Michele Moreau, APNA Award for Excellence in Leadership - RNMichele Moreau, BA, RN-BC
2014 Award for Excellence in Leadership - RN

Over the past four years, Michele Moreau has led the transformation of a 24-bed child and adolescent acute psychiatric inpatient unit from one that took a “black and white” approach “with rigid rules and expectations” to a unit where staff are enabled to provide care in a way that embraces the underpinnings of the psychiatric-mental health nursing approach: person-centered, innovative, and sensitive care that is empowering rather than punitive. Take for example, the ‘sit-out chair’, which was in use on the unit when Moreau became Nurse Manager in 2010: “Staff was expected to follow a ‘sit out’ chart that dictated their interventions, based on a child's behavior,” she remembers. This included requiring the children “to do their time in a chair in the middle of a common area. The children's inability to sit calmly in a chair for a specified time often led to a more restrictive intervention.” Moreau soon ended this practice and the “sit out chair” disappeared.  She remembers this moment as beginning her “journey of leading and educating the staff on what our purpose was in these children's lives and how to look beyond the behaviors that these children exhibited - It was time to learn about the children who are often misunderstood and begin teaching skills,” she says.

As a part of the New Hampshire state hospital system, the Anna Philbrook Center cares for children from all over the state.  As Nurse Manager, Moreau is responsible for 44 staff - 13 Registered Nurses and 31 Mental Health Workers. “Michele took over the leadership role at a time when the service had undergone major changes that impacted negatively on the unit, including a reduction in beds and staffing and personnel changes,” says R. Joffree Barrnett, a colleague who nominated her for the award. These changes “reduced staff morale and threatened the quality of care. Her personality style, intelligence, leadership and dedication to her work had a major positive impact on all personnel (not just the nursing staff), the level of motivation, and directly improved the quality of care on the unit.”

For Moreau, initiating change meant first creating relationships with her staff.  “Enthusiasm, optimism, and being present on the unit are important to gain the respect and trust of your staff,” she says. “Allowing staff to think creatively fosters innovation and empowers them to be part of any change.” She also engages staff through teaching and role modeling. “I have held several training sessions for all of my staff focusing on trauma and children and milieu management,” she says. As a result of such training programs, “we have moved away from a level/privilege system and now look at each child individually, focusing on their abilities to guide their treatment.” This is further reinforced during nurses’ meetings, where current literature supporting the changes is discussed and shared. “Eventually all the staff will begin to view the children differently...inquiring about the why's instead of only seeing the what (behavior).”

In addition to facilitating change through staff education and support, Moreau is working to engage the children’s caregivers as well. “My vision also includes a patient/family centered approach in which there is direct collaboration with caregivers,” she says. With some policy changes, much progress has been made towards achieving that vision. “Parents/guardians are spending more time on the unit and visiting hours are not so strict,” she says. “We often have parents spend the night in the hospital and incorporated a family fun night each week.” Changes like this have given staff an opportunity to interact with caregivers. “It has allowed nurses to engage [caregivers] in direct care of the patient and teach skills to both,” she explains. “This was a dramatic change for the staff, but the positive outcomes we’ve seen have shown them the value in having the caregivers actively participate in treatment.”

Distilled into a few sentences, Moreau’s philosophy and what she strives to communicate to her staff is this: “In order to truly meet our patients’ needs, we must never assume.  Clarifying our observations with the patient before reacting will change the way we respond and help us be sensitive to their struggles. Inquiring about the “why's” instead of acting on the “what's” will always result in the least restrictive intervention.” With a philosophy like this, it is no surprise that her colleague Diane Allen says of her, “Michele’s most significant contribution to the people she serves is her unwavering dedication and commitment to helping patients recover from their illnesses, and to consistently provide that help in a kind, compassionate and empathetic manner. She is a passionate and articulate advocate for nothing less than the best in patient care.”

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