Excellence in Nursing It`s not an event – It`s a Journey

Excellence in Nursing
It’s not an event – It’s a Journey
SUCCESS
Next Exit
Roberta Christopher, EdD(c), MSN, APRN, NE-BC, CHTS-CP
Assistant Professor, Jacksonville University
Former Magnet Program Director for UF Health Jacksonville
The Journey
2004 – Began
2010 – Submitted
2011 – Magnet
designation
2015 – Submitted for
2nd designation
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•
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695 bed academic medical center
34,000 inpatient admissions each year
Trauma Center, Inpatient and Outpatient services, Home
Health, & Long Term Care
http://ufhealthjax.org/jobs/nursing/
Nursing Structure
Nurse
Manager
CEO
Director
Nurse
Manager
Chief Nurse
(CNO)
Director
Nurse
Manager
Charge
Nurse
Charge
Nurse
Charge
Nurse
Charge
Nurse
Charge
Nurse
Charge
Nurse
CNO & Nursing Directors
Nursing Excellence – ANCC Magnet Model
Need a
roadmap
for your
journey
http://nursecredentialing.org/Magnet/ProgramOverview/New-Magnet-Model
The Journey - Process
• CNO with a compelling Vision for Excellence
• Roadmap for Excellence = ANCC Magnet Standards
• Gap Analysis (Assessment & Diagnosis)
• Strategic Plan (Planning & Implementation)
• Enculturation (Evaluation)
Transformational Leadership
• Chief Nurse = Vision
• Excellence is
o Not free
o Not just about
nursing
o Strategic
o A process = journey
o Ongoing
Gap Analysis = Where are you today?
•
Pathway to Excellence or Magnet?
•
Assessment – Eligibility Requirements
 CNO must have Master’s degree (BSN, MSN or
DNP?)
 100% Nurse managers have degree in nursing
(BSN or graduate)
 100% Nurse leaders (directors) have degree in
nursing (BSN or graduate)
 Benchmark quality data (falls with injury, hospital
acquired pressure ulcers (HAPU) stage II>, CLABSI
(central line associated blood stream infection),
CAUTI (catheter associated urinary tract infection),
patient satisfaction, nurse satisfaction)?
 Nurse research & evidence based practice
The Future of Nursing
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Examined the Institute of Medicine’s (IOM) eight
recommendations
http://www.thefutureofnursing.org/IOM-Report
Nurses need to achieve higher levels of education
 80% BSN by 2020
 Require master degree for directors and
encourage for nurse managers
 Encourage doctorate degrees for leaders
Enhance leadership competency & development
Enhance new graduate residency program
The Good
The Bad
&
The Ugly
Brutal Honesty
with ourselves
Gap Analysis = Magnet Standards
Magnet Standard
Evaluation
EP22EO – Nurse Sensitive
Quality Indicators
(Unit/clinic level nurse
sensitive indicator
outperform the
mean/median of national
database used.
• Falls with injury
• HAPU Stage 2 >
• CLABSI
• CAUTI
• Nurse Sensitive Core
Measure
• Nurse Sensitive Clinical
Indicator from Outpatient
Services
• CLABSI &
CAUTI do not
meet standards
1 = Does
not meet
standard
2=
Partially
meets
standard
2
3 = Fully
meets
standard
Used Excel Spreadsheet
Benchmark & Pull Last 8
Quarters of Data
Senior Leadership Support
 Executive Summary of gap analysis
findings
 CNO shared with CEO (hospital
president) and other senior leaders
 Business case for Magnet
• Why should organization support?
• How much will it cost?
• What is the return on investment?
• What’s in it for me/us?
Business Case example
James A. Haley Veterans Hospital (2004) http://www.va.gov/nursing/docs/FinalBusCasereport11-26.pdf
Examples in the literature
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•
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Drenkard, K. (2010). The business case for Magnet.
Journal of Nursing Administration, 40(6), 263-271.
Higdon, K., Clickner, D., Gray, F., Woody, G., & Shirey,
M. (2013). Business case for Magnet in a small
hospital. Journal of Nursing Administration, 43(2), 113118.
Steinbinder, A. (2009). Bumps on the road to Magnet
designation. Nursing Administration Quarterly, 33(2),
99-104.
Executive Summary

