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magnet component #3:exemplary professional practice
Ronald Reagan UCLA Medical Center Magnet Recognition Handbook AN OVERVIEW OF RRUCLA NURSING EXCELLENCE & OUR JOURNEY TO MAGNET RE-DESIGNATION 2015 RRUCLAMC 2015 Magnet Recognition Handbook Table of Contents What is Magnet? - Background Magnet Components & Magnet Document Highlights Transformational Leadership – – Nursing Strategic Plan – Advocacy and Influence – Visibility, Accessibility, and Communication Structural Empowerment – – Professional Development – Interprofessional Involvement – Professional Development – RNs Involved in Professional organizations – Degree and Certification Goals – Teaching and Role Development – Commitment to Community Involvement – Recognition of Nursing – UPC Accomplishments Exemplary Professional Practice – – Professional Practice Model – Care Delivery System – Staffing Scheduling, & Budget Processes – Interprofessional Care – Accountability, Autonomy, & Competency – Ethics, Privacy, Security, and Confidentiality – Culture of Safety – Quality of care Monitoring and Nurse Sensitive Indicators New Knowledge, Innovations, and Improvement – Research – Evidence-Based Practice and Innovation Access to Online Resources RRUCLAMC Magnet Champion Contact Information Path to Prepare for Site Visit – aka “The 12 P’s” A Few More Quick Tips for the Appraiser Interview… Magnet Cart Rounds – Coming to your unit soon! Page # 3 4-22 4-7 4 5-6 6-7 8-13 8 8 9-10 10-11 11 12 13 14-20 14 15-16 16 17 17-18 18 19 20 21-22 21 22 23 24-25 26 27 28 What is Magnet? The Magnet Recognition Program® is the gold standard in measuring a healthcare organization’s nursing excellence. Magnet as we know it today is the culmination of over 30 years of research initiated by Nurse Scientist Margaret L. McClure, RN, EdD, FAAN and the American Academy of Nursing (AAN) in response to a nation-wide nursing shortage in the early 1980s. McClure studied the practice environments of hospitals that were able to successfully attract and retain nurses during this critical time, teaming with the AAN to identify similar qualities shared by these organizations, which they named the “14 Forces of Magnetism,” later refined to the “5 Magnet Components” we recognize today: COMPONENTS OF MAGNET Based on this ever-evolving research, the American Nurses Credentialing Center (ANCC) periodically updates their rigorous Magnet Recognition Program® requirements based upon emerging evidence and healthcare trends, shaping the advancement of successful nursing practice. Most recently, the ANCC updated their requirements in the 2014 Magnet Manual, requiring 49 exemplary examples of nursing excellence or “Sources of Evidence (SOE)”. These SOEs provide nurses with an opportunity to demonstrate how their organization meets the Magnet standards. In fact, RRUCLA is one of the first re-designating hospitals to submit a document using the 2014 Magnet Manual! Why is Magnet Recognition Important? Magnet status is the highest honor awarded by the ANCC and recognizes RRUCLA nurses’ ability to provide quality patient care and to initiate innovations in their professional nursing practice. It ensures that UCLA is able to attract and retain the highest level of nursing professionals to provide excellent patient care. As the public grows increasingly medically savvy, they rely on Magnet® designation as an important indication of quality patient care when choosing healthcare providers. The Magnet Recognition Program® advances 3 goals within health care organizations: 1. Promote quality in a setting that supports professional practice 2. Identify excellence in the delivery of nursing services to patients and families 3. Disseminate best practices in nursing care You can access the Ronald Reagan UCLA Medical Center 2015 Magnet Redesignation Document by logging on to the UCLA Health Nursing website at http://nursing.uclahealth.org/body.cfm?id=215 3 MAGNET COMPONENT #1: TRANSFORMATIONAL LEADERSHIP Nursing Strategic Plan Magnet Standard: Nursing’s mission, vision, values and strategic plan align with UCLA Health’s priorities to improve performance. RRUCLA Evidence: The Department of Nursing shares the mission, vision, and values of UCLA Health: MISSION: VISION: VALUES: To deliver leading edge patient care, research, and education. Healing humankind, one patient at a time, by improving health, alleviating suffering, and delivering acts of kindness. Integrity, Compassion, Respect, Teamwork, Excellence, and Discovery. Similarly, the Department of Nursing Strategic Plan is aligned with the UCLA Health Strategic Plan. The Nursing Strategic Plan is updated annually at the Nursing Strategic Planning Retreat led by Chief Nursing Officer Heidi Crooks, MA, RN. Here, nurse executives, unit directors, and clinical nurses collaborate to ensure contributions from all practice areas and service lines are included. Unit-level goals are then created using the Nursing Strategic Plan as a guide, thus providing an aligned vision and continuity across the organization. Access the RRUCLA Evidence: Please view the UCLA Health Strategic Plan and the UCLA Nursing Strategic Plan by visiting the UCLA Nursing website: http://nursing.uclahealth.org/body.cfm?id=216 You can also read more in the Magnet Document about how the UCLA Health Nursing Strategic Plan is utilized to influence and guide nursing practice in the following SOEs: NURSING STRATEGIC PLAN - TL1EO Enhancing the Practice Environment in Order to Reduce Nursing Turnover Partnering to Decrease Sepsis Mortality Health System Nursing Admin Health System Nursing Admin QMS Overhead ADVOCATING RESOURCES - TL2 Clinical Nurse Specialists Advocate for Specialty Surgical Surfaces Nurse Residents Advocate for Products to Support Infection Prevention 4 Float/Resource Finance NRE 4ICU 7ICU 8W Entersomal Therapy OR Admin 8ICU