Exam 1
What has been concluded from research done with Magnet Hospitals?
-Via AAN: high-performing hospitals with well-qualified nurse executives in a decentralized environment, with organizational structures that emphasized open, participatory management.
2 IPNG
Primarily nursing management/administration with some staff nurse input
What is shared governance?
an organizational innovation that legitimizes health care professionals' decision-making control over their practice, while extending their influence to administrative areas previously controlled by managers
Partnership
the building of relationships between professional care staff and the organizations management for the purpose of safe effective efficient patient care at the point of service.
Which hospitals in the Kansas City area were the first to receive recognition of being Magnet Hospitals?
-Children's (2003)--> first in KS or MO -TUKH (2006)
Empirical Quality Results/Outcomes
-Clinical (patient) -Community -Workforce -Organizational Outcomes
What are the scoring criteria for the Index of Professional Nursing Governance (IPNG)?
1, 2, 3, 4, 5
How many "Forces of Magnetism" were there in the original Magnet Model?
14
What is the definition of an Approved Provider of Continuing Education in KS?
An approved provider means that they are accepted by the board and are responsible for developing, administering and evaluating of continuing nursing education programs/offerings
Councilor Model
Structured around specific committees and councils that have defined authority and function within identified areas
What is shared governance designed to accomplish for both nursing staff and nursing management?
-Expected results of shared governance regardless of model: • Nursing staff actively participating in decisions normally done exclusively by management • Nursing staff gain some control over work environment • Nursing Staff feel more invested in their organization and more satisfied
What is the time frame for temporary permit to practice in Kansas?
120 days
How much hospital's budget is allocated to supply expenditure?
31%
What is the equivalent of a contact hour for continuing education in KS?
50 total minutes of participation in a learning experience
Accountability
Acceptance of the idea that health care professionals take an individual responsibility to deliver safe, effective, and efficient patient care and assist others in recognizing and implementing this obligation.
Nursing Personnel
o Making nursing staff hiring decisions o Procedures for transferring and floating o Determining raises, benefits, salaries o Doing performance appraisals
Goals
o Negotiate solutions to conflicts among staff o Create a formal grievance procedure o Formulate mission, philosophy, goals and objectives for hospital.
Definition of Value Analysis
o Systematic process o Customer focused o Engage key stakeholders with clinical expertise o Financial analysis o Purchasing/contracting o Reduce overall cost o Maintain or improve quality and outcomes
Which group is given credit for creating the concept of a Magnet hospital and which association is this group aligned?
-American Nurses Credentialing Center (ANCC) -Aligned with ANA Scope and Standards for Nurse Administration
What activities need to be done and continued once an organization reaches the goal of Magnet designation in order to thrive in this complex adaptive system?
-Examining and revising standards for excellence recognition -Producing evidence to validate practices -Cataloguing and managing large databases of evidence -Mentoring for growth -Advancing nursing science
14 Forces of Magnetism
1. Quality of Nursing Leadership 2. Organization Structure 3. Management Style 4. Personnel Policies and Programs 5. Professional Models of Care 6. Quality of Care 7. Quality Improvement 8. Consultation and Resources 9. Autonomy 10. Community 11. Nurses as Teachers 12. Image of Nurses 13. Interdisciplinary Relationships 14. Professional Development
Ownership
Recognition and acceptance of the value of the health care professionals work. Ownership also designates the roles and expectations of each health care provider.
1Which state does not require CEU's for licensure renewal?
MO
How much of the hospital expenditure is taken up by physician preference items?
Physician preference items= most expensive=61% of supply expenditure
Which Magnet criterion is shared governance designed to meet?
Structural Empowerment
Equity
Each team member brings essential knowledge and ability to the accomplishment of quality patient outcomes. Equity is not referring to scope of practice, authority, or rewards.
Congressional Model
Involves elected representatives who oversee the operations of a unit or department.
What should be the focus of acuity systems?
