The Impact of a Professional Nursing Practice Environment in the School Setting

1. The Impact of a Professional Nursing Practice Environment in the School Setting Presented by Tammy Webb, BSN, RN Julie Harris, MSN, RN, CPST Lori Batchelor, BSN, MHA, RN, CPN, NEA-BC

2. The History of Magnet

3. The Magnet Model: 5 components

4. Emphasizes visionary strategic planning Strong vision and well-articulated philosophy Transformation may cause turbulence – involves atypical approaches to solutions…ontrolled destabilization that births new ideas and innovations Transformational Leaders not only lead people where they want to go, they must also lead people where they need to be to prepare them for the future Transformational Leadership Transformational Leadership Transformational Leadership

5. Transformational Leadership Strategic Planning • MVV • Strategic goals • Nursing leaders advocate for resources to support the strategic priorities • Improves nursing effectiveness and efficiency Transformational Leadership

6. Transformational Leadership Advocacy and Influence • Nurse Leaders • influence system wide changes • Guide periods of transition during planned and unplanned changes • Supports leadership development and succession planning Transformational Leadership

7. Transformational Leadership Visibility, Accessibility and Communication • Leaders are visible to direct care nurses • Nurses have access to leaders • Leaders use input from nurses to improve the work environment • Changes are made based on this input Transformational Leadership

8. Transformational Leadership • Nurses at all levels are able to articulate a clear vision of nursing practice • All ideas are heard, respected and given equal consideration • Communication is timely, clear, moving easily both horizontally and vertically • Nurses report that they feel up-to-date with all nursing news that impacts their practice • Suggestions from frontline nurses are visibly incorporated into decisions • Outcome measures indicate empowerment and engagement • Frontline nursing involvement & synergy results in new, innovative, practical ideas • Reduced turnover

9. Provides the foundation of nursing services Solid structures and processes provide an innovative environment Environment is flat, flexible and decentralized Self governance and share decision making Strong relationships and partnerships developed among all types of community organizations Support and expectation for life long learning Positive image of nurses as key contributors to clinical practice and care delivery Structural Empowerment Structural Empowerment Structural Empowerment

10. Structural Empowerment • Professional engagement • Decentralized decision making with staff involvement • Feedback reaches all personnel involved in decisions more quickly • Shared decision making shapes professional character, structure and behavior of the nursing organization and provides a framework for organizing the work of the nurses • Nurses participate in professional organizations (local, state and national)

11. Structural Empowerment • Commitment to Professional Development • Support for formal academic education • Sets goals for professional development, certification and participation at conferences • Provides continuing education for nurses • Provides career development opportunities The organization places high value on each and every individual’s professional development and partners with them to provide opportunities and resources for growth

12. Structural Empowerment • Teaching and role development • Promote the teaching role of nurses • Facilitates the effective transition of new graduate nurses • Support community educational activities • Support academic practicum experiences and serve as preceptors, instructors and faculty

13. Structural Empowerment • Commitment to community involvement • Affiliations with schools of nursing, consortiums and community outreach • Supports and recognizes nurses participation in community service • Addresses the healthcare needs of the community and establishes partnerships

14. Structural Empowerment • Recognition of Nursing • Recognizes the contributions of nurses • Ensures that the community recognizes and value of nursing at the organization The image of nursing is “about relationships – with patients and families, with self and with colleagues”

15. A comprehensive understanding of the role of nursing exists and “lives” in the organization The application of that role with patients, families, communities, and the interdisciplinary team How nurses practice, collaborate, communicate and develop professionally Alignment of nursing practice to the MVV Mutual respect among healthcare team and recognition of nurses’ contribution The goal of this Component is more than the establishment of strong professional practice; it is what that professional practice can achieve Exemplary Professional Practice Exemplary Professional Practice

16. Exemplary Professional Practice • Professional Practice Model (PPM) • Standards of practice and standards of care (investigate, develop, implement and evaluate) • Nurse involvement in analyzing nurse satisfaction and engagement • How nurses apply, evaluate and adapt the PPM

17. Example: Model of Care and Professional Practice Model

18. Exemplary Professional Practice • Care Delivery System • Involves the patient/family in care decision making • Patient care assignments ensure continuity, quality and effectiveness across systems • Application of regulatory standards as applicable • Access to internal and external resources • Staffing, scheduling and budgeting • Interdisciplinary Care • Ethics, Privacy, Security and Confidentiality • Diversity and workplace advocacy

