Abstract
Specialty nursing organizations, such as the National Association of Bariatric Nurses (NABN), provide a venue for the genesis of standardized practice, expectations of care and the dissemination of new knowledge. However, fostering involvement closer to the point-of-care is critical to ensuring successful outcomes for both patients and the nurses caring for them. State chapters of the National Association of Bariatric Nurses are a natural segue way to providing local resources and support to those caring for the unique needs of bariatric patients and their families. As with many types of care, local and regional differences can provide distinct opportunities and challenges for nurses and the patient care team. This article will describe the development of the first state chapter of the National Association of Bariatric Nurses and offer strategies and insight for further state chapter development.
NABN was formed from a successful consortium between East Carolina University College of Nursing and Pitt County Memorial Hospital in Greenville, North Carolina. The consortium formed in 2003 in order to consider the care provided to the population of patients who decided upon a surgical option for the management of extreme weight issues. The consortium was comprised of many healthcare providers who were intent on moving this work forward. 3 During the following years, this organization would see tremendous growth and interest in the care of the morbidly obese patient.
In 2010, the 7th Annual National Association of Bariatric Nurses Conference in Norfolk, Virginia, became the turning point for the launch of the first state chapter of this promising organization. One of the best-attended special interest groups offered at this conference was entitled “Growing a State Chapter.” There were many states represented that expressed interest in implementing a state chapter and bringing the mission of NABN closer to home. However, it would become clear that North Carolina would, at that time, herald the greatest number of resources to charter the first state chapter of NABN. This would consist of creating a team of both novice and expert clinicians that could provide ideas, insight, and direction in creating a statewide framework.
State Chapter Group Development
During the chapter development, many key individuals contributed ideas and suggestions for implementation. Tuckman 4 described a model of group development that included four phases: forming, storming, norming, and performing. The development of the North Carolina state chapter of NABN followed a very similar course during its development. Thus this model will be utilized to describe the state chapter organizational process.
Forming
The formative phase for development of the North Carolina chapter occurred during the 2010 NABN Convention in Norfolk, Virginia. During the state chapter interest group meeting, there were representatives from various hospitals and programs throughout the United States, including several from North Carolina: East Carolina University and Pitt County Memorial Hospital, Greenville (Eastern Region); Rex Healthcare, Raleigh (Central Region); and New Hanover Regional Medical Center, Wilmington (Southeastern Region). During the 2 days of the conference, continued interest was generated between these organizations, and by the conclusion, initial plans were already underway. The seed for chapter development had been sown, and continued conversations between NABN members about the development of the North Carolina chapter continued by e-mail and telephone conversation throughout 2010. A review of NABN bylaws was essential to ensure that all requirements of state chapter development could be successfully completed. The NABN leadership and office support teams were invaluable resources during this formative phase. They provided guidance and direction to ensure that the initial state chapter requirements were fulfilled.
Storming
During this phase of group development, critical decisions and directions begin to take shape, which is a necessary component of group cohesion. 4 Differing ideas and solutions can provide a medium for friction. However, that was not the challenge during this phase. Rather, the challenge was one of communication and response rate. The core group that would eventually meet and charter this new chapter provided excellent direction and vision; reaching out to others was not the issue. A blast e-mail and letter communication campaign to NABN members (both active and inactive) throughout North Carolina was sent out with modest responses. Despite numerous contacts within the state, relatively few members showed interest. It is still unclear exactly what creates a barrier for interest and participation in state chapter membership, and this may provide opportunities for future research within the national organization as other states coordinate their own chapters.
Norming (genesis of a state chapter)
Per NABN bylaws, specific planning guidelines included the following: development of objectives for the chapter; election of officers; establishing an address; discussion of financial components, including state and national membership; and submission of the State Chapter Charter to the board of directors for approval. The first meeting of the North Carolina state chapter of NABN took place on July 30, 2011, at Rex Healthcare in Raleigh, North Carolina, and would become the official address of the state organization. As stated before, North Carolina is ripe with expert bariatric nursing clinicians and scholars, and we were fortunate to have their expertise available to us. Ten nurses participated in this inaugural meeting. Within this group of 10, three NABN board members were in attendance: Sharon Sarvey, PhD, RN, NABN President; Mary Ann Rose, EdD, RN, President-Elect, NABN; and Kim Joyner, RN, Vice President. Their combined knowledge of NABN history, policy, and protocol could not be overstated and was instrumental during this time. During this meeting, the officers of the North Carolina chapter were determined, including the President, Vice-President, and Secretary/Treasurer.
The mission statement of the North Carolina Chapter must mirror the mission statement of NABN. The objectives that were established for the North Carolina state chapter closely mirror those of the national organization but clearly define the challenges that exist more locally. The objectives include:
(1) Education, for both caregivers and the public. (2) Community outreach and increased awareness of obesity-related issues. (3) Provision of a forum for caregivers of bariatric patients to discuss common and unique issues that were occurring in their communities. (4) Continuity of care and the challenges that exist for bariatric patients within the span of the North Carolina healthcare system. (5) Development of best practices for the unique needs of bariatric patients and caregivers within North Carolina.
Within each state and region of the United States, and certainly within the international arena, there will be different challenges that will face both patients and caregivers that are population specific, culturally diverse, and unique to that locale. It is imperative that there are ample resources, including state chapters, which are tailored to meet the needs of diverse caregivers, patients, and populations.
Performing
Our success in this stage is yet to be determined. There was a brief meeting of the North Carolina chapter at the national NABN meeting in September 2011 that focused on the next planning stages. It was essential that this planning stage included facets that would support newly formed objectives within the state chapter. By consensus, it was decided that caregiver education would be the focus for the subsequent state chapter meeting, which was planned for Spring 2012 in Wilmington, North Carolina. Included within this planning was discussion related to increasing the number of nurses who have bariatric nursing certification, streamlining best practices, and ensuring proper training and education for nurses at the point of care. As you can see, the performing stage is still evolving, and will be judged on the ability of this new chapter to fulfill its mission to caregivers, patients, families, and communities.
Conclusion
Being first has its challenges, and there is much to learn within the first year of a fledgling chapter. However, the opportunities that exist within this construct are many. The ability to promote local education and best practice for caregivers can only strengthen the care provided to obese patients within our healthcare systems. It is essential that other states follow North Carolina's example and bring the unifying mission of NABN closer to home.
Disclosure Statement
Elizabeth Rochin is a member of the Board of Directors and Treasurer for the National Association of Bariatric Nurses. Kathy Ross is the President of the North Carolina Chapter of the National Association of Bariatric Nurses. No competing financial interests exist.