1 CARE LOVE HOPE Nursing Matters Arkansas Children s Hospital Professional Nursing Practice Guide
2 Mission Arkansas Children s Hospital is committed to working with others to achieve high quality, cost-effective, fully accessible service for Arkansas most precious resource - our children, without regard to race, religion or inability to pay. Vision. Values. In order to enhance, sustain and restore the health and development of children, Arkansas Children s Hospital provides excellent clinical PATIENT CARE SERVICES Strategic Imperatives In order to achieve excellence in patient and family care, Patient Care Services has defined these Strategic Imperatives: Structural empowerment Quality of care in an environment that promotes safety Support organizational transformation Ensure the workforce for the future Professional excellence Maintain fiscal stability Interdisciplinary care Community involvement services, teaching and research.
3 2 A Word from Leadership Welcome to the world of nursing at Arkansas Children s Hospital! Joining Children s in 2008, I was honored to become a part of something special, one of a group of outstanding nurses dedicated to both the nursing care of children and to their own professional practice of nursing. During those initial few months we made a commitment to pay tribute to our history, build upon the strength of a proud foundation of Care, Love and Hope in the way that only nurses could contribute, yet embrace the possibilities and opportunities of what more we could be and embark upon a new journey toward nursing excellence. Together we created a bold new vision of nursing at ACH, born of our desire to ensure the provision of exceptional nursing care to children well into the future. Today we are all a part of an exciting new era. Building upon the newly-established Model of Care and Professional Practice Model, we stepped up to the challenges of change to create an innovative infrastructure supportive to empowerment and participation among and between the nurses of ACH. Gathering the ideas of nurses across the enterprise, the Councilor structure for shared decision-making was carefully developed to serve as the platform for dialogue on issues that matter most to nurses. The result: Four core Councils that form the basis of the entire structure: Quality & Safety, Recruitment & Retention, Clinical Practice, and Professional Excellence. It is with great admiration and gratitude that I congratulate the members of the Coordinating Council for their dedication to making this important new reality for Children s, for nursing, for our interdisciplinary partners, and for our patients and their families. PATIENT CARE SERVICES I invite you to be a part of our new and exciting vision for the future of nursing and to children s health care. Whether you support ACH nursing with direct involvement in a council or task force, by imparting your experience and sensitivity to care at the bedside, or by sharing your story of your personal journey of nursing with others, my heartfelt thanks to you for your support throughout the past two years and into the months ahead as we continue to make huge strides into our exciting future. Sincerely, Lori Lori J. Brown, BSN, MSN, CENP Senior Vice President Patient Care Services Chief Nursing Officer Arkansas Children s Hospital
4 Philosophy Arkansas Children s Hospital s philosophy of care is to provide care, love and hope within the framework of Patient and Family-Centered Care. The ACH service and behavioral standards serve as the guiding principles for professional care delivery. Quality care excellence is achieved when care is safe, effective, patient-centered, timely, efficient and equitable.
5 4 Nursing Model Patient and Family-Centered Model of Care We believe that the family is the primary source of strength and support for the children, adolescents and adults we serve. We view family members as vital to enhancing the patient s health and well-being. We respect and honor the beliefs, values and perspectives of each patient and family member, regardless of their individual circumstances. We strive to demonstrate compassion, respect, collaboration, support and advocacy. ACH nurses partner with patients, families and other disciplines to plan, deliver and evaluate individualized care which achieves optimal outcomes for each patient. Nurses also collaborate with patients, families and other providers to create an empowered environment where best practices can be evaluated and implemented to assure safe, evidence-based and comprehensive care. Evidence-Based Practice Professional Practice Model ACH nurses realize patient and familycentered care through our practice model which incorporates professional development, shared decision making, interdisciplinary teamwork and evidencebased practice. ACH strives to create a nurturing professional development environment that empowers nurses to advance their education and skills to provide specialized care. ACH nurses are responsible for their own professional development and for nurturing the professional development of colleagues and students. Because we value the expert knowledge of our nurses, we believe that shared decision-making creates an environment of shared accountability for excellent outcomes. Interdisciplinary teamwork is also key to excellent outcomes. In this empowered environment, nursing care is planned, delivered and evaluated using the principles of evidence-based practice.
6 SHARED DECISION MAKING COUNCIL STRUCTURE Introduction In March 2009, a group of nurses came together with the goal of developing a shared decision-making model (Council Structure) for Arkansas Children s Hospital. Known as the Coordinating Council, membership includes staff nurses, patient care managers, specialty RNs, outpatient and inpatient nursing directors, clinical nurse specialists and members of Patient Care Executive Leadership (PCEL). The Council Structure provides an organized approach to addressing matters relative to patient care delivery and clinical practice. The Council Structure is interdisciplinary in nature and works across departments in order to accomplish the goals of quality and safety in patient care. Four Core Councils CORE COUNCIL Quality and Safety Professional Excellence Recruitment & Retention Clinical Practice PURPOSE OF COUNCIL The purpose of the Quality and Safety Council is to assure optimal outcomes through: 1) the use of internal and external benchmarks and national standard to evaluate practice 2) the identification of high risk, problem prone or safety issues in the care environment 3) the promotion of improved organizational performance using quality, safety and process improvement tools The purpose of the Professional Excellence Council is to develop a culture that promotes professional nursing practice, stimulates excellence in practice through appreciative inquiry, and supports the advancement of nursing at ACH and in the community. The purpose of the Recruitment and Retention Council is to promote an environment which ensures the workforce of the future by advancing evidence-based strategies to attract and retain nurses who demonstrate the ideals of the ACH Model of Care and Professional Practice Model. The purpose of the Clinical Practice Council is to assure excellence in patient and familycentered care and clinical practice by promoting consistency of care across the continuum, proactively implementing innovative practice changes and revising current practice based on the best available evidence.
