Empowering Teams through Reflection: Nurse-Facilitated Clinical Event Debriefing in Four NICUs

Clinical debriefing isn’t just a tool - it’s a culture shift.

In this multi-site NICU initiative, nurse-led debriefings proved both feasible and impactful for improving care and supporting healthcare teams.

Background

Neonatal intensive care units (NICUs) are high-stakes environments where rapid, coordinated responses to critical events are vital. Debriefings after clinical events offer opportunities for reflection, learning, and emotional support. Yet despite their known benefits, regular debriefings are often hindered by practical barriers such as time constraints and lack of trained facilitators.

Study Aim

This quality improvement project aimed to implement a structured, nurse-facilitated clinical event debriefing programacross four NICUs in a regional neonatal network. The goal was to normalize debriefing as a routine part of care and assess the impact on healthcare provider (HCP) experience and participation.

Methods

A multidisciplinary working group—including NICU clinicians, QI leads, and debriefing specialists—adapted an existing debriefing tool to meet the specific needs of the NICU environment. Site champions were designated, and charge nurses were selected as debriefing facilitators.

Facilitators participated in two-hour virtual training sessions focusing on structured communication and psychological safety. Triggers for debriefing were defined, and an implementation database was created to log debrief activity and themes. After 6 months, a post-implementation survey assessed uptake and impact.

Key Findings

• Pre-implementation: 81 HCPs completed a baseline survey. Most were familiar with and comfortable participating in debriefs, but cited lack of time and insufficient facilitator availability as key barriers.

• Implementation: Over six months, 95 debriefings were conducted across the four NICUs. The median number of participants per debrief was 7 (IQR 5–8), and most sessions were led by nurse facilitators. Debriefs were concise, with a median duration of 12 minutes (IQR 8–17).

• Outcomes: Debrief discussions frequently generated actionable recommendations related to equipment, teamwork, and process gaps. Feedback highlighted improved team communication and learning.

• Post-implementation: The follow-up survey revealed positive perceptions of structured debriefs. While time constraints remained a top barrier, fewer respondents listed this as a deterrent compared to the baseline.

Conclusion

This study demonstrates that a nurse-led, structured clinical event debriefing initiative is both feasible and beneficial in NICU settings. Beyond promoting continuous quality improvement, the program fostered team reflection, psychological safety, and systems-based learning. Embedding debriefs into NICU culture empowers frontline staff to identify and solve challenges collaboratively.

Implications for Practice

NICUs seeking to implement similar initiatives should invest in facilitator training, designate local champions, and incorporate brief, structured debriefs into routine workflow. Even short debriefs can yield meaningful improvements in care and team cohesion.