Magnet Site Visit Preparation

2022 Magnet Site Visit Preparation

2022 Magnet Site Visit Preparation Transformational Leadership

Intention of Component Reflects Nursing’s mission, vision, values and strategic plan align with the organization’s priorities Nurses advocate for resources to support unit and organizational goals

How we do this at AtlantiCare

My notes

Our work is organized in the “5B” format • Refer to Strategy Map in badge holder • Look at your Unit Scorecard • Nursing Strategic Plan (attached) We advocate for resources in several ways: • Directly to whom we report to (clinical nurse to nurse manager) • Unit Based Forums • Shared governance council meetings • Committees, workgroups • Staff meetings CNO (Kathy Birkenstock) is a member of: • Quality Committee of Board of Trustees • Senior Leadership Team Examples of change: • Revised care delivery model - now called “Caring Model” • Co-lead pandemic response

The CNO influences organization- wide change beyond scope of nursing

Nurses lead effectively through change The CNO supports ongoing leadership development with a focus on mentoring and succession planning

• Pandemic • Oracle Cerner downtime

Leadership development programs: • Grows and Strides • Serving Leader • Pathways to Leadership • Foundations in Leadership • LEAN Green Belt Training

Nurse leaders (CNO, AVPs, Directors, Managers), with clinical nurse input, use trended data to acquire resources to support care delivery

Examples Trended Data Used Resources Acquired Fall rates Pig tails, chair and bed alarms Pressure injury rates Beds, Support surfaces Camera capture Mortality rate Precedex protocol Readmission committee 30 day readmission rates Readmission rates LACE tool High Risk model • Unit-level rounding • Nurse Advisory & Staffing Council (NAC) • “CNO Update” monthly email • CNO coffee talks • Violence prevention (signage, Broset, Security in ED, Tiger Texting reports)

The CNO uses various methods to communicate, be visible, and accessible to nurses Nurse leaders use input from clinical nurses to influence change in the organization

2022 Magnet Site Visit Preparation

2022 Magnet Site Visit Preparation

Structural Empowerment How we do this at AtlantiCare

Intention of Component Reflects Clinical Nurses are involved in interprofessional decision-making groups at organizational level

My notes

A few examples at AtlantiCare: Decision-making Group Patient Outcome Falls committee Injury falls rate HAPI committee HAPI stage 2+ Diabetes committee Hypoglycemia protocol A few examples: ONLNJ AWHON ENA ANA AACN AANP ANPD PNA AANA ONS activities (Rising Stars, Preceptor Class, PCI, clinical topics, simulation) • HealthStream • Nursing Reference Center on the Starfish • Conferences • Certification review • Nursing Professional Practice & Development Specialists provided

The organization supports nurses participation in professional organizations

The organization supports nurses’ professional development

Professional development activities provided to improve nursing practice and patient outcomes

Professional Development Activity

Patient Outcome

Falls HAPI

Injury falls rate HAPI stage 2+

Diabetes

Hypoglycemia protocol

CHG bathing

CLABSI

Nursing education is provided to those interested in a nursing career

• SAW & ECHO programs • Student clinical experiences • Mentors for PCAs • Hire student nurses as PCAs

Organization provides opportunities to improve nurses’ expertise in effectively teaching patients/families Organization facilitates the effective transition of RNs and APNs into the work environment Organization provides education to improve nurse expertise as a preceptor Nurses are recognized for their contributions in addressing strategic priorities of organization (Strategy Maps)

• HealthStream • Nursing Reference Center on Starfish • Krames embedded in EMR • Drug cards • Rising Stars – New Graduates • Nurse Manager Transition Program • APN Program • Preceptors and Mentors • Share the Success Bonus • Shinning Stars • Professional Nursing Ladder • Link with Lori, Starfish experience • Awards • Unit-level celebrations • Preceptor class • HealthStream courses

2022 Magnet Site Visit Preparation

AtlantiCare Strategic Priorities

2022 Magnet Site Visit Preparation

2022 Magnet Site Visit Preparation

Exemplary Professional Practice

Intention of Component Reflects Nurses are involved in development, implementation, evaluation of the Professional Practice Model (PPM) Unit level RN satisfaction data outperform the mean of national database used Nurses are involved in interprofessional practice to ensure care coordination Nurses incorporate regulatory, specialty standards, guidelines, professional organization standards of practice into care delivery

How we do this at AtlantiCare

My notes

See attached. We use the councils to evaluate and develop the PPM and clinical nurses implement.

