Welcome to the Downstate Magnet™ Consortium Meeting

December 6, 2010

Exemplary Professional Practice (EP)

Exemplary Professional Practice

The true essence of a Magnet organization stems from exemplary professional practice within nursing

Exemplary professional practice Is the key driver of a Magnet organization Requires comprehensive understanding of the role of

the professional nurse Accountability, competence & autonomy

Exemplary Practice

Excellence in practice and behaviors worthy of Honor Being imitated Respect and admiration

Nurses have control over staffing and scheduling practices

Nurses work collaboratively with the other disciplines As a result, the quality of outcomes is better

Nursing practice in Magnet organizations actualizes ideals & beliefs of the profession

Nurses are accountable for safe, ethical, evidence-based care

Exemplary Professional Practice

Professional practice is based upon tenets Self-regulating Peer Review Control of practice Code of conduct Contract with society

Nursing theory supports practiceRequires values clarificationFoundational documents describe principles of

nursing

Exemplary Professional Practice

Accountability Ownership for the consequences of one’s decisions and actions Reflecting on actions and effectiveness Directs future efforts Promotes learning (CHCM, 2009, p. 162)

Requires ongoing education Lifelong learning

Appreciative Inquiry is a skill set Identify what is currently working well What it will take to build on the excellence which already exists When we are performing at a high level, what components make this possible Staff should recognize the excellence of co-workers

Clarify values Individual caring, autonomy, sharing, improvement, inquiry Organizational change, collegiality, consensus, communication, celebration

Exemplary Professional Practice

Principles of Practice Based on standards

ANA Scope & Standards of Practice ANA Code of Ethics with Interpretive Statements Nurse Practice Act Professional organization standards Other professional standards

Evolving Evidence-based

Exemplary Professional Practice

EP encompasses the following seven forces Professional Models of Care Consultation & Resources Autonomy Nurses As Teachers Interdisciplinary Relations Quality of Care: Ethics, Patient Safety & Quality

Infrastructure Quality Improvement

Empirical Domains of Evidence (EO)

Professional Practice ModelSafe and Ethical PracticeAutonomous PracticeQuality Processes

Exemplary Professional Practice

Nine subcomponents of EPProfessional Practice ModelCare Delivery SystemStaffing, Scheduling & Budgeting ProcessInterdisciplinary CareAccountability, Competence & AutonomyEthics, Privacy, Security, & ConfidentialityDiversity & Workplace AdvocacyCulture of Safety Quality Care Monitoring & Improvement

These components work together to create great nursing and outcomes

Exemplary Professional Practice

Professional Practice Model Graphic description which demonstrates relationships

& supports decision making Aligns with the organization’s mission, vision,

philosophy and values Incorporates standards Provides consistency in practice Supports nursing care delivery Centered on the patient

Exemplary Professional Practice

Professional Model of Care Magnet hospitals lead research efforts and test

practice models Nurses analyze data to influence decisions Engage staff in the budget process Nurses must know unit based quality data Measure staff effectiveness against quality

outcomes Discuss skill mix Could have a good ratio but not have good

outcomes What are the issues?

Exemplary Professional Practice

Magnet organizations are expected to outperform the mean of the national database used (benchmarking) Must submit most recent annual or biannual nurse satisfaction

results including the mean or median Can be displayed at single unit level, like units, or organizational

level Narrative must include participation rates, analysis and

evaluation of data and database used Must follow through on action plans Information must get back to staff

Must demonstrate comprehensive, not cursory, analysis of survey results

Exemplary Professional Practice

Care delivery system Integrated with the professional practice model Based on acuity, staffing mix, best practices Is responsive to change Promotes consistency, efficiency, and accountability for care Describes

How care is delivered Skill set required

Nurses’ authority is clear Authority is the right to act in areas where one is given & accepts

responsibility Varies by unit, population Roles are clear Use internal consultants Productivity is measured

Exemplary Professional Practice

All care delivery systems address Staffing patterns Schedules Scope of Practice Assignments Accountabilities Transitions in care Continuity of care

Exemplary Professional Practice

Staffing, Scheduling and Budgeting Processes Use of trended data to formulate staffing plan Consistent application of the Care Delivery System Nurse participation in staffing and scheduling

processes Use of guidelines such as ANA Principles of Nurse

Staffing How nurses analyze data to guide decisions about

budget Formulation Implementation Monitoring Evaluation

Staffing, Scheduling and Budgeting Processes RN competencies Management support Access to clinical experts Valuing of RN contributions Commitment to fill vacancies in creative ways

Exemplary Professional Practice

Exemplary Professional Practice

Assignments ensure continuity, quality & effectiveness Good hand off communication (use of tool)

Beside nurses should have resources 24/7Use of consultants (internal/external)

enhance care

Exemplary Professional Practice

Interdisciplinary Care Comprehensive plan of care developed through partnerships

with Patients and families Physicians Pharmacy Nutrition Rehabilitation Social work

