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Study Guide for Success

Magnet Site Survey December 10-13, 2013

Let’s knock their socks off! As we prepare for the upcoming Magnet Site Survey, December 10-13, we would like to take this opportunity to remind each of you why this is happening…why we take the time to apply for re-designation…why we care about being a Magnet® Hospital. We all know that “magnet” in the true sense of the word means “attraction.” Magnet in the nursing world identifies environments that attract and retain the best nurses who provide high-quality, innovative care. At the same time, being a Magnet ® Hospital also means that UWHC supports and recognizes your professional practice, and gives you the tools to continuously grow and achieve new levels of nursing excellence. Magnet should not be viewed as extra work. It is just the opposite…and as we all know…opposites attract! It should serve as a strong source of confidence, pride and comfort - knowing that you not only work for the best, but that YOU make us the best for patients and families. Thank you for all you do for patients and families. You make us proud every day.

We know you’ll all shine and knock the socks off the surveyors!

Beth Houlahan, MSN, RN, CENP Senior Vice President Nursing and Patient Care Services Chief Nursing Officer

Susan Rees, DNP, RN, CPHQ, CENP Vice President, Development Nursing and Patient Care Services

Transformational Leadership Today’s health care environment is changing. Unlike yesterday’s leadership requirement for stabilization and growth, today’s leaders must transform their organization’s values, beliefs, and behaviors. The intent is no longer to just solve problems, fix systems and empower staff, but to actually transform the organizations to meet the future. Transformation calls for new ideas and innovations.*

Transformational Leadership includes: • Strategic planning • Advocacy and Influence • Visibility, Accessibility and Communication*

As the executive leader for nursing, Beth Houlahan is strategically positioned to advocate for nursing and encourage decision-making at all levels.

… at UWHC Transformational leadership is experienced at all levels of nursing. UWHC nurses have developed a strong vision for nursing as evidenced in the Professional Practice Model. As essential professional partners, the nursing service ensures congruence with the organizational mission, vision, values, and strategic and quality plans. As our executive leader, Beth Houlahan is strategically positioned to advocate for nursing and influence decisionmaking at all levels of the organization. The entire leadership team is visible, accessible, and committed to providing open communication with all nurses. There is strong commitment to collaborative decision making and this commitment is supported by a strong council structure that expects staff nurse input.

Examples: • I n 2011, Beth Houlahan presented data to the UWHC Executive Council on nursing vacancies and medical leaves — outlining the need to hire an additional 44 nurse residents in January and February 2012 in order to stay ahead of the normal rate of nurse turnover and to cover staff on medical leaves. Her proposal was endorsed and represented an investment totaling $1,664,189. for the purpose of upholding the organizational goals of “best work and learning environment” and “service excellence”, as well as the Nursing and Patient Care Services strategic goal of delivering outstanding patient- and family-centered care (PFCC) that is superior in quality and safety and that is fiscally responsible.

• The strategic planning process used by UWHC Nursing and Patient Care Services includes the steps of: • articulating the mission, vision, values; • assessing the situation; • agreeing on priorities; • writing the plan; • implementing the plan; and • evaluating and monitoring the plan. The process takes place within the Nursing and Patient Care Services collaborative governance structure and the process is used to establish the strategic plan for the next five years, with updates completed as needed. •O ne way to advocate for resources is through the Nursing Product Evaluation and Standardization Council. In November 2012, these nurses proposed three product changes within the system: •L aura Forcia, RN, nurse clinician, B4/4 rehab, advocated for switching the external male catheters to a shorter version that had proven to function more effectively. •S ara Freiburger, RN, nurse clinician, chemotherapy services, advocated for the addition of a softer flossing tool for oncology patients. •K endra O’Connell, RN, clinic coordinator, advocated for a new dressing for use with intravascular ports. All three were approved by the council.

Structural Empowerment Solid structures and processes provide an innovative environment where professional practice flourishes and where the mission, vision and values come to life to achieve the outcomes believed to be important for the organization. Staff needs to be empowered to find the best way to accomplish the organizational goals and desired outcomes. This may be accomplished through a variety of structures and programs—one size does not fit all. Strong relationships and partnerships developed among all types of community organizations to improve patient outcomes and the health of the communities they serve.*

The DAISY Award was adopted in July 2012 as a way to reward and recognize remarkable care, superior clinical skills and extraordinary compassion in nursing.

This Structural Empowerment includes: • Professional Engagement •C ommitment to Professional Development

•C ommitment to Community Involvement • Recognition of Nursing*

2011-2013 Recipient

• Teaching and Role Development

… at UWHC Empowered individuals solve problems, identify improvements and exercise initiative. UWHC nursing service works diligently to support an empowering environment through programs that recognize excellence in care delivery. Nurses are lifelong learners and the organization supports the efforts of individual nurses who participate in professional development activities. Both the nursing service and the broader organization understand the importance of monitoring the level of empowerment through satisfaction and engagement surveys.