19. Exemplary Professional Practice • Accountability, competence and autonomy • Ready access to current literature, professional standards and or other data • Use of self-appraisal performance and peer review • Participative management and shared leadership • Nurses are accountable to resolve issues related patient care and operations • Nurses are permitted and expected to be autonomous in their practice, the provision of patient care, within professional standards

20. Exemplary Professional Practice • Culture of Safety • Workplace safety for nurses • System wide approach to risk assessment and error management • Use of Nursing Sensitive indicator data (e.g. nosocomial infections, pain, and PIV infiltration) • Quality Care monitoring and improvement • Allocation of resources to improve the quality of nursing • Dissemination of quality data to direct care nurses

21. Integration of evidence based practice (EBP) and research Education for nurses Targets for productivity and participation Application of existing evidence and new evidence Visible contributions to the science of nursing Innovation within an empowering work environment New Knowledge, Innovation& Improvements Empirical Outcomes New Knowledge, Innovation, & Improvements

22. New Knowledge, Innovation& Improvements • Research • Utilize current research findings in practice • Support for human rights of participants in research protocols • Develop, expand and advance nursing research • Evidence Based Practice (EBP) • Existing nursing practice is based on evidence • Translation of new knowledge into practice • Innovation

23. The question for the future is not “What do you do?” or “How do you do it?” but rather, “What difference have you made?” Nurses make essential contributions to: patient, nursing workforce, organizational and consumer outcomes Outcomes are dynamic Relationships among: Structure Process Outcome Empirical Outcomes Empirical Outcomes Empirical Outcomes

24. Empirical Outcomes • Environment where staff feel empowered and involved with problem solving • A reliable and Anticipatory environment • Patient and families are actively engaged in care and experience high satisfaction • Standardized, streamlined and effective processes are in place to support care delivery

25. Fundamentals of NursingLeadership • 2005 NASN position statement: It is the position of the National Association of School Nurses that the school nurse is the leader in the school community to oversee school health policies and programs. The school nurse serves in a pivotal role to provide expertise and oversight for the provision of school health services and promotion of health education. Using clinical knowledge and judgment, the school nurse provides health care to students and staff, performs health screenings and coordinates referrals to the medical home or private healthcare provider. The school nurse serves as a liaison between school personnel, family, community and healthcare providers to advocate for health care and a healthy school environment.

26. Role of a Nurse Leader • tackles nursing issues head on • inspires others • foresees a better future • operates according to a basic set of principles

27. Characteristics of aNurse Leader • Collaborative • Inventive • Skilled • Visionary • Mindful

28. Collaborative • Conveying enthusiasm about achieving important goals • Helping others to meet their challenges • Expressing confidence in the abilities and potential of others • Giving freely of time, resources, and positive advice • Serving as an advocate for those facing difficulties

29. Inventive • Initiating positive action without being asked to do so • Responding quickly and effectively to changing conditions • Finding new ways to accomplish desire results • Putting cleaver ideas into action • Providing creative solutions to stubborn problems

30. Skilled • Acquiring and mastering all necessary skills to achieve desired results • Continuing to sharpen vital skills • Following important tasks through to completion • Using their experience • Balancing the demands of multiple critical tasks

31. Visionary • Working tirelessly to achieve important goals • Foreseeing a better future and helping it come to pass • Mapping a clear path to desired goals • Inspiring others with both actions and words • Painting an inspiring future that motivates others

32. Mindful • Making and keeping realistic promises • Freely admitting mistakes • Respecting the human needs of others • Showing concern for the problems and feelings of others • Reflecting on the implications of past and pending decisions

33. Responsibilities of a Nurse Leader • Focus on the situation, issue, or behavior, not on the person. • Maintain the self confidence and self esteem of others. • Maintain constructive relationships. • Take initiative to make things better. • Lead by example. • Think beyond the moment.

34. Responsibility #1: Focus on thesituation/behavior • Remain objective • Solve problems • Make better decisions • Maintain constructive relationships

35. Responsibility #2: Maintain self confidence & self esteem of others • Avoid ridicule and negative comments • Avoid criticizing others • Show respect • Help others reach their goals CRITICISM

36. Responsibility #3: Maintainconstructive relationships • Support others • Keep a positive attitude • Communicate • Share information

37. Responsibility #4: Takeinitiative to make things better • Look around your area for opportunities for improvement • Offer help Do you need help?

