive, historic, systemwide strikes that Kaiser nurses held in 1997 as part of the 1996 to 1998 round of bargaining. As you may remember, we were only a few years out from our staff nurse revolt, when bedside nurses finally took control of our union and organi- zation from the nurse managers and broke away from the American Nurses Association. We nicknamed the old guard the "sorority sisters" and the "ladies' auxiliary" because they were more concerned about their résumés and making it to management than helping bedside nurses take care of patients. Well, we still had a lot of these types sitting on our professional practice commit- tees, so we wanted a way to jumpstart a new structure to implement nursing practice issues that we staff nurses controlled. So to round out the 1998 contract talks, the Kaiser bargaining team nurses brainstormed and this is what they came up with: RN positions focused solely on identifying and solving systemwide Kaiser nursing practice issues. It's amazing because the QL program brings together RNs from every area of Kaiser: inpatient, outpatient, home health, hospice, call centers, and nurse practition- ers. And since that time, the number of QL positions has more than doubled from 18 to 37 and their paid time to meet, think, and organize has increased, too. And what was the importance or signifi- cance of these positions? First and foremost, Kaiser agreeing to these QL positions required a major shift in think- ing about who was qualified to make deci- sions about patient care, safety, and quality. When we were in bargaining talks the round before that (in 1993 and 1994), we actually had a management representative say during a session when we raised issues of nursing practice, "I don't understand why you're talking about that. What nurses think has no bearing. Doctors make the patient care decisions." Wow. That's so patronizing and condescending. Well, that's what we were dealing with. The QL program really gave Kaiser RNs control of their practice and acknowledged that they are the experts in their field of nursing prac- tice. They knew that in their hearts, but the QL program validated that. So how did the dynamic change? The Kaiser staff nurses really began to think of themselves as on par with nursing colleagues in administration. The QL meetings was a forum where they could be heard and listened to, and real problems identified and documented, and real solu- tions proposed, decided upon, and imple- mented. Do you have any examples of memorable QL accomplishments? Well, there are way, way too many to list here. Some of them were small, and some big, but it all adds up. One I remember vividly early on is an issue that operating room nurses brought up about the way instruments were being cleaned or not cleaned. It turned out that some laparoscop- ic equipment was getting sterilized after use, but not properly cleaned, so that blood and tissue still remained. The QLs identified that and got that fixed. So what's next for the QLs? I think it really says something after 15 years that the number of nurses dedicated to this program has doubled. It's a unique program and Kaiser is the only hospital system that has it. "Conversations with Kay" appears regularly in National Nurse. Through McVay's stories, we docu- ment the origins of the modern staff RN movement as well as the changing practice and culture of nurs- ing and healthcare. Conversations with Kay