Collegial relationships evident Mutual respect as everyone’s contributions impact the

patient experience and outcomes Must have conflict management strategies in place Ensure continuum of care

Exemplary Professional Practice

Accountability, Competence & Autonomy Accountability means being responsible for own actions Competence– use of communications, technical skills,

clinical reasoning, values in daily practice for benefit of individuals and community Competency assessment contributes to safe and ethical practice Routine use of self appraisal and goal setting Peer evaluation means other nurses give fellow nurses feedback

during performance appraisals Nurses need to be able to judge performance of peers with

similar roles and level of licensure Peer review encourages professionalism through

accountability and self-regulation of practice

Exemplary Professional Practice

Professional Peer Review Constructive Collegial Systematic Formalized At all levels Conducted over time

Autonomy Right to exercise clinical and organizational judgment

within an interdependent team in accordance with nursing discipline Control over nursing practice

Exemplary Professional Practice

Exemplary Professional Practice

Ethics, Privacy, Security & Confidentiality How nurses address complex ethical issues Use ANA Code of Ethics

Make visible Operationalize principles Ongoing education Look for ethical issues in daily rounds

Resolve privacy, security and confidentiality issues

Exemplary Professional Practice

Diversity & Workplace Advocacy Address healthcare disparities Non-discriminatory climate Address unsafe, incompetent or unprofessional

conduct Assess community needs Meet unique needs of patients Workplace initiatives to address

Caregiver stress Diversity Rights Confidentiality

Exemplary Professional Practice

Culture of SafetyProactive assessment & approach

Prevent injuriesInnovateSafety initiatives incorporate national best

practicesBased on standards such as ANA’s Safe Patient

Handling and Movement Sufficient resources are available to respond to

safety initiatives Facility-wide approachMeasure improvements in nurse workplace safety

Nurse sensitive indicators Submit data for most recent 8 quarters for four nurse-

sensitive clinical indicators Falls and pressure ulcers must be reported Two other indicators must be chosen

Blood stream infection, UTI, VAP, Restraint use, pediatric infiltration or other specialty-specific nationally benchmarked data

Include the median or mean of national database Can be displayed at single unit level (ICU for example), by clinical groups (Med/Surg units) or at organizational

level

Exemplary Professional Practice

Nurse sensitive indicators Data must be statistically valid; provided by vendor Majority of data must outperform the mean the majority

of the time Five of eight quarters must outperform mean

Narrative must include analysis and evaluation of data Database to which contributed

Must include a graphic display and table with Data from last eight quarters Benchmark mean or median for each quarter Axis labels Clarify if data point is “no data submitted” or “zero”

Exemplary Professional Practice

Exemplary Professional Practice

Quality Care Monitoring & ImprovementNurses at all levels analyze data and use

national benchmarksAction plans are developed that lead to

systematic improvementsResources are allocated for quality

Avoid data paralysis; should be direct, meaningful & simple

Magnet hospital data demonstrates outcome measures at or above benchmark mean in patient and nurse sensitive indicators

Quality Care Monitoring & Improvement Submit data for most recent eight quarters for four

measures of patient satisfaction with nursing Pain Education Courtesy and respect from nurses Careful listening by nurses Response time

Include mean or median of the database Data can be display at unit, clinical group (like units),

or organizational level Majority of data must outperform the mean or median

the majority of the time

Exemplary Professional Practice

Exemplary Professional Practice

Quality Care Monitoring & Improvement Narrative must include analysis, evaluation and

resultant action plans Other requirements as outlined under nurse sensitive

indicators

Exemplary Professional Practice

Nine subcomponents of EPProfessional Practice ModelCare Delivery SystemStaffing, Scheduling & Budgeting ProcessInterdisciplinary CareAccountability, Competence & AutonomyEthics, Privacy, Security, & ConfidentialityDiversity & Workplace AdvocacyCulture of Safety Quality Care Monitoring & Improvement

Narratives should provide sufficient examples to indicate compliance with the source of evidence (SOE) Demonstrate not isolated to a single group or area Must demonstrate attribute exists throughout the

organization Should be straightforward, concise, include minimal

extraneous information Explain clearly how SOE is present and

operationalized Illustrate dynamic/innovative focus on excellence How integrated and internalized across breadth of

organization

Exemplary Professional Practice

References

American Nurses Credentialing Center (2010). Exemplary Professional Practice: Criteria For Nursing Excellence: Magnet Recognition Program®. Silver Spring, MD: Author.

American Nurses Credentialing Center (2008). Application Manual: Magnet Recognition Program®. Silver Spring, MD: Author.

Creative Healthcare Management (2009). Relationship-Based Care Leadership Practicum. Minneapolis, MN

http://www.nursecredentialing.org/Documents/Magnet/

2008-Manual-Updates.aspx