Exemplary Professional Practice
Download
Report
Transcript Exemplary Professional Practice
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 practice
Requires values clarification
Foundational 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 Model
Safe and Ethical Practice
Autonomous Practice
Quality Processes
Exemplary Professional Practice
Nine subcomponents of EP
Professional Practice Model
Care Delivery System
Staffing, Scheduling & Budgeting Process
Interdisciplinary Care
Accountability, Competence & Autonomy
Ethics, Privacy, Security, & Confidentiality
Diversity & Workplace Advocacy
Culture 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
Nurses’ authority is clear
How care is delivered
Skill set required
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
Exemplary Professional Practice
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
Assignments ensure continuity, quality &
effectiveness
Good hand off communication (use of tool)
Beside nurses should have resources 24/7
Use 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
Exemplary Professional Practice
Autonomy
Right to exercise clinical and organizational judgment within an
interdependent team in accordance with nursing discipline
Control over nursing 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 Safety
Proactive assessment & approach
Prevent injuries
Innovate
Safety initiatives incorporate national best practices
Based on standards such as ANA’s Safe Patient
Handling and Movement
Sufficient resources are available to respond to safety
initiatives
Facility-wide approach
Measure improvements in nurse workplace safety
Exemplary Professional Practice
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
Quality Care Monitoring & Improvement
Nurses at all levels analyze data and use national
benchmarks
Action plans are developed that lead to systematic
improvements
Resources 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
Exemplary Professional Practice
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
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 EP
Professional Practice Model
Care Delivery System
Staffing, Scheduling & Budgeting Process
Interdisciplinary Care
Accountability, Competence & Autonomy
Ethics, Privacy, Security, & Confidentiality
Diversity & Workplace Advocacy
Culture of Safety
Quality Care Monitoring & Improvement
Exemplary Professional Practice
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
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). RelationshipBased Care Leadership Practicum. Minneapolis, MN
http://www.nursecredentialing.org/Documents/Magnet/
2008-Manual-Updates.aspx