TPN Services MAGNET COMPONENT #1: TRANSFORMATIONAL LEADERSHIP Advocacy & Influence Magnet Standard: At RRUCLA, a strong trust exists between the CNO, nursing directors, and clinical nurses. Nurses are empowered to advocate for the needs of patients and families, and nursing leaders use their influence to ensure that these needs are met. RRUCLA Evidence: Chief Nursing Officer Heidi Crooks, MA, RN, nursing leaders, and clinical nurses serve on hospital committees to advocate for resources that ensure that nurses have the best practice environment to care for patients. Through unit practice councils, hospital committees, and other structures, clinical nurses and nurse leaders have worked together to advocate for improvement. All efforts led to safer care for our patients and families! Access the RRUCLA Evidence: The great successes of RRUCLA nurses’ advocacy and influence are highlighted in the Magnet document and include the following SOEs: CNO INVOLVEMENT IN ORGANIZATIONAL INFLUENCE - TL3 CNO-Led Successful Implementation of SafeHandling & Mobility Program Health System Redesigning for the Future of UCLA Health: The CNO’s Strategic Role Nursing Admin Emergency Dept NRE 6ICU 6N Anesthesiology Data Respository Speech Clinic Performance Excellence Anesthesiology Compliance, Privacy, & Security DOM Enterprises Admin Family Medicine NPI Path & Lab Med Peds PT/OT Admin CNO INVOLVEMENT IN ORGANIZATIONAL DECISION-MAKING - TL4 Selection, Planning, & Implementation of a Fully Integrated Electronic Health Record: The CNO’s Strategic Role NURSE LEADERS GUIDING CHANGE - TL5 Leading Through Emergent and Unplanned Change – Sigma Pump Functionality Challenge 4ICU 6E Nursing Admin Implementation of a Bedside Report Practice Change on Inpatient Units RRUCLA Nursing Admin 7W 5 Neurosurgery Nutrition Operations Ambulatory Physcian Support PT/OT Inpatient Risk Mngt Social Work Pharmacy Radiation Oncology Procurement & Strategic Sourcing Nursing Admin Surgery Urology Clinical System Team EMR Physician Support 7E/5E 7W MAGNET COMPONENT #1: TRANSFORMATIONAL LEADERSHIP DEVELOPING LEADERS - TL6 Mentoring and Succession Planning for Clinical Nurses: Professional Role-Based Coach Program Mentoring and Succession Planning for Nurse Managers: Succession Planning Program Health System External Consultant Nursing Admin 7E/5E Nursing Admin Labor & Delivery 7W MOU 8W NICU Float/Resource PICC Radiology Nursing Admin Materials MGMT 7ICU IR Radiology Anesthesiology Operations Disaster Resource Operative Services Center Division of Infectious Performance Disease Excellence Emergency Resnick Outpatient Department, System Programs GIM & HSR RR General Surgery HR Operations & Staff Office of the Patient Develop Experience Health System Nursing Admin Mentoring and Succession Planning for Nurse Leaders: UCLA Health System Leadership Academy Mentoring and Succession Planning for the Chief Nursing Officer: CNO Succession Planning DATA DRIVEN RESOURCING - TL7 Trended Fall Data Leads to Acquisition of Low Beds 8N Nursing Admin Enterostomal Therapy Nursing System Materials MGMT Procurement & Strategic Sourcing Visibility, Accessibility, & Communication Magnet Standard: Nurse leaders are available to clinical nurses and are open to hearing nurses’ views and concerns. Nurse leaders and clinical nurses work collaboratively to make decisions in the best interest of our patients, their families, and our nurses. RRUCLA Evidence: Heidi Crooks, CNO and the directors of nursing have brown bag sessions, attend various unit meetings, and have open-door policies to hear concerns. Through these venues, the nursing directors and CNO have advocated for practice changes. Access the RRUCLA Evidence: Read more about the efforts of nurse leaders to increase their visibility and to serve as advocates and role models for clinical nurses, patients, and families in the following SOEs: 6 MAGNET COMPONENT #1: TRANSFORMATIONAL LEADERSHIP CNO VISIBILITY AND ACCESSIBILITY - TL8 Clinical Nurse Advocacy for Patient Safety Around the Hospital 6E OR Enterprises OR Admin Admin 5E 6E 6N 6W 7E 8N NPH Emergency Dept. NICU Ambulatory Ensuring Clinical Nurse Competency INFLUENCING CHANGE - TL9EO Addition of Pediatric NPs in Response to Nurse Concerns about Quality & Safety in the PICU Operations Nursing Admin HR NRE PICU OR Nurse Recruitment Peds Nursing Admin PICU 7E/5E Internal Medicine 7W Nursing Admin 8ICU Operations Care Coordination Risk Management Pt Liaison Program Pt Placement & Transfer Ctr Emergency Preparedness, Safety, and Security Creation of a Multidisciplinary Toolkit for Management of Escalating Patient Behaviors in Response to Clinical Nurse Concerns about Safety and Quality of Care 7 MAGNET COMPONENT #2: STRUCTURAL EMPOWERMENT Interprofessional Involvement Magnet Standard: The UCLA Health Department of Nursing supports the continuous professional development of our nurses. UCLA Health nurses serve in leadership roles on interprofessional councils and participate in decision-making that improves care for patients. RRUCLA Evidence: UCLA Health supports structures and processes that ensure nurses from all settings and roles actively participate in organizational decision-making groups such as councils, committees, and performance excellence teams. Nurse representatives serve on the Ethics Committee, Pharmacy and Therapeutics Committee, Clinical Effectiveness Committee, and a variety of other quality committees. Nurses volunteer, apply, or are appointed to decision-making groups and serve in various roles on the groups, including group leader or chair of the committee. Nurses’ participation on these committees has led to improved patient outcomes and safer practices throughout UCLA Health. Access the RRUCLA Evidence: Read more about the work on interprofessional committees in the following SOEs: INTERPROFESSIONAL DECISION-MAKING GROUPS - SE1EO Improving the Care of