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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 practiceRequires values clarificationFoundational 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 ModelSafe and Ethical PracticeAutonomous PracticeQuality Processes
Exemplary Professional Practice
Nine subcomponents of EPProfessional Practice ModelCare Delivery SystemStaffing, Scheduling & Budgeting ProcessInterdisciplinary CareAccountability, Competence & AutonomyEthics, Privacy, Security, & ConfidentialityDiversity & Workplace AdvocacyCulture 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
How care is delivered Skill set required
Nurses’ authority is clear 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
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
Exemplary Professional Practice
Assignments ensure continuity, quality & effectiveness Good hand off communication (use of tool)
Beside nurses should have resources 24/7Use 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
Autonomy Right to exercise clinical and organizational judgment
within an interdependent team in accordance with nursing discipline Control over nursing practice
Exemplary Professional 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 SafetyProactive assessment & approach
Prevent injuriesInnovateSafety initiatives incorporate national best
practicesBased on standards such as ANA’s Safe Patient
Handling and Movement Sufficient resources are available to respond to
safety initiatives Facility-wide approachMeasure improvements in nurse workplace safety
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
Exemplary Professional Practice
Quality Care Monitoring & ImprovementNurses at all levels analyze data and use
national benchmarksAction plans are developed that lead to
systematic improvementsResources 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
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
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 EPProfessional Practice ModelCare Delivery SystemStaffing, Scheduling & Budgeting ProcessInterdisciplinary CareAccountability, Competence & AutonomyEthics, Privacy, Security, & ConfidentialityDiversity & Workplace AdvocacyCulture of Safety Quality Care Monitoring & Improvement
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
Exemplary Professional Practice
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). Relationship-Based Care Leadership Practicum. Minneapolis, MN
http://www.nursecredentialing.org/Documents/Magnet/
2008-Manual-Updates.aspx