PATIENT OUTCOMES instead of caregiver activities
What is the process of inactivating license in KS?
o 1. Before expiration of an active license, a licensed mental health technician may request to be put on inactive status. o 2. The request shall be accompanied by the inactive license fee specified in K.A.R. 60-8-101. o 3. Continuing licensed mental health technician education shall not be required while on inactive status. o 4. The licensee shall remain on inactive status until filing an application and meeting all the requirements for reinstatement. o An RN may request to put on inactive status before the expiration of an active license. This request comes with an inactive fee. Continuing education is not required to those nurses while on inactive status. The license will remain on inactive status until the filing an application and meeting all requirements for reinstatement.
History of Value Analysis
o Came from the world of business/manufacturing o GE initiated the concept of value analysis during WWII o By the 1960s, Department of Defense o 1990s - adoption in healthcare o Shortage of raw materials, skilled labor and parts; had to look for acceptable substitutions and found that these were often less expensive and provided the same function; systematic process by which they looked at new products
Participation
o Committee Participation o Forming new committees o Writing nursing unit policies and procedures o Writing the goals for the nursing unit for the next year.
Practice
o Developing Patient care standards o Developing and participating in Quality Improvement activities o Selecting products used in nursing care o Adjusting staffing levels to meet changing patient needs o Setting the requirements for CEU hours
Resources
o Making daily patient care assignments o Consulting hospital services outside of nursing o Access to office and care equipment o Procedures for controlling the flow of patient admissions, transfers, discharges
What are the impediments to nursing departments adopting a shared governance structure?
• A major impediment to the implementation of shared governance has been the reluctance of managers to change their roles • Consensus decision making takes more time than autocratic decision making, and not all nurses want to share decisions and accountability • Shared governance requires a substantial and long-term commitment on the part of the workers and the organization
What are the characteristics of an acuity system that meet the needs of both patients and healthcare providers?
• Objective and reliable • Valid • Patient-centered • Efficient • Inclusive and collaborative • Aligned • Predictive • Outcomes driven • Actionable • Informative
Why is shared governance popular in today's nursing world?
• Popular now because it is a way to meet the structural empowerment conditions to hold Magnet status. • Nursing Engagement in the Clinical Practice Environment Leads to Increased Job Satisfaction. • Retains Experienced and Talented RN's. • Attracts New RN's
Know the ANA principles regarding competence in the nursing profession outlined in Huston (2014), p. 294, Box 19.1
• The ANA supports the following principles in regard to competence in the nursing profession: o The public has a right to expect nurses to demonstrate competence throughout their careers. o Nurses are individually responsible and accountable for maintaining competence. o The nursing profession must shape and guide any process assuring nurse competence. o Regulatory bodies define minimal standards for regulation of practice to protect the public. o Employers are responsible and accountable to provide an environment conducive to competent practice. o Assurance of competence is the shared responsibility of the profession, individual nurses, regulatory bodies, employers, and other key stakeholders.
What was the reason for the Attorney General gave for not supporting the Nursing Compact idea in Kansas?
• Their response for not participating in the "Nurse Compact" process would remove the Kansas Board's control over the license issued. They believe that it would be "an unconstitutional delegation of legislative authority" by granting other states the ability to determine if a nurse is qualified. The board does not support a multistate license because of many practical concerns such as sharing information, disciplining, cost, and problems providing information needed for the operation of the system.
What are the components needed to attain and maintain Magnet Hospital status in today's environment?
• Transformational leadership; • Structural empowerment; • Exemplary professional practice; • New knowledge, innovation, and improvements; and • Empirical quality results (Pinkerton)." (Marquis 279) • Advance a professional work environment by engaging clinical nurses in the decision making process and giving them autonomy over their nursing practice • Organizations do not become stagnate, but continue to elevate nursing practice
1 IPNG
Nursing management/administration only
What is the definition of "practice of nursing" in KS Nurse Practice Act?
• Kansas: Performed by a registered professional nurse for compensation or gratuitously, and the process in which substantial specialized knowledge derived from the biological, physical, and behavioral sciences is applied to: the care, diagnosis, treatment, counsel and health teaching of persons who are experiencing changes in the normal health processes or who require assistance in the maintenance of health or the prevention or management of illness, injury or infirmity; administration, supervision or teaching of the process as defined in this section; and the execution of the medical regimen as prescribed by a person licensed to practice medicine and surgery or a person licensed to practice dentistry.