Stroke Patients Ensuring Safe Access to Blood Products 6ICU Neurosurgery 6N ED Pharmacy PT/OT Admin-MP SMH Radiology 7ICU Emergency Dept 8ICU Labor & Delivery Emergency Med QMS Overhead Neurology Nurses Involved in Professional Organizations Magnet Standard: UCLA Health nurses are involved with professional organizations that help to shape practice and facilitate evidence-based change. RRUCLA Evidence: Many UCLA Health nurses are members of professional nursing organizations. Some examples include the American Association of Critical Care Nurses (AACN), the Emergency Nurses Association (ENA), and the American Organization of Nurse Executives. UCLA Health nurses utilize professional nursing organization standards to improve clinical practice and patient outcomes at UCLA. Access the RRUCLA Evidence: Read more about UCLA Health nurses’ involvement with professional organizations has helped improve delivery of care: PROFESSIONAL ORGANIZATION PARTICIPATION - SE2EO Use of ASORN Guidelines to Improve Surgical Site Markings JSEI OR Improving Delirium Assessment in the Neurotrauma ICU Based on AACN Recommendations 6ICU Neurosurgery 8 JSEI Pre/Post OP Unit NRE MAGNET COMPONENT #2: STRUCTURAL EMPOWERMENT Degree & Certification Goals Magnet Standard: The RRUCLA Department of Nursing is committed to supporting and facilitating the educational and professional development of our nursing staff. RRUCLA Evidence: RRUCLA nursing has set a strategic goal and has a plan to ensure that 80% of our nurses have a BSN or higher nursing degree by the year 2020, in alignment with the IOM/RWJF Future of Nursing Recommendations. % of RNs with BSN or Higher Degree Percentage of RNs 74% 72% 70% 68% 66% 64% 62% 60% 2012 2013 2014 % of RNs with BSN+ 63% 67% 73% Target 63% 66% 68% UCLA Health has supported nurses’ professional development by working to increase professional certification. We are happy to report that in 2014, our number of Certified RNs reached 738, 62 more than our goal! Professional Nursing Certification 2011-2014 # of certifications 800 600 400 200 0 Baseline 2011 2012 2013 2014 Certified Nurses, Overall 439 478 564 610 738 Organization Goal (whole number) 400 450 525 600 676 Access the RRUCLA Evidence: Read more about the efforts to increase education and certifications for nurses in the following SOEs: PROFESSIONAL NURSING CERTIFICATION - SE3EO Increasing Professional Nursing Certification at the Organizational Level Increasing Professional Nursing Certification at the Unit Level NRE NRE 9 Peds MAGNET COMPONENT #2: STRUCTURAL EMPOWERMENT CONTINUING EDUCATION PROGRAMS - SE4EO Improving Referrals to Palliative Care in the ICU through Education Use of a Structured Infection Prevention Program to Decrease Rates of CLABSI 4ICU 4ICU 6E 6ICU 7E/5E 7ICU NRE 7N 7W 8ICU 8N 8W Nursing Admin NON-NURSE CAREER PROGRAMS - SE5 Community Partnership with King Drew Magnet High School of Medicine and Science PEDS PICU NICU Dialysis Float pool Infection Control Nursing Admin 8W Cardiology Peds IR Radiology ED GOU/4ICU Pt Escort Service Surgery - Recovery - MP 6ICU 6N 7E/5E Teaching & Role Development Magnet Standard: UCLA Health nurses recognize the important role we play in ensuring that patients understand their health. RRUCLA Evidence: UCLA nurses use evidence-based teaching strategies to engage patients in their health. Nurses serve in leadership roles on the Patient Engagement Committee and have provided feedback about teaching tools in CareConnect, including discharge and medication teaching resources. Across the organization, nurses have led efforts to standardize teach-back strategies in order to ensure that patients understand information about their health, hospitalization, medications, and discharge plans. Teaching & Professional Role Development At UCLA Health, nurses never stop learning. The UCLA Health Department of Nursing Research and Education (NRE) has established an infrastructure to provide nurses across the health system with opportunities for lifelong professional growth. Educational and professional development programs are structured to best meet the unique needs of our clinical nurses and to support them in their efforts to ensure consistently high quality care for our patients and their families. Classes are designed to provide current clinical and professional nursing content and are delivered using evidence-based teaching/learning strategies. Access the RRUCLA Evidence: Read more about the efforts of nurses to increase education and to serve as role models for their patients, families, and next generation of nurses in the following SOEs: 10 MAGNET COMPONENT #2: STRUCTURAL EMPOWERMENT NURSES AS TEACHERS - SE6 Teach-Back Educational Summit and Meducation Toolkit to improve nurses’ expertise in patient and family teaching 7CCU 7W NRE DOM ED TPN Services CONTINUING EDUCATION PROGRAMS - SE7 Onboarding & Orientation of Newly Hired Experienced Nurses Onboarding & Orientation of New Graduate Nurses HR Recruitment NRE NRE Growing Expert Preceptors through a Standardized Preceptor Program Labor and Delivery NRE Diabetic Services Nursing Admin HR Operations Personnel DEVELOPING NURSE PRECEPTORS - SE8 Commitment to Community Involvement Magnet Standard: UCLA Health nurses are committed to improving the health of both our local and international communities, and they are responsible for leading and supporting efforts to ensure all people are provided the best healthcare possible. RRUCLA Evidence: UCLA nurses have taken leadership and volunteer roles in over 100 community organizations. In these organizations, our nurses work tirelessly to provide leading-edge patient care and to facilitate an improved quality of life for individuals in our community. Access the RRUCLA Evidence Read more about the efforts of nurses to serve our local & international community in the following SOEs: COMMUNITY OUTREACH - SE9 UCLA