Breakdown of how many Sources of Evidence (SOEs) were
scored
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1 (does not meet standard)
2 (partially meets standard)
3 (Fully meets standard)
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Timeline to resolve 1s and 2s
Plan to resolve deficiencies
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Associated costs and return on investment (business case)
How would Magnet support organizational goals & mission?
What would be required to move forward
What the CNO needed from leaders/organization to be
successful
Strategic Plan
• CNO held
retreat with
directors
• SWOT analysis
• Strategic
Priorities
• Action Plan
Example SWOT Analysis
Strategic Plan - Example
Goal: 80% BSN by 2020
Method/Strategy:
Evaluation Method:
Target (Calendar/Fiscal Year): CY14 >44%
Responsible Director:
Strategic Plan - Example
Goal: 80% BSN by 2020
Method/Strategy:
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Added BSN requirement to clinical nurse job
descriptions
 New hires must have BSN degree within 3
years of hire or transfer into the position,
and must be enrolled within 12 months of
hire
Did NOT require current employees to go back to
school
Required BSN for all fellowship programs (critical care,
emergency, labor & delivery, etc.)
Strategic Plan - Example
Method/Strategy:
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Tuition reimbursement
Website with college information for BSN programs
On site (at the hospital) BSN programs or connected
with online programs
Worked with schools of nursing to give nurses
discounts (5-10% off tuition costs)
Did NOT increase hourly rate for BSN
Implemented Bonus program (Professional
Recognition Program - PRP) based on points = points
for BSN, certification, research (Recognizing Nursing Professional Growth
and Development in a Collective Bargaining Environment, Journal of Nursing Administration, 41[5],
p. 197-200)
Strategic Plan - Example
Evaluation
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Quarterly tracking of BSN rates
Benchmarked using NDNQI
CNO Dashboard (Organization goal/progress)
Unit Dashboard (Unit goal/progress)
Qualitative feedback from staff
Tracked participation in PRP Bonus program and
dollars awarded
Tracked use of tuition reimbursement
80% BSN by 2020 (Magnet = OO7)
Example Nursing Dashboard
Other Essential Actions
•
Hired full time Magnet Program Director
 Magnet budget
 Reports to CNO
 Focused on research
 Teach & enculturate evidence-based
practice
 Served on Institutional Review Board
Nursing Shared Governance
Nursing Professional Practice Framework
Nursing Satisfaction &
Recognition
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Daisy Award Program http://daisyfoundation.org/daisy-award
Nurse’s Week events & awards program
Newspaper Ad
Professional Recognition Program (Bonus
Program)
Fun events
Development Programs
Build Excellence into your Electronic
Medical Record
Excellence takes
everyone in your
entire hospital
Interprofessional
Collaboration is
essential!
Last Thoughts . . . .
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It’s a marathon (Ironman) not a sprint
 Marathon = Vision, endurance, training plan,
strategy, belief that you can go the distance
 Enculturation is key
 You can not do this overnight
 Not about perfection, it’s about Excellence
Motivation for your nurses
 “I believe we are Magnet because you believe we
are Magnet!”

Magnet and Excellence starts with you
Keep Growing & Partner
with Schools of Nursing
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Jacksonville University School of Nursing
Online RN to BSN program
Participate on Nursing Research Council at UF
http://www.ju.edu/chs/Nursing/BSN/Pages/Online-RN---BSN.aspx
Believe – You ARE Excellent!
Who will
be the
first
Magnet
Hospital
in
Germany?
Special Thanks
Franz Wagner & Helene Maucher for
making this possible!
Questions? More Information?
Roberta Christopher
[email protected]