Examples: • I n FY12, $867,991 was provided in tuition reimbursement to advance nursing education or for non-nurses to obtain initial nursing education. •E ach inpatient nursing unit budgets 0.28 full-time equivalent (FTE) annually to cover the time nurses attend meetings associated with committees, councils, and task forces. •A mong all nurses at UWHC, 79 percent had a BSN or higher degree at the end of FY12. This exceeded the goal of 78.8 percent and benchmarks very favorably with other Magnet facilities. •C onference tuition and travel are budgeted in department cost centers every fiscal year. In FY12, a total of $109,745 was spent to support external conference attendance. A total of 131 nurses received complete or partial support to attend 89 conferences.

•N ED provides ongoing education for staff, with many of the programs providing contact hours. In FY12, 93 different programs were offered with a total of 3,943 participants. • UWHC provides clinical sites and precepted experiences for many academic facilities on an annual basis, which translates to approximately 500 nursing students a year. • The DAISY Award was instituted at UWHC on July 19, 2012, and is currently awarded every month. •O n July 20, 2011, the Emergency Nurses Association (ENA) notified UWHC that the Emergency Services Department (ED) was selected as an inaugural Lantern Award recipient. • In August 2011, Terry Gion, MS, RN, CRRN, Rehabilitation Unit (B4/4) CNS was selected by the Association of Rehabilitation Nurses (ARN) recipient of the 2011 Advanced Practice Nurse Role award. • University HealthSystem Consortium (UHC)/American Association of Colleges of Nursing (AACN) Nurse Residency Program (NRP) at UWHC received national accreditation from the Commission on Collegiate Nursing Education (CCNE) on June 5, 2012. • Lynnda Zibell-Milsap, MS, RN, PMHCNS-BC, LPC, APNP, Senior Clinical Nurse Specialist (CNS) – Psychiatric Liaison, was honored with the 2012 Psychiatric Liaison CNS Leadership Award from the International Society Psychiatric Nursing (ISPN).

University of Wisconsin Hospital and Clinics

Exemplary Professional Practice Nursing Professional Practice Model

• Culture of Safety

• Accountability, Competence, and Autonomy

• Quality Care Monitoring and Improvement*

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• Staffing, Scheduling, and Budgeting processes

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• Care Delivery Systems

• Ethics, Privacy, Security and Confidentiality

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Exemplary Professional Practice includes:

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The true essence of a Magnet® organization stems from exemplary professional practice within nursing. This entails a comprehensive understanding of the role of nursing; the application of that role with patients, families, communities, and the interdisciplinary team; and the application of new knowledge and evidence. The goal of this component is more than the establishment of strong professional practice; it is what that professional practice can achieve.*

Innovation

The UWHC Nursing Professional Practice Model

… at UWHC UWHC nurses are dedicated professionals, committed to delivering exemplary care. Guided by the nursing Professional Practice Model, the Primary Nursing delivery model, the patient- and family-centered care model and the organization’s Interdisciplinary Model of Care, UWHC nurses deliver culturally congruent care that is individualized to the patient and family. Safety, quality, and confidentiality are always at the forefront of clinical nursing practice at UWHC. As nursing professionals, UWHC nurses maintain accountability, competence, and autonomy through the practice of self-evaluation and peer feedback.

Examples: • The input of staff nurses on the Acute Medical Progressive Care Unit (D6/5) was considered and highly valued prior to finalizing the staffing model, due to their knowledge and expertise related to this patient population. During FY12 budget preparation, direct-care nurses expressed a need for additional nursing assistants (NAs), particularly on evenings and weekends, to assist them with managing patient assignments so the nurses could focus on more complex tasks and patient assessments. In follow-up, the D6/5 nurse manager and director of medical nursing met with the D6/5 staff to further review needs based on acuity of the patients. Staff input along with careful review of admission/discharge/transfer (ADT) activity, HPPD, and acuity benchmarks resulted in an increase of NA staff on

evenings and weekends for a total increase of 2.3 full-time equivalent (FTE) in FY12. • UWHC has approximately 40 masters-prepared clinical nurse specialists (CNS) and other nurses who provide clinical support. This represents a major organizational commitment to the engagement of internal experts to improve care in the practice setting. • Nurses often assume leadership roles in interdisciplinary collaboration, such as the Psychosocial Resource Group led by two clinical nurse specialists (CNSs), Lynnda ZibellMilsap, MS, RN, PMH CNS-BC and Nathan Whitman, MS, RN, PMH CNS-BC. • The position for program director for Transitional Care was created and filled by Maria Brenny-Fitzpatrick, MSN, FNP-C, GNP-BC, APNP. The responsibilities include being “accountable for developing, coordinating and evaluating transitional care across UW Health.” • Nurse clinician for the Bariatric Clinic – East, Michele Vargo, RN, is responsible for coordinating the care of bariatric patients and facilitating the weekly meeting for the multidisciplinary team. This leadership role is integral in coordinating the assessment and treatment plans of each discipline in order to provide a coordinated care experience.