Nurses Respond to Typhoon Haiyan Pt Relations PACU 6E HR Clinical System Team Materials Mgmt UCLA RN Orchestrates 27th Annual Oley Foundation Conference PICC RADIOLOGY TPN Services Enterostomal Therapy 6ICU PEDS COMMUNITY HEALTHCARE NEEDS ASSESSMENT - SE10EO Facilitating a Camp Experience for Children with Heart Disease: The Camp Del Corazon Experience Catheterization Lab Float Pool 11 GONDA PEDS Resource Team 7E/5E MAGNET COMPONENT #2: STRUCTURAL EMPOWERMENT Recognition of Nursing Magnet Standard: Nurses are valued and recognized at UCLA Health. RRUCLA Evidence: At UCLA Health, outstanding nurses are recognized for their contributions to our vision of healing humankind, one patient at a time. Nurses are recognized as individuals for exemplary performance, as well as in teams demonstrating high levels of collegial support and collaboration to achieve extraordinary results. One program that enables us to appreciate both individuals and teams for their contributions to our strategic priorities and mission at UCLA Health is the biannual DAISY Award Program. Patients, family members, and health system employees may nominate nurses for a DAISY Award. Nomination forms are available on all inpatient units and clinics for anyone to complete, and are collected by the Human Resources Department. Manager of Nurse Recruitment Sheri Monsein, MN, RN, was instrumental in initiating the DAISY Award Program at UCLA Health and continues to administer the program. It is a key component of our strategy for recruitment and retention of excellent nurses. Access the RRUCLA Evidence: Read More about UCLA Health’s recognition and celebration of our outstanding nurses in the following SOEs: Recognition of a Clinical Nurse Recognition of a Group of Nurses RECOGNING NURSES - SE11 SON PICU 6W 5E OB 7E/5EMS Nurse Recruitment Nurse Recruitment 8N Nursing Admin 7ICU Nursing Admin 2014 Daisy Award Winner Maxine Pintado, RN, being honored by Director of Inpatient Nursing Cathy Ward, DNSc, RN, and Chief Nursing Officer Heidi Crooks, MA, RN 12 MAGNET COMPONENT #2: STRUCTURAL EMPOWERMENT RRUCLA Unit Practice Council Accomplishments The Unit Practice Councils and the subcommittees of the Nursing Quality Outcomes Council, led by Nurse Subject Matter Experts, can be proud of their accomplishments this past year: Unit UPC Initiative Outcomes Main OR Practice change to improve communication during Patient Handovers Safer Handovers; ↑ medication safety compliance; ↑ teamwork at handover Emergency Depart. Security Improvements Enhancement of Patient & Provider Safety MICU Teach Back Initiative Reached 73 Percentile in HCAHPS: “RN explained things in a way you could understand.” Peds Bug Buster Committee efforts, including 2 RN Dressing Changes 170 days without a CLABSI 5E OB OFRAS Tool Development • Improved OB fall rate • Tool disseminated nationally NICU Improving Turnaround Time for the First Dose of in Antibiotic in the NICU PICU Nurse Rounding Script 6 East Medication Teaching Cards 6ICU New change of shift visitation guidelines to include family members 6 North Patient Falls Initiative 6 West Implemented Green Apple Project Role-Based Practice Quality Improvement Champions Program initiated “Home is Where the Heart Is” Discharge Teaching Handbook Communication Workshops, Crucial Conversation Skills Collaborative Teamwork with Fall Prevention Toileting Program 7E/5E MS 7ICU 7CCU 7 West rd 7COU 5 Minute Time Out 8 East Transforming Tragedy to a Safe Practice Change Opportunity: Icodextrin Protocol 8ICU CUSP Initiative to reduce CLABSI 8 North Modified Floating Policy in January 2013 8 West HAPU Prevention GOU ‘Always’ Project Cath Lab MD-RN Verbal callback with medications during procedures st ↑ Percentage of patients that received their 1 dose of an antibiotic within an hour ↑ in Parent Satisfaction “RN Discussed Plan of Care Daily” Scores • Received Joint Commission recognition as Best Practice th • HCAHPS - Reached 90 %ile for Medication Communication th Reached 90 %ile for HCAHPS question: “RN explained things in a way you could understand.” Decrease in Patient Injury Falls: 9 Months with 0 Falls with Injury Improved glucose control in diabetic patients Reduction in CLABSIs th Above 70 %ile for HCAHPS Medication Communication for 2013 Improvement in RN-RN Communication, Interdisciplinary Communication, & RN-Patient Communication on Unit • 4 Months without a Bathroom related fall! • 7 Months with 0 Falls with Injury Improved HCAHPS Score: “Treated with Courtesy and Respect” from 80% → 91% • 100% Compliance with new Icodextrin Protocol; 0 Icodextrin Events since implemented Overall reduction in CLABSI rates; 0 CLABSI occurrences in Jan. 2014 Increase in primary nursing/continuity of care Hospital Acquired Pressure Ulcers for 4 Months; ↑HCAHPS Scores ↑in RN teach-back protocol knowledge and compliance, ↑in patient satisfaction Improved RN-MD communication, increased patient safety 13 MAGNET COMPONENT #3: EXEMPLARY PROFESSIONAL PRACTICE Professional Practice Model Magnet Standard: Nurses at UCLA Health own and live the Professional Practice Model to drive the work of nursing forward for our patients, families, community, and the organization. RRUCLA Evidence: The Professional Practice Model (PPM) at UCLA Health is exemplary because it was conceived and advanced over time through the collaborative efforts of clinical nurses and their nurse leaders utilizing the Professional Role Development Strategic Initiative. The purpose of this Initiative is to strengthen RN professional role autonomy and decision-making authority, ensuring empowerment is lived and experienced by all registered nurses at UCLA. Access the RRUCLA Evidence: Read more about RRUCLA’s Professional Practice Model and how our outstanding nurses utilize the PPM to advance nursing practice in the following SOEs: PROFESSIONAL PRACTICE MODEL - EP1 Evaluation of the Professional