38. Responsibility #5: Leadby example • Be a good example • Model appropriate behavior • Honor your commitments • Admit your mistakes I made a mistake…

39. Responsibility #6: Thinkbeyond the moment • Remember – there are always consequences • Consider how your decision will impact others • Avoid personal gain at the expense of others • Be thoughtful in making plans and decisions • Anticipate the future

40. Fundamentals of NursingLeadership • Think about nurses who have mentored you. What qualities made them successful? Incorporate these qualities into your role as a school nurse. • Feeling frustrated about a situation at work – Review the responsibilities. How can you apply them to your situation?

41. Sources • AchieveGlobal, Inc. (2003). The Principles and Qualities of Genuine Leadership. • National Association of School Nurses. (2011). Position Statement - Role of the School Nurse. Retrieved from http://www.nasn.org/Default.aspx?tabid=279

42. Nursing LeadershipArkansas School Nursing Association Lori L. Batchelor BSN, MHA, RN, CPN, NEA-BC Arkansas Children’s Hospital Ambulatory Care Services Director

43. Nursing Leadership and the School Nurse • The document Nursing in the Public Schools of the United States of America (Maria Applewhite, RN, 2003, retrieved from http://www.cwru.edu/med/epidbio/mphp439/School_Nursing.htm.) Seven Specific Roles of the school nurse of the 21st Century • Provides direct health care to students and staff • Provides leadership for the provision of health services • Screening and referral for health conditions • Promotes a healthy school environment • Promotes Health • Serves in a leadership role for health policies and programs • Serves as a liaison between school personnel, family, community and health care providers.

44. Nursing Leadership and the School Nurse • LPN vs. RN does it really matter? • Communicating with Families • Interdisciplinary/Intercollegial Relationships • Does a school nurse make a difference to the health and wellness of school age children?

45. Nursing LeadershipLPN vs. RN does it matter? • According to the March/April 2011 edition of American Nurse 43 (2) pg3, Karen Daley, ANA President. “It is critically important that nurses without a BSN take advantage of opportunities to pursue advanced education in order to become better prepared to care for patients in an increasingly complex health care delivery system.” • According to the National Association of School Nurses (retrieved from http://www.nasn.org/Default.aspx?tabid=279) “Educational preparation for the school nurse should be at the baccalaureate level, and the school nurse should continue to pursue professional development and continuing nursing education.”

46. Nursing LeadershipLPN vs. RN does it matter? • According to the American Academy of Pediatrics (AAP)Policy Statement: Role of the School Nurse in Providing School Health Services (Pediatrics 121(5) 2008) • AAP supports: • The goal of professional preparation for all school nurses. • Having a full-time school nurse in every school • Pediatrician support of the school nurse • Coordination of care • Continuing education of school nurses

47. Nursing LeadershipLPN vs. RN does it matter? • Why would education make that difference? • Community Health/Epidemiology • Nursing Research/Statistics • Management/Leadership All provide for a more comprehensive knowledge base that assists in considering all factors that influence patient illness, health or wellness.

48. Nursing LeadershipLPN vs. RN does it matter? • Institute of Medicine findings: ‘The Future of Nursing: Leading Change, Advancing Health’(2011, Holmes, A.M., Nursing Management). • 1st recommendation: increase proportion of nurses with a bachelor’s degree of science in nursing (BSN) to 80% by 2020. • Currently BSN prepared nurses average 45-55% depending on the region.

49. Nursing LeadershipLPN vs. RN does it matter? • National Association of School Nurses recommends BSN preparation for School Nurses • Growing Evidence for the BSN prepared Nurse • Lower rates of patient death • Lower rates of medical errors • Better patient outcomes

50. Nursing LeadershipLPN vs. RN does it matter? • National Database of Nursing Quality Indicators (an arm of the American Nursing Association) • More than 1600 Hospitals participating nationally • Evaluating patient outcomes on a variety of measures including: • Nursing Professional Certification • Nursing Education Level: • LPN • RN • RN, BSN • RN, MSN and/or RN, PhD