What is the continuing nursing education (CNE) contact hours requirement for license renewal in KS?
• Kansas: Proof of completion of 30 contact hours of approved CNE • Missouri: There is no minimum requirement
What is the source of evidence showing that nurse staffing matters in patient outcomes?
• National Database of Nursing Quality Indicators (NDNQI)
What is the value analysis equation?
• Value = Quality + Outcomes/Cost • Value = Quality/Cost
What activities need to be done and continued once an organization reaches the goal of Magnet designation in order to thrive in this complex adaptive system?
"For Magnet organizations, the emphasis on long-term sustainability of excellence is essential. It requires broad-based thinking about the use of resources, employee management, technology advancement, and impact of the community and the environment." p. 96
What is the unique mindset organizations must have in order to achieve excellence?
"Organizations dedicated to excellence require a mindset that is at peace with chaos and complexity"
What are the attributes that are present and are continued in Hospitals that have lived the Magnet journey more than once?
"The success of Magnet designation moves the organization into a new level of performance that requires skills that emphasize innovation, agility, and sustainability."
What is the replacement fee for lost or stolen license in KS?
$25
What is the fee for licensure by endorsement or licensure in KS?
$75
What are the elements that make acuity systems a component of safe staffing?
**(Process + People + Tools = Outcomes) • Skill mix • Nurse certification • Agency/contract nurses • International education • Culture • Care delivery models • Physical environment • Workflow/Patient flow • Resources • Technology
What is the significance of lifelong learning in Magnet hospitals and how does it occur?
**Lifelong learning is an expectation -Magnet culture inspires change agents who think and act from an understanding of complex systems and multiple interrelationships rather than single-focused short-lived initiatives -Occurs by years of deliberate practice and coaching, not an innate talent or skill
What is the unique mindset organizations must have in order to achieve excellence?
-Leadership support for Magnet -Infrastructure for shared decision-making, quality improvement, peer review, interdisciplinary relationships, evidence-based practice, and nursing research -Professional development programs -Professional model of care as a basis for nursing practice -Nurses at all levels (direct care, management, and leadership) should be knowledgeable and actively involved in the above processes, programs, and activities -The Sources of Evidence (measures of excellence) should be developed, disseminated, and enculturated throughout nursing services
What is the time frame for a Magnet Hospital designation? Is this time frame still current today?
-Magnet status is awarded for a 4-year period -Process consists of: Application, written documentation, site visit, commission vote -For re-submission: Submit application one year in advance
CNO Qualifications for Magnet
-Master's Degree -Nursing Degree at baccalaureate level or higher **Effective January 1, 2011, 75% of nurse managers must have at least a baccalaureate degree in nursing
What are the sources of evidence related to empirical outcomes within the Magnet Model?
-Nurse-sensitive indicators -Nursing research -Practice changes -Professional development -Work environment changes--> Community involvement
Specific research conclusions about Magnet
-Organizational structure supported nursing leadership -Staff nurses had autonomy and clinical authority in directing patient care -Ability to attract and retain professional nurses -Researchers called this the "magnet" effect—thus, Magnet Hospitals
What are empirical outcomes?
-Outcomes are categorized in terms of clinical outcomes related to nursing, workforce outcomes, patient and consumer outcomes, and organizational outcomes. These outcomes will represent the "report card" of a Magnet-recognized organization, and a simple way of demonstrating excellence
Structural Empowerment
-Professional Engagement -Commitment to Professional Development -Teaching and Role Development -Commitment to Community Involvement -Recognition of Nursing
Exemplary Professional Practice
-Professional Practice Model -Care Delivery System(s) -Staffing, Scheduling, and Budgeting Processes -Interdisciplinary Care -Accountability, Competence, and Autonomy -Ethics, Privacy, and Confidentiality -Diversity and Workplace Advocacy -Culture of Safety -Quality Care Monitoring and Improvement
New Knowledge, Innovations, and Improvements
-Research -Evidence-based Practice -Innovation
What are the attributes that are present and are continued in Hospitals that have lived the Magnet journey more than once? (specific)
-Staff Empowerment -Shared Decision Making -Professional Development -Interprofessional Relationships -Nurse Recruitment/Retention -Higher Standard of Practice -Recognition/Satisfaction
Transformational Leadership
-Strategic Planning -Advocacy and Influence -Visibility, Accessibility, and Communication
What are the specific areas of competence needed for nursing graduates according to the Future of Nursing report as identified in the Huston (2014) chapter?
