Magnet Readiness

SE: Give an example of an improvement that has been made because of nurse involvement on a St. Luke's committee, workgroup or council

-Changes to EPIC order sets -Code 4 documentation changes -Wound documentation changes -Product changes

TL: How does the Chief Nursing Officer (CNO), Terrie Vos, support you?

-Charge nurse pay -Essential shift differentials -Agency Assistance -Purchase and installation of ceiling lifts, ultrasound machines, and point of care testing equipment She is accountable for the nursing budget including support for shared governance time, professional development opportunities (conference attendance, pay for skills fair instructors, residency program). She supports our participation in national research such as the NDNQI falls study and READI study

SE: Describe how Aurora supports nurses who seek additional formal nursing education

-Loan forgiveness -tuition reimbursement -professional development committee activities -career advancenment opportunities (HUC-->CNA-->RN)

SE: Name an improvement that occurred because of nursing involvement in professional organization

-Local-Anesthesia Systemic Toxicity (LAST) education module -Aromatherapy implementation -Journal Articles: Pre-op teaching process and IV starts

SE: What has your unit done in the past year to recognize and celebrate the contribution of nursing?

-Nurses week celebration -Daisy Award Celebration -Staff meeting acknowledgment -Annual holiday party -Certified nurses day celebration

What are the goals and guiding principles of the Magnet Program?

-Promote QUALITY in a setting that promotes PROFESSIONAL PRACTICE. -Identify EXCELLENCE in nursing care. -Disseminate BEST PRACTICES in nursing services.

EPP: Describe a nursing intervention you are using that is evidence based.

-Scrub the Hub -Aromatherapy -Mepilex sacral dressing for friction/shear reduction -Antibotic administration withing 1 hour cut-time (SCIP protocol)

EPP: How do I access resources to conduct nursing research?

-Unit CNS -System nursing research website -Center for Nursing Research and Practice -Aurora Libraries -Nursing Research and Innovations Committee (NRIC)

SE: How does Aurora recognize the contribution of nurses?

-Unit acknowledge at staff meetings -Nurse excellence awards at unit and system level -Annual nurses' celebration -Annual report -Pat on the back -Daisy Award -Aurora Star

SE: How does shared governance on your unit impact you in your practice?

-Unit skills fair and education -staffing recommendations -ACC chair uses bidirectional communication to disseminate all relevant info

EPP: Name 3 resources available to assist someone with evidence-based process

1. Unit CNS 2. Aurora library 3. Center for Nursing Research 4. Shared governance councils 5. Nursing Research and Innovations Committee

What are the 5 Magnet Components?

1.) Transformational Leadership 2.) New Knowledge, Innovations, and Improvements 3.) Structural Empowerment 4.) Exemplary Professional Practice 5.) Empirical Outcomes

SE: How many nurses are certified in the Surgery Center?

7

SE: Who is our ACC and how did they get there?

ACC chair- Kara Belmas Diane Hoffman Lidia Gorman Anjelica Sanchez Nikki Lorino Janet Danek -Safety Mary Winn -Magnet Elected from unit staff after self or peer nomination. ACC terms are for 2 years.

SE: Who is involved in qaulity improvement projects?

ALL OF US! We are all responsible and accountable for our patient outcomes.

EPP: Who can access the ethics committee?

Anyone! Contact unit CNS or ethics committee directly

SE: What is the ACC?

Area Coordinating Council- a group of caregivers who participate in shared governance on the unit/area level

SE: What is ANSG?

Aurora Nursing Shared Governance

SE-SHARED GOVERNANCE: What structure allows nurses at all levels to be included in decision making?

Aurora Nursing Shared Governance (ANSG) supports clinical decision making where the work is done. Practice issues are discussed, evaluated, and elevated to the level where they will have direct impact via communication and links between councils.

EPP: How does the ANA scope and standards of practice affect your nursing care?

Each unit has nursing standards of practice that are based on the ANA standards and incorporate any specialty standards for that unit. The standards include basic guidelines of nursing practice: assessment, diagnosis, outcome identification, coordination of care, health teaching, health promotion, evaluation, ethics, culturally congruent practice, communication, collaboration, leadership, education, evidence-based practice and research, quality of practice, professional practice evaluation, resources ultilization, and environmental health. We integrate standards into policy, procedure, documentation, shared governance accoutability and our organizational goals.

What are empirical Outcomes?

Empirical outcomes describe "What difference have you made?" Magnet recognized organizations that are pioneers who demonstrate solutions to the numerous problems inherent in our healthcare systems today. Clinical outcomes related to patients and consumers, nursing, the nursing workforce, and the organization is comparted to benchmarks. This is our report card of how we demonstrate EXCELLENCE. Examples include falls, CAUTI, CLABSI, and pressure ulcer prevelance rate, patient and RN satisfacation rates and staffing decisions.

How often does a hospital redesignate? How many designations does St. Luke's have?

Every 4 years. SLMC has 4 designations, going for 5th!!

What is exemplary professional practice?

Exemplary professional practice entails a comprehensive understanding of the role of nursing and how it applies to patients, families, communities and interdisciplinary team. It concerns how new knowledge and evidence are applied and what strong professional practice can achieve.

EPP: What is the Aurora Nursing Professional Practice Model? How do you demonstrate the professional practice model?

Familiarize yourself with the model. It is posted in the lounge.

