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

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1 Excellence in Nursing It s not an event It s a Journey

2 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

3 The Journey 2004 Began 2010 Submitted 2011 Magnet designation 2015 Submitted for 2 nd designation 695 bed academic medical center 34,000 inpatient admissions each year Trauma Center, Inpatient and Outpatient services, Home Health, & Long Term Care

4 Nursing Structure CEO Chief Nurse (CNO) Director Nurse Manager Nurse Manager Charge Nurse Charge Nurse Charge Nurse Charge Nurse Director Nurse Manager Charge Nurse Charge Nurse

5 CNO & Nursing Directors

6 Nursing Excellence ANCC Magnet Model Need a roadmap for your journey

7

8 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)

9 Transformational Leadership Chief Nurse = Vision Excellence is o Not free o Not just about nursing o Strategic o A process = journey o Ongoing

10 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

11 The Future of Nursing Examined the Institute of Medicine s (IOM) eight recommendations 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

12 The Good The Bad & The Ugly Brutal Honesty with ourselves Gap Analysis = Magnet Standards Magnet Standard Evaluation 1 = Does not meet standard 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 2 = Partially meets standard 2 3 = Fully meets standard

13 Used Excel Spreadsheet

14 Benchmark & Pull Last 8 Quarters of Data

15 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?

16 Business Case example James A. Haley Veterans Hospital (2004)

17 Examples in the literature Drenkard, K. (2010). The business case for Magnet. Journal of Nursing Administration, 40(6), 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), Steinbinder, A. (2009). Bumps on the road to Magnet designation. Nursing Administration Quarterly, 33(2),

18 Executive Summary Breakdown of how many Sources of Evidence (SOEs) were scored 1 (does not meet standard) 2 (partially meets standard) 3 (Fully meets standard) Timeline to resolve 1s and 2s Plan to resolve deficiencies 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

19 Strategic Plan CNO held retreat with directors SWOT analysis Strategic Priorities Action Plan Example SWOT Analysis

20 Strategic Plan - Example Goal: 80% BSN by 2020 Method/Strategy: Evaluation Method: Target (Calendar/Fiscal Year): CY14 >44% Responsible Director:

21 Strategic Plan - Example Goal: 80% BSN by 2020 Method/Strategy: 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.)

22 Strategic Plan - Example Method/Strategy: 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 )

23 Strategic Plan - Example Evaluation 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

24

25 80% BSN by 2020 (Magnet = OO7)

26 Example Nursing Dashboard

27 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

28 Nursing Shared Governance

29 Nursing Professional Practice Framework

30 Nursing Satisfaction & Recognition Daisy Award Program Nurse s Week events & awards program Newspaper Ad Professional Recognition Program (Bonus Program) Fun events Development Programs

31

32 Build Excellence into your Electronic Medical Record

33 Excellence takes everyone in your entire hospital Interprofessional Collaboration is essential!

34 Last Thoughts.... 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

35 Keep Growing & Partner with Schools of Nursing Jacksonville University School of Nursing Online RN to BSN program Participate on Nursing Research Council at UF

36 Believe You ARE Excellent!

37 Who will be the first Magnet Hospital in Germany?

38 Special Thanks Franz Wagner & Helene Maucher for making this possible!

39 Questions? More Information? Roberta Christopher

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