-continuous improvement of the quality and safety of health care systems -informatics -EBP -knowledge of complex systems -skills and methods for leadership and management of continual improvement -population health and population-based management -health policy knowledge, skills, and attitudes
Which types of management styles fit best with the different models of shared governance?
-councilor model -administrative model -congressional model
How does the manager/administrator's role change in a shared governance environment?
-nurse-manager's role becomes one of consulting, teaching, collaborating, and creating an environment with the structures and resources needed for the practice of nursing and shared decision making between nurses and the organization
What types of organizations are eligible to apply for Magnet?
-one individual as CNO -Use of ANA Scope and Standards for Nurse Administrators -Compliance with all federal laws and regulations administered by the United States OSHRC, EEOC, HHS, DOL, and NLRB as they relate to registered nurses in the workplace -Nurse-sensitive quality indicators data at the unit level and benchmarked at the highest or broadest level possible
Components and Attributes of the new Magnet Model
-transformational leadership -structural empowerment -exemplary professional practice -New knowledge and improvements -empirical quality results/outcomes
What are the six primary content areas of the Index of Professional Nursing Governance (IPNG) survey and what questions do they contain?
1. nursing personnel 2. Information 3. Resources 4. participation 5. practice 6. goals
What are the components of successful teams in a shared governance model?
1. partnership 2. accountability 3. equity 4. ownership
How many years is a nursing license valid in KS?
2 years
Recent research findings with Magnet
A driving force to achieve magnet status is the clear link between this designation and improved outcomes. US News & World Report utilizes Magnet designation as a primary competence indicator in its assessment of almost 5,000 hospitals to rank and report the best medical centers in 16 specialties
Administrative Model
Consists of committees or forums in which people communicate and share ideas. The sharing of ideas leads to shared decision making
Of all the parts of the Magnet Model, which one is considered the most critically important component?
Empirical Outcomes
258 IPNG
Equally shared by staff and administration
1How many registered nurses served on the KS Board of Nursing?
Kansas: 11 total members, 6 are registered nurses
What is the process of appointment in KS State Board of Nursing?
Kansas: They are appointed by the Governor from a list of nominated nurses by the Kansas State Association of Nurses.
What nursing activities are included in a shared governance arrangement?
Nursing advisory council = research council + informatics & innovation council + quality practice council + clinical practice council + nursing leadership council + professional development & recruitment council
3 IPNG
Primarily nursing management/administration with some staff nurse input
4 IPNG
Primarily staff nurses with some nursing management/administration input
259-344 IPNG
Primarily staff with some administration input
173-257 IPNG
Shared governance, primarily management and administration with some staff input
5 IPNG
Staff nurses only
345-430 IPNG
Staff only
What regulatory agency mandates acuity systems in hospitals?
The Joint Commission and State Regulatory Compliance
86-172 IPNG
Traditional governance management and administration only
What are the license exemptions to practice in KS?
o The board may issue an exempt license to any licensee as defined in rules and regulations who makes written application for such license on a form provided by the board, who remits a fee as established pursuant to K.S.A. 65-1118 and amendments thereto and who is not regularly engaged in the practice of practical nursing in Kansas but volunteers practical nursing service or is a charitable health care provider as defined by K.S.A. 75-6102 and amendments thereto. o Each exempt licensee shall be subject to all provisions of the nurse practice act, except as otherwise provided in this subsection (f). Each exempt license may be renewed biennially subject to the provisions of this section. The holder of the exempt license shall not be required to submit evidence of satisfactory completion of a program of continuing nursing education for renewal. o To convert an exempt license to an active license, the exempt licensee shall meet all the requirements of subsection (c) or K.S.A. 65-1117 and amendments thereto. The board shall have authority to write rules and regulations to carry out the provisions of this section.
Information
o Unit budget and expenses o Quality of hospital nursing service o Hospitals financial status o Results of satisfaction surveys o Hospitals strategic plans for the next few years