Practice Model Nursing Admin 7E/5EMS Using the PPM to Implement a Teamwork-Based Care Delivery Model on 7W 7W Nurse Satisfaction Survey Overview All Units RESULTS OF THE PROFESSIONAL PRACTICE MODEL - EP2EO NURSE SATISFACTION DATA - EP3EO 14 MAGNET COMPONENT #3: EXEMPLARY PROFESSIONAL PRACTICE Care Delivery System Magnet Standard: RRUCLA nurses are guided by the UCLA Health Department of Nursing’s Professional Practice Model, our organizational vision, and the relationship-based care delivery model to create partnerships with patients and their families. Nurses strive to understand each patient as a unique person with individualized goals and preferences. Further, in order to ensure continuity of care, nurses document these specific needs in CareConnect. The “patient story” screen enables nurses to capture information that is meaningful to the patient and facilitates a context for patient and family partnership with clinicians. RRUCLA Evidence: UCLA Health’s Care Delivery System is Relationship-Based Care (RBC). Key elements of RBC include: • • • • • • Professional nursing practice is patient-centered; all decisions are centered around the unique needs of our patients and their families. Interprofessional communication and teamwork is incorporated into care delivery on behalf of the patient. The patient and the patient’s family are seen as persons (body, mind, and spirit) by all care providers. Careful scheduling of patient assignments allows for continuity of care. “Care of self” is important to maintain optimum health. This fosters empathy for the experience of others and for being a productive member of the nursing care team. Nurses know that each person’s unique life story determines how he or she will experience an illness. Access the RRUCLA Evidence: Read more about RRUCLA’s care delivery model and about how our outstanding nurses utilize RBC to improve patient outcomes in the following SOEs: ESTABLISHING A PLAN OF CARE - EP4 Nurse as Patient – Providing Individualized Care to a Colleague Ensuring Optimal Care for Peds Patients Across the Continuum of Care 4ICU ED Peds Care Coordination for Liver Transplant Patients 8N Care Coordination for Aortic Repair Patients UCLA Aortic Center INTERPROFESSIONAL COLLABORATION - EP5 8ICU REGULATORY & PROFESSIONAL STANDARDS - EP6 Incorporating Vascular Access Standards into Care 7E/5E Case Management GOU ED STANDARDS OF CARE AND PRACTICE - EP7EO Using AWHONN and Baby-Friendly Standards to Enhance Skin-to-Skin Initiation After Vaginal Births 15 5E OB L&D PICU CCTT NRE SIM LAB MAGNET COMPONENT #3: EXEMPLARY PROFESSIONAL PRACTICE INTERNAL EXPERTS - EP8EO Internal Consultant facilitates reduction in adverse glycemic events: The Green Apple Project 6W 7E 7E/5E 7W 8N Diabetes Services Nursing Admin Pharmacy Staffing, Scheduling, & Budgeting Processes Magnet Standard: The acuity and care needs of patients on the unit, along with the skill-mix of clinicians, affect staffing decisions. Working together, nurse leaders and clinical nurses have developed staffing plans that strategically allocate staff resources to meet the needs of their patient population. RRUCLA Evidence: Clinical nurses are empowered to adjust RN and support staff assignments/schedules to best adapt to changes in patient and environmental conditions while maintaining the quality of care. Further, through the work of the UPC and other shared governance structures, clinical nurses are empowered and encouraged to utilize trended data gathered on their unit to influence budgetary spending and allocation of resources. Nurses participate in staffing and scheduling: o Acuity ratings are documented for each patient every shift o Lead nurses consult with clinical nurses regarding staffing needs o Clinical nurses participate in self-scheduling Nurses participate in recruitment & retention: o Participation in hiring interviews o Mentorship to novice nurses Nurses participate in budgetary data analysis: o Trended data is used to influence budget allocation decisions o Lead nurses consult with clinical nurses regarding staffing needs Access the RRUCLA Evidence: Read more about how RRUCLA’s nurses are empowered to influence staffing, scheduling, and budgeting needs in the following SOEs: STAFFING/SCHEDULING PARTICIPATION - EP9 CTICU Nurse Advocates for Resources to Meet Acuity Demands NICU Clinical Nurse Advocates for Resources for Detriorating Neonate 7ICU NICU Operating Room Clinical Nurses Shift Start Times to Provide Adequate Staffing Creation of a Nurse-led Volunteer Companion Program to Subsitute for Constant Observation Aides OR Clinical Advancement Program for PICU Nurses PICU BUDGET DATA ANALYSIS - EP10 Nursing Admin Peds RECRUITMENT & RETENTION - EP11EO 16 MAGNET COMPONENT #3: EXEMPLARY PROFESSIONAL PRACTICE Interprofessional Care Magnet Standard: At UCLA Health, healthcare providers recognize their role as a vital component of their patient’s interprofessional healthcare team. RRUCLA Evidence: For RRUCLA physicians, nurses, administrative and clinical care partners, social workers, and therapists, collaboration is the key to positive patient outcomes. From participation on hospital- and system-wide interprofessional committees to multidisciplinary care at the patient’s bedside, interprofessional care teams are united in their shared goal of, “Healing humankind, one patient at a time.” Access the RRUCLA Evidence: Read more about how nurses at RRUCLA are a vital part of the interprofessional team in the following SOEs: NURSING LEADERSHIP ROLES - EP12 Transitioning Patients from the OR to Cardio-Thoracic ICU: An Interprofessional Standardized Handover 7ICU Anesthesiology PATIENT EDUCATION PROGRAMS - EP13EO Colorectal Surgery Education for Patients Infection Control Enterostomal Therapy Hemapheresis QMS Overhead Anesthesiology Sterile Processing 8E 8N OR Admin PERIOP 8W SOM OR PEDS Urology Surgery