We use Press Ganey (PG) survey

Huddles Boost Rounds Care Managers Nurse Navigators Hand off reporting Shift Report Nurses regularly review specialty standards & guidelines and incorporate them into policies, protocols, & guidelines. Some examples: Specialty Standard ARMC policy/protocol Am Diabetes Association (ADA) Hypoglycemia protocol CMS Guidelines Sepsis protocol American Heart Association (AHA) Acute Stroke guidelines Wound Scope and Standards Pressure Injury policy Some examples: • Professional Practice & Development • Wound Care Nurses • Infection Preventionists Staffing coordinators Unit-level meetings 3pm staffing huddle Supervisors Logistics & Patient Flow Department

Nurse use internal or external experts to improve clinical practice

Nurses are involved in staffing and scheduling to meet the needs of patient population Nurses use trended data in budgeting process with clinical nurse input to redistribute or obtain additional nursing resources

• FTEs • Patient volume/visits • Hours of Care • Unit-level activities • Interview potential staff •

Nurses participate in recruitment and retention

Nurse Staffing & Advisory Council (NAC)

Nurses lead or participate in interprofessional groups to improve care and implement patient education activities Professional literature is available to support decision-making Nurses engage in formal performance review that includes self-appraisal and peer feedback for professional development Nurse use available resources to address ethical issues related to clinical practice Workplace safety for nurses is evaluated and improved

• Falls committee HAPI committee • Sepsis committee VTE committee • VAP committee CAUTI/CLABSI • Many others

Nursing Reference Center Medical Library

We complete this process annually

Ethics committee Palliative Care Pastoral Care Providers Manager/Supervisor Violence Prevention Committee Risk Management

2022 Magnet Site Visit Preparation

The framework for AtlantiCare’s Nursing PPM includes Swanson’s Theory of Caring, evidence-based practice, research and our mission, vision, and values. Swanson’s Theory of Caring includes five caring processes: knowing, being with, doing for, enabling, and maintaining belief and when applied to nursing practice, stimulates the caregiver’s attitude and improves the overall patient well-being. ARMC nurses use the PPM components to describe how they practice, collaborate, and develop professionally. Components of the model include: • Ethical Practice Standards of Care • Shared Decision-Making Professional Practice • Healthy Work Environment Culture of Safety • Quality Outcomes Excellent Customer Experience • Life-Long Learning Interprofessional Collaboration • Culture of Caring The following are brief examples of how clinical nurses use the PPM (components of the PPM highlighted in red): 1. I implement fall precautions ( culture of safety and culture of caring ) to keep patients safe from harm. 2. I provided patient education on new medications ( excellent customer experience ). 3. I attend boost rounds and huddles ( interprofessional collaboration ). 4. When ethical concerns in clinical practice arise, the Ethics Committee, Palliative Care Team, Pastoral Care and other resources are available to assist in a resolution ( Ethical Practice ). 5. Pressure injury prevention strategies are implemented according to the standards of care in the policy. 6. I chair of my unit-based forum ( shared decision-making ). 7. I am a member of the Violence Prevention Committee ( healthy work environment ). 8. I am the unit’s CAUTI Champion; our rate has improved over the last year ( quality outcomes ). 9. I am a certified ED Nurse (CEN) and received tuition reimbursement to get my BSN ( life-long learning ). 10. Continuing education and skill competencies are assessed to ensure quality patient care ( professional practice ).

2022 Magnet Site Visit Preparation

2022 Magnet Site Visit Preparation Care Delivery Models

What is a Care Delivery Model? A structured system for work assignments, responsibilities, and authority to provide patient care. The four classic nursing care delivery models are: 1. Total patient care- a nurse provides total care to a patient or group of patients during his/her shift 2. Functional nursing- task-oriented as it involves giving a particular nursing function to each worker 3. Team nursing- groups of professional and non- professional nursing personnel work together to identify, plan, implement and evaluate comprehensive patient-centered care 4. Primary nursing – a nurse provides care for a patient during the entire hospital stay or episode of care Units that use the functional nursing model are the operating rooms, PACUs, and procedural units. Intensive care units generally use the Team model. AtlantiCare uses functional and team models depending on the unit or department where nurses provide care. In 2019, clinical nurses revised the care delivery model called the “ Caring Model ” and implemented it on medical and surgical, telemetry, PCU, RCU, and obstetrics units. The Caring model combines total patient care and team nursing to deliver patient care utilizing the following staff: • The Caring Nurse Leader • The Flex Nurse • The Clinical Nurse

• Patient Care Associate • Administrative Associate • Clinical Manager

2022 Magnet Site Visit Preparation New Knowledge, Innovations, and Improvements

Intention of Component Reflects

How we do this at AtlantiCare

My notes

The organization supports the advancement of nursing research

The shared governance council structure includes an EBP and Research council to guide and approve research studies Nurses are voting members on the IRB Nurses disseminate research findings at: Unit-level meetings UBF Committees Councils Conferences Nursing journals We train nurses to trained to evaluate the literature to find EBP Policies are supported with evidence (references) Nurses initiate and are included in the design and implementation of innovation: Covid-19 patient care such as windows, IPads, baby monitors, ventilators outside rooms ESA app for symptom and well-being screening, and scheduling vaccinations The shared governance council structure includes Clinical Practice and Informatics Council Education is evidence-based

Nurses disseminate the findings from the organization’s completed nursing research studies to internal and external audiences

Clinical nurses evaluate and use evidence- based findings in their practice

Innovation in nursing is encouraged and supported

Nurses are involved with the design and implementation of technology to enhance the patient experience and nursing practice.

IT Ninjas

Nurse Informaticists

Nurses are involved with the design and implementation of workflow improvements and space design to enhance nursing practice.

Nurses have input into the design of workflow: Caring Project Unit safety design