EPP: What documents support your practice in general?

Foundational documents are: -ANA scope and standards (adult and peds), -Code of ethics for nurses, -Social Policy Statement

EO: What do you do to prevent pressure ulcers?

Frequent repositioning of patient and devices, padding bony prominence's, friction reductions (mipilex sacral dressing), chart skin assessment

EO: What do you do to prevent VAE?

Hand Hygiene Stress ulcer prophylaxis VTE prophylaxis HOB>30 degrees Oral care q2hr and prn Oral care/suctioning prior to patient respositioning Daily interruption of sedation Daily assessment of weaning/extubation readiness

EO: What does HAPU stand for?

Hospital Acquired Pressure Ulcer

EPP: What is the IRB?

Institutional Review Board IRB reviews and approves all research proposals for the protection of human rights and welfare. Nursing representation is on the IRB.

SE: Who is the ASLMC NCC chairperson?

Jon Iserloth- a staff nurse on 10T

EO: what do you do to prevent patient falls?

Never leave a patient unaccompanied while toileting (within arms reach and attentive) Bed and chair alarms Early mobilization utilize assistive devices

EO: What is NSI? What NSI does your unit focus on?

Nurse Sensitive Indicators 1. Nurse skill with IV 2. Nurse concern for comfort 3. Response to concern/complaints

EO: How are you involved in the unit budget?

Nurses can put in requests for equipment ex bladder scanner, Vein finder, IV ultrasound. Discussing staffing mix and need for new hires; input in making assignments or flexing hours

SE: What is the NCC?

Nursing Coordinating Council NCC is a part of the shared governance structure that connects the ACCs at the site or system level and coordinates their individual efforts

SE: What is your specialty's professional organization?

Nursing: American Nurses Association (ANA) OR- CNOR certification (AORN - Association of periOperative Registered Nurse) Pre/Post- CAPA certification (ASPAN - American Society of Perianesthesia Nurses)

SE: How do you participate in peer review?

One peer pairing is assigned by ACC and you choose the other. Top page is turned in to manager. Open ended questions. Face to face conversations. Setting a goal based on conversation.

EO: What do we measure to indicate patient satisfaction?

Patient survey (HCAPS from Press Ganey) responses related to: Pain, Education, Courtesy and respect, Listening and call light response

What are you most proud of on your unit?

Personal response.....Time to shine!! :)

EPP: What does PDSA stand for?

Plan, Do, Study, Act process for quick action plan implementation and quality improvement

EO: Where can you find the most recent NSI data?

Posted on the board outside the lounge. Shared at monthly ACC meetings and staff meetings

EO: What is your unit care delivery model? How do you flex when patient acuity increases or staff call in sick? How are you involved in staff decisions? Do you use a tool to determine acuity?

Primary Nursing Help out co-workers, utilize team lead or functional/breaks RN Typically 3-4 patient assignment load; lighter load for general cases We do not use a tool to determine patient acuity.

What is the Magnet Recognition Program?

Recognition for healthcare organizations for QUALITY PATIENT CARE, NURSING EXCELLENCE and INNOVATIONS IN PROFESSIONAL NURSING PRACTICE. (developed by the American Nurses Credentialing Center- ANCC)

TL: How does the organization keep you safe?

Safety committee and updates shared at meetings educational offerings

SE: If you are not certified, what is your plan for certification?

Start thinking of a plan! :)

SE: If you do not have your BSN, what is your plan for this achievement?

Start thinking of a plan! :)

What is structural empowerment?

Structural empowerment means that solid structural processes are in place to provide an environment where professional practice flourishes the mission, vision and values of the organization come to life to achieve the outcomes that are important to the organization.

TL: Who represents you at Administrative Table?

Terrie Vos, the nursing directors and the nursing leadership within the units and shared governance (ACC, NCC, champion groups and committee reps) Practice concern would be Sheila Hardrath, Lee Jeske, Terrie Vos as well as our leaders in quality or infection prevention

EPP: What is the evidence based practice and quality improvement model?

The IOWA model of evidence based practice to promote quality care

What makes you a "Magnet Nurse"? What makes St. Luke's a Magnet Hospital? What is it like being a nurse at St. Luke's ? How do you think St. Luke's nurses are perceived by the community?

These are all your personal responses :)

What is New Knowledge, Innovations, and Improvements?

This component includes new models of care, application of existing evidence, new evidence and the visible contributions of the science of nursing.

What is transformational leadership?

Transformational leader requires vision, influence, and clinical knowledge to lead people where they need to go to meet the needs of the future, birth new ideas, and innovations.

EO: What does VAP stand for? What does VAE stand for? How is VAP different from VAE?

VAP= ventilator associated pneumonia VAE= ventilator associated events VAE is an event with a declining respiratory status on a vent (increased PEEP/Fi02); VAP is an advanced form of VAE involving a pneumonia acquired while intubated. CDC changed definitions for 2013 so we now monitor all VAE and not just VAP

EO: What resourcse do you have to help with wound and pressure ulcer prevention?

Wound care RN consult Hyperbaric medicine department Education on staging and wound assessment Pressure ulcer details report in EPIC

SE: How are you involved in unit or hospital decisions about your practice?

You can make recommendations to ACC ACC-->NCC-->System NCC

TL: Who do you go to in you have an issue?

You have many individuals you can bring concerns to: your supervisor, manager, directors, CNO, HR