DOM Pharmacy Accountability, Autonomy, & Competency Magnet Standard: Accountability, autonomy, and competency assurance are essential to achieving and maintaining the highest level of professional nursing care. Structures and processes are in place to ensure that all healthcare providers are held accountable for their work. RRUCLA Evidence: Competencies are assessed annually for all UCLA Health employees. These competency assessments are combined with self-appraisal and peer feedback to provide a transparent, 360◦ performance evaluation. Clinical nurses are thereby empowered to use their clinical expertise to advocate for patients and families, in the same way that nurse leaders advocate on behalf of their clinical nurses, and that CNO Heidi Crooks advocates for nurses and nursing practice across the health system. Access the RRUCLA Evidence: Read more about the accountability, autonomy, and competency of nurses at RRUCLA in the following SOEs: 17 MAGNET COMPONENT #3: EXEMPLARY PROFESSIONAL PRACTICE RESOURCES FOR AUTONOMOUS PRACTICE - EP14 Nurse-Driven Skin and Wound Care Practices Early Mobility in the Medical ICU Enterostomal Therapy PICU 4ICU Nursing Self-Appraisal and Peer Feedback Promote Professional Development for Clinical Nurses Nursing Self-Appraisal and Peer Feedback Promote Professional Development for Nurse Leaders 7W NRE 7W NRE PERFORMANCE & PEER REVIEW - EP15 NURSING AUTONOMY - EP16 Autonomous Nursing Practice in Complex Care Coordination Autonomous Nursing Practice in Neonatal End-of-Life Care Children's Heart Center Clinical Nutrition Social Work NNP Program L&D Respiratory Therapy NICU Spiritual Care Peds Ethics, Privacy, Security, and Confidentiality Magnet Standard: At UCLA Health, nurses are guided by the ANA Code of Ethics in their care delivery. RRUCLA Evidence: There are many resources available to clinical nurses and nurse leaders to help to guide this component of their professional practice, including: • UCLA Ethics Center, which provides 24-hour consultation for ethicsrelated matters • Clinical nurses participation on the UCLA Ethics Committee • Ethics Grand Rounds • Circle of Caring Retreat • Annual training on policies and procedures around confidentiality • The UCLA Privacy Management Office, which monitors patient privacy and compliance Access the RRUCLA Evidence: Read more about the ethics, privacy, security, and confidentiality practices of UCLA Health in the following SOE: ETHICAL ISSUES - EP17 Ethics Center Services Support and Develop Ethical Nursing Practice Ethics Center NICU Culture of Safety 18 NRE MAGNET COMPONENT #3: EXEMPLARY PROFESSIONAL PRACTICE Magnet Standard: At UCLA Health, the safety of our patients and our healthcare personnel is of the utmost concern. RRUCLA Evidence: There are many resources available to clinical nurses and nurse leaders to help safeguard the health and well-being of patients, families, and health system employees. Several successful safety interventions have been initiated by clinical nurses throughout RRUCLA. Access the RRUCLA Evidence: Read more about RRUCLA’s culture of safety practices in the following SOEs: WORKPLACE SAFETY - EP18EO Reducing Needlestick Injuries through Standardization of Safety Needles Improving Nurse Safety in the Emergency Department by Targeting Workplace Violence 4ICU Enterostomal Therapy 6E Infection Control 6N Materials mgmt 7E/5E TPN Services 7ICU Occupational Health 7N PT/OT Inpatient 8ICU Respiratory Therapy OR Admin Procurement & Strategic Sourcing PICU ED Nursing Admin Security Department PROACTIVE RISK MANAGEMENT - EP19EO Nurses improve Safety by Reducing Medication Errors 6N 6E 6W 7E 8W 8ICU 8N 7E/5E PEDS 7W Diabetic Services Nursing Admin ED Anesthesiology IT Help Desk EVALUATING PATIENT SAFETY DATA - EP20EO Implementation of the ‘Bug Busters’ Committee on Acute Care Pediatrics Implementation of SBAR Standardized Practice to Reduce Time to Transport by the CCTT Infection Control Peds NRE Critical Care Transport Team Nurses Leading Improvement in Medication Labeling and Communication in Perioperative Settings OR PATIENT SAFETY GOALS - EP21EO 19 MAGNET COMPONENT #3: EXEMPLARY PROFESSIONAL PRACTICE Quality of Care Monitoring and Nurse Sensitive Indicators Magnet Standard: At UCLA Health, measures of the safety of our patients, quality of nursing care, and patient satisfaction are collected throughout the year. Our data is then sent to the American Nurses Association (ANA) National Database of Nursing Quality Indicators (NDNQI) and to the National Healthcare Safety Network (NHSN), where it is incorporated into the national mean score for all academic medical centers. Our Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores are also reported to the Center for Medicare and Medicaid Services’ (CMS) Hospital Compare website. RRUCLA Evidence: We benchmark our performance against the ANA’s NDNQI academic medical center mean for falls with injury and hospital-acquired pressure ulcers – stage II & above. Falls with Injuries: The majority of inpatient units at RRUCLA (14/17) outperformed the NDNQI benchmark mean for the majority of the last eight quarters reported for falls with Injury. Hospital-Acquired Pressure Ulcers (HAPU): The majority of inpatient units at RRUCLA (10/15) outperformed the NDNQI benchmark mean the majority of the last eight quarters reported for HAPU – stage II & above. For central line-associated bloodstream infections (CLABSI) and catheter-associated urinary tract infections (CAUTI), UCLA Health has chosen to benchmark our performance against the National Healthcare Safety Network (NHSN) Centers for Disease Control and Prevention (CDC) cohort pooled mean. Central-Line Associated Bloodstream Infections: The majority of inpatient units at RRUCLA (12/23) outperformed the NHSN benchmark mean the majority of the last eight quarters reported for CLABSI. Catheter-Associated