7 6 Council Structure CLINICAL AREA (3 possible configurations) DESIGNATED GROUP ORGANIZATIONAL One Council Medical-Surgical Group Quality and Safety Recruitment and Retention Two Councils Intensive Care Group Professional Excellence Four Councils Surgical/Ancillary Group Clinical Practice Ambulatory Group
8 Clinical Area Councils Each department (or group of departments with shared patient populations/processes) can choose to form their councils in various ways: One council that will encompass all core councils: Quality and Safety; Professional Excellence; Recruitment and Retention; and Clinical Practice. Two councils with one council consisting of Professional Excellence/Recruitment & Retention; and a second council consisting of Quality and Safety/Clinical Practice. Four councils with one council consisting of Quality and Safety; a second consisting of Clinical Practice; a third consisting of Recruitment and Retention; and a fourth consisting of Professional Excellence. Designated Group Councils At the designated group councils, the four Core Councils (Quality and Safety; Professional Excellence; Recruitment and Retention; and Clinical Practice) come together as one council to address matters relative to the designated groups. Each designated group council will send a representative(s) to the organizational councils. Four designated groups include the following clinical areas: DESIGNATED GROUP INCLUDING THE FOLLOWING CLINICAL AREAS Intensive Care PICU, NICU, CVICU, Burn Center, IMU, ED, Transport, ECMO, Resource Team, Extend Medical-Surgical Adolescent, General Medicine, Dialysis, Neuro, 5E Med, 5D Progressive, Resource Team, Extend, IV Team, ECU, Day Med, 3D Hemoc, Hemoc Clinic, Aphresis, 3E, 4E, ITU, ED Surgical Services and Ancillary Services OR, ASC, PACU, CVOR, Radiology, Cath Lab, Cardiac Diagnostics, Sedation Ambulatory Care Primary Care Clinics: Adolescent CL, GPC, Circle of Friends Specialty Clinics: Clinics 1-6, Neuro CL, Cardiology CL, Eye CL, Ortho CL, ENT/Dental, WLR CL, Specialty Nurses Organizational Council Each of the four Core Councils separate into one council for Quality and Safety; one for Professional Excellence; one for Recruitment and Retention; and one for Clinical Practice. The organizational councils serve as the first venue where all departments/areas come together. Information Flow Between Councils Information may enter/exit the Council Structure from the clinical area, designated group or organizational councils. Information may flow between: Clinical area and group councils Group and organizational councils Organizational and clinical area councils Clinical area, group or organizational councils and hospital or adhoc committees
9 8 Council Bylaws Established bylaws exist for each council and include: purpose, function, level of authority, scope of responsibility, membership, membership selection, council member expectations, member roles and responsibilities, and meeting frequency. Council Membership The following roles are evident in each council: 1. Chair - RN 2. Co-Chair - RN 3. Facilitator 4. Chair-Elect - RN (Org level only) 5. Recorder 6. Members - elected and appointed 7. Interdisciplinary members Council Meeting Frequency The Designated Group and Organizational Councils meet monthly. The Clinical Area Councils meet 1-2 weeks prior to the Designated Group and Organizational Councils. Other Councils and Cabinets In addition to the Core Councils that are represented at the clinical area-based, group and organizational level, other cabinets and councils also support the shared decision-making model: The Nurse Advisory Cabinet provides a forum for open exchange of information with frontline staff on key issues and matters of significant importance to nursing within ACH, thereby serving as advisory to the CNO and PCEL. The Leadership Advisory Cabinet provides a forum for open exchange of information between Council Chairs, ACH nursing and patient care directors, and other ACH nurses who are serving in leadership roles on key issues and matters of significant importance to nursing within ACH, thereby serving as advisory to the CNO and the Patient Care Executive Leadership team. The Nursing Director Council provides a forum for directors to discuss evidence-based practices and policy relative to leadership and management in support of patient care. In addition, this council facilitates communication and consistency between directors to support the integration of Director s Council decisions into actual practice. The Coordinating Council provides oversight to the overall effectiveness of the council structure in meeting its defined objectives. It also facilitates ongoing communication and the continuing evolution of the council structure to ensure that the Shared Decision-Making Model, including staff input, ownership and accountability for practice and the work environment, is fully realized.
10 Nursing Notes PATIENT CARE SERVICES
12 Nursing Matters is published for nurses and other clinicians at Arkansas Children s Hospital 1 Children s Way, Little Rock, Arkansas July 2010 For career opportunities or more information visit us at or call (501)
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