New Knowledge, Innovations and Improvements Magnet® organizations have an ethical and professional responsibility to contribute to patient care, the organization, and the profession in terms of new knowledge, innovations, and improvements.*

New knowledge, Innovations, and Improvements includes: • Research • Evidence-Based Practice

Many nurses take part in the annual Nursing Poster Fair as a prime opportunity to showcase research, evidence-based or quality improvement projects.

• Innovation*

… at UWHC Supported by the structures and processes of an academic medical center, UWHC nurses demonstrate commitment to patient care and the profession by contributing new knowledge through research, delivering evidence-based care to patients and advancing the profession through innovation and improvement. • The creation and maturation of the Nursing Research Council contributes to the infrastructure at UWHC by educating and mentoring nurses to develop research and scholarly projects. • The first-ever completion of a research study by Nursing Research Council members during FY13. The study was a quantitative descriptive study about the use of heat to facilitate peripheral IV insertion. This study helped define practices for a clinical trial designed to test the efficacy of heat use in PIV insertion. The Nursing Research Council plans to conduct a clinical trial. Tammy Kiger, MSN, RN, Nursing Informatics Specialist, who is a member of the Nursing Research Council, served as the Principal Investigator of the study.

• G eriatric CNSs Suzanne Purvis, DNP, RN, GCNS-BC and Shelly VanDenBergh, MS, RN, GCNS-BC, identified a need for older patients without loved ones to visit or those who suffer from a cognitive impairment, and developed the STaR program (Singing, Talking and Reminiscing). The program trains volunteers to spend time with these adults and provide stimulation to enhance their care and patient experience—a great example of CNSs collaborating with patients/families, staff and volunteers to design a patientcentered program that improves the hospital experience for older adults. • U WHC participated in 10 research studies during the two year period reported in the Magnet document.

Empirical Outcomes The question for the future is not “What you do?” or “How you do it?” but rather, “What differences have you made?” Outcomes need to be categorized in terms of clinical outcomes related to nursing; workforce outcomes; patient and consumer outcomes; and organizational outcomes. Quantitative benchmarks should be established. These outcomes will represent the “report card” of a Magnet ®-recognized organization, and a simple way of demonstrating excellence.*

… at UWHC UWHC nurses know they are providing quality patient care and making essential contributions to the organization, the profession, and the community because we empirically measure outcomes and monitor our progress. In addition, we search out relevant benchmarks in order to evaluate our performance. •D ata regarding nurse sensitive clinical indicators are collected on a routine basis. Patient falls are an example. Nine of sixteen units, or 56 percent, outperformed the unit-specific Academic Medical Center (AMC) mean benchmark more than 50 percent of the time during calendar years 2011 and 2012. •U WHC has collected nurse satisfaction data through NDNQI® from 2003 to 2011. The most recent survey yielded a response rate of 72 percent. At the overall organizational level, UWHC outperformed the benchmark in 60 percent (three out of five) of the subscales including Nurse Manager Ability, Leadership, and Support of Nurses; Staffing and Resource Adequacy; and Collegial Nurse-Physician Relations.

•P atient satisfaction data for inpatient units is collected by Press Ganey™ (PG) using surveys mailed to patients after discharge. UWHC selected Press Ganey™ AMC “Top-Box” 50th percentile score as the benchmark for all adult and pediatric inpatient units, and the following units outperformed the PG benchmark in these respective domains: •E ducation Domain: Thirteen of 19 units, or 68 percent. •C ourtesy and Respect from Nurses Domain: Thirteen of 19 units, or 68 percent •C areful Listening by Nurses Domain: Fourteen of 19 units, or 74 percent •R esponse Time Domain: Thirteen of 19 units, or 68 percent

Helpful Interview Tips In addition to reviewing the information in this pocket guide, please review the tips below that will be helpful if any member of the survey team engages you in conversation.

The focus of the Magnet appraiser is to clarify, verify and amplify the information submitted in our Magnet application. Be comfortable. Collect your thoughts before the interview so that you can show the good work you do each day. Listen carefully to the question asked. Answer that question, and do not volunteer unnecessary details.

If you don’t know the answer, tell the surveyor that you don’t recall, but explain how you would find the answer. Be confident. Respond to questions confidently based on your actual practice or experience, the same way you would answer if you were having a stress-free conversation with a colleague. Emphasize the shared core values of: • Excellence • Innovation

If you don’t understand the question, ask the surveyor to repeat the question. Don’t try to guess what the surveyor is asking if it is not clear to you.

• Compassion • Integrity • Respect

Relax and maintain a positive attitude, reflecting pride in your practice and the organization. Our survey’s success is based upon the input of many people throughout the organization. Take time to think before answering the question. Be prepared to provide a specific example. Whenever possible, avoid using words that suggest uncertainty.

• Accountability

Keep a pocket guide with you and make notes about how you would answer questions related to the Magnet model within your unit.

Speak from the heart about your practice and nursing at UWHC.

* S ource for all model components: Magnet Recognition Program ® Model at nursecredentialing.org/magnetmodel.aspx ND-37548-13