Urinary Tract Infections: The majority of RRUCLA inpatient units (2/8) did not outperform the NHSN benchmark mean the majority of the last eight quarters reported for CAUTI. To improve our CAUTI rates, house-wide surveillance began in Q2 2014. Additionally, the organization has created a multidisciplinary taskforce to review best practices, create a nurse-driven protocol to remove indwelling urinary catheters, and provide house-wide education on the details of the maintenance bundle practices. This taskforce includes participation from nursing leadership, physicians, IT leaders, and clinical nurses. Access the RRUCLA Evidence: Read more about RRUCLA’s nurse-sensitive indicators and patient satisfaction scores in the following SOEs: NURSE SENSITIVE QUALITY INDICATORS - EP22EO Nurse-Sensitive Quality Indicators: Data Collection & Benchmarks All Units Nursing Admin Patient Satisfaction Survey Overview All Units Nursing Admin PATIENT SATISFACTION - EP23EO 20 MAGNET COMPONENT #4: NEW KNOWLEDGE, INNOVATIONS, & IMPROVEMENT Research Magnet Standard: The Department of Nursing at Ronald Reagan UCLA Medical Center offers a variety of resources to support the development of clinical nurses in their professional roles of scientist and transferor of knowledge. RRUCLA Evidence: As nurses conduct research, there are multiple structures in place to support dissemination internally, including: • The “Investigator” newsletter • Nursing Research Grand Rounds • The Annual Nursing Research and Evidence-based Practice Conference These structures and processes are supported through the Nursing Practice Research Council. UCLA Health nursing leadership created the Nursing Practice Research Council (NPRC) with a vision to develop and support innovations that heal humankind through the application of evidence-based knowledge to clinical practice. The NPRC laid the foundation for research and evidence-based practice (EBP) at UCLA Health and continues to focus on its mission of increasing the scientific foundation of practice through research conduct and utilization activities in the following four areas of work: 1) Research development - providing consultation in the design, implementation, analysis, and publication of nursing research 2) Research utilization – identifying and disseminating clinical research findings that are sufficient and appropriate to apply to nursing practice 3) Research education – occurring through classes throughout the year and through the annual Research and Evidence-Based Practice Conference 4) Research dissemination - providing structures and processes for the dissemination of research and other levels of evidence Access the RRUCLA Evidence: Read more about RRUCLA’s nursing research in the following SOEs: ADVANCING NURSING RESEARCH - NK1EO Improving the Care Experience for Children with Complex Chronic Conditions and their Families in the PICU: Parent and Nurse Perceptions PICU Nursing Grand Rounds Support Internal Dissemination of Nursing Research 7W DOM ETHICS SOM Neurology DISSEMINATING RESEARCH KNOWLEDGE - NK2 Dissemination of Nursing Research to External Audiences: The Annual UCLA Nursing Research and Evidence-Based Practice Confernece 21 NRE PICU MAGNET COMPONENT #4: NEW KNOWLEDGE, INNOVATIONS, & IMPROVEMENT Evidence-Based Practice & Innovation Magnet Standard: Nurses at UCLA Health are encouraged and supported to understand the evidence base for their clinical practice and to adapt practice to reflect the most current evidence. They are further supported to design and implement innovative adaptations to care when the current evidence is lacking or an improvement in care is needed. RRUCLA Evidence: There are many resources to promote nursing research, evidence-based practice, & innovation, including but not limited to: • UCLA Nursing Research and EBP Program • Clinical practice council • Mosby’s on-line resource • Nurse EBP fellowship program • Nursing grand rounds • “The Investigator” newsletter • Annual Research and EBP Conference • Access to UCLA Medical Sciences Library • UCLA Chief Nursing Informatics Officer and nurse informaticists Access the RRUCLA Evidence: Read more about RRUCLA’s evidence-based practice and nursing innovations in the following SOEs: INTEGRATING EVIDENCE-BASED FINDINGS INTO PRACTICE - NK3 Use of the Clinical Practice Council to Develop New Early Mobility Practices Use of the Clinical Practice Council to Revise Urinary Catheter Management Practices 4ICU 6ICU 7CCU 7ICU 8W 6E PACU PICU 8ICU NURSING INNOVATION - NK4 Interprofessional Innovation in Fall Prevention PT/OT Admin-MP Respiratory Therapy CCTT GOU 6N 7E 7N 6N 6E 8N 7E/5E 6ICU OR QMS Overhead Peds PICU ED Innovation in Pediatric Sepsis Management Nursing Admin IMPLEMENTATION - NK5EO Enhancing Nurse Immunization Screening Using E.H.R. Functionality Improvement in Patient Experience with Technology 7E/5E Infection Control ISS/CareConnect ED 6E 8N 8ICU GOU Nursing Admin PICU QMS Overhead IMPROVING WORK FLOW AND SPACE DESIGN - NK6EO Nurses Leading Efforts to Reduce Waste 8E 22 L&R Materials Management Learn more about Magnet Designation® & UCLA Health’s Magnet Journey! Please visit the UCLA Health Department of Nursing website at http://nursing.uclahealth.org/body.cfm?id=99 Simply click on the ‘Magnet Journey’ tab at the top of the page to gain access to: • RRUCLAMC’s Magnet Document • UCLA Health Strategic Plans • UCLA Health’s Annual Nursing Report • Magnet Site Visit Resource materials • And much more! 23 RRUCLAMC MAGNET CHAMPIONS UNIT UCLA Health UCLA Health UCLA Health UCLA Health UCLA Health Float Pool/ Resource Team ED GOU OR Cath Lab PTU/PACU/TRU MPU 4ICU 5N Perinatal 5 NICU Quality MITS Admin NAME & ROLE Jennifer Zanotti, MS, RN Magnet Program Director Charlene Collazzi, BA – Magnet Analyst Jennifer Baird, PhD, RN EMAIL ADDRESS [email protected] [email protected] [email protected] Elizabeth Rowan, BSN, RN - Magnet Fellow [email protected] Megan Sitrin MSN, RN - Magnet Fellow [email protected] Susanne Polka, BSN, RN Bethany Reichard, BSN, RN Anndalos Bindra, MSN, RN Kim King, RN Maya King, RN Rolanda Florence, BSN, RN Natalia Cardenas, RN Brittany Marmion, BSN, RN Kristin Helstrom, RN Gene St. Pierre, MSN, RN Kerry Gold-Tsakonas, BSN, RN Marcia Santini, MS,RN Erik Coll, BSN, RN Kayla Vandegrift, BSN, RN Amelia Morva, BSN, RN John Sy, RN Marcy Trinidad, RN Miriam Gonzales-Lopez, MSN, RN Lauren Fujihara, MSN, CNS, RN Angelica Lewis, MSN, RN, NP [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] Linsey Weigt, MSN, RN Joseph Floody, BSN, RN Cherrylin McLarney, MSN, RN Michele Puzon, MS, RN (TRU) Linda Delgizzi , MSN, RN (PTU) Linda Olson MSN, RN (PACU) Linsey Weigt MSN, RN Camilla Kodama, RN Xueqing Xu, MSN, RN Yu-Han Kao, MSN, RN Ana Andress, BSN, RN Vicky Ramirez, BSN, RN Ariana Bruno, RN Taylor Gorman, BSN, RN Chelsea Stone, RN Melissa Viloria, BSN, RN Elijah Lee, RN [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] Debbie Suda, MSN, RN Nicole Casalenuovo, MSN, RN Jennifer Barnato, BSN, RN Caroline Armstrong, BSN, RN [email protected] [email protected] [email protected] [email protected] Heaven Holdbrooks, MSN, CNS, RN Anahit Sarin-Gulian, MSN, RN Brittany Laddusaw, BSN, RN Mae de Vera Reyes, MSN, RN Yolanda Kastner, BSN, RN Brenda Clemens, BHA, RN Meg Furukawa, MN, RN Cait Walsh, MSN, RN Tracy Guy, MPH 24 [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] RRUCLAMC MAGNET CHAMPIONS UNIT 5West/3 Peds 5 PICU/PCTU 6ICU 6N 6E 6W 7ICU 7N 7CCU/COU 7E/5EMS 7W 8ICU 8N 8E 8W Stein Eye OR Bowyer Ambulatory Pall. Care NAME & ROLE EMAIL ADDRESS Chai-Chih Huang, MSN, RN Donna Estrella, BSN, RN Khanh Luu, MSN, RN Margo Goldman, BSN, RN Sufia S. Husain, DNP, RN Janine Carr, BSN, RN Barbara Anderson, MSN, RN Kaitlyn Lattanzio, BSN, RN Kathryne Figuracion-Cheng, BSN, RN Scott Demar, MSN, RN Derek Wilcox, BSN, RN Pamela Nye, MS, RN Paulette Salg, BSN, RN, PHN Kathy Cheetham, BSN, RN Sarah Jividen Taylor, BSN, RN Kathleen Caparoso, BSN, RN Kristine Greene BSN, RN Michel Queen, BSN, RN Stephanie Jackson, MSN, RN, CNS Norma McNair, PhD, RN Sheila Richardson, MSN, RN Charlene Earnhardt, MSN, RN Dalya Lovy, BSN, RN Gilbert Barco, RN Anthony Chan, BSN, RN Wendy Tsau, MN, CNS, RN Shubjeet Dhillon, BSN, RN (COU) Mimmi Lowrie, BSN, RN (CCU) Tina Mamais, MSN, CNS, RN Michelle Zadunayski, MSN, RN Beki Heffler, MN, RN Tammi Burns, BSN, RN Cherie Neil, MSN, RN John-Gabriel Pantaleon, BSN, RN Renee Appleby, BSN, RN Jennifer Do, MSN, RN Mo Keckeisen, MSN, RN Jill Dowds, BSN, RN Jyotpreet Jagpal, BSN, RN Melanie Donovan, BSN, RN Andrew Baird, BSN, RN David Eskenazi, BSN, RN Vivien Lee, BSN, RN Linda Chao, MSN, RN Monica Choi, MSN, RN Leilani Quiambao, BSN, RN Poni Agarwala, MSN, RN Jean Oriondo-Fournier MSN, RN Marcia Wicktor MSN, MPH, RN Rochelle Torres, BSN, RN Jenneh Bockari, BSN, RN Quanna Batiste, MSN, RN Toyin Lawal, BSN, RN Noelle Hunter MSN, RN Edith O’Neil-Page, MSN, CNS, RN 25 [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] 26 A few more quick tips for the Appraiser Interview: MAGNET APPRAISER VISIT IS THE EXACT OPPOSITE OF A JOINT COMMISSION VISIT! Speak up! Be excited to share the great work you do for pts every day! Appraisers are peers – They want you to succeed! More questions = Appraiser’s curiosity: They want to learn more about the Best Practice on your unit, not grill you! Clarify, Amplify, Verify – Appraisers are here to validate the great things they read in our Magnet Document – so be sure to read up on where your unit is mentioned! (www.uclahealthmagnet.org Login = uclarr Password = magnet8114) Also, share your unit’s 3 Exemplars! Describe then demonstrate Provide an overview of a larger topic, then WHEN TELLING YOUR STORY… narrow focus to your unit/practice/etc. EXAMPLE: “At RRUCLAMC, RNs have many resources to ensure conditions are safe & sanitary for our patients. On our unit, we are proud of our efforts around implementing a new hospital-wide standard for CHG bathing…”) No Cognitive Leaps! The details – people & committees involved, their actions, etc. – are the most interesting and compelling part of the story. Take a few minutes to brag about the exceptional work you & your colleagues accomplished! Stay Pronoun- Free! Don’t assume the Appraiser knows who you are LANGUAGE ADVICE: talking about when you say “We” or “They” – who/which committee did this work? Recognize colleagues & resource structures by name! Fun Fact– the only pronoun allowed is “I” No Passive Voice! Advances in Professional Nursing Practice don’t “just happen” – You move it forward every day through your dedicated & strategic actions, so make sure you use an “active voice” when sharing your great work! EXAMPLE: Not: “We saw CLABSI rates were high, so the unitbased Infection Prevention group as formed.” Instead: “The UPC recognized our unit’s CLABSI rates were high, and decided to form an Infection Prevention group. The UPC did this by recruiting staff via email and during staff meetings…” Pass the Ball! Share the story telling! Make sure no one person dominates the interview, chime in if your colleague forgets to mention a detail, plan beforehand and split the story between your colleagues! Praise your colleagues for a job well done! Recognition and comradery between colleagues is always viewed as a positive – Plus it feels pretty darn good, too! 27 COMING SOON TO YOUR UNIT: MAGNET CART ROUNDS! Be on the lookout for a visit from the Magnet Cart on your unit, say ‘Hello’ to the wonderful Resource Team Magnet Champions, and get ready to have some Magnet fun! Play a Magnet game, learn more about our Magnet Journey, prep for our upcoming site visit, and grab a treat! For more information, please contact Magnet Fellows Megan Sitrin, MSN, RN at [email protected] &/or Elizabeth Rowan, MSN, RN at [email protected] 28
