Stepping Up: Ensuring the Future of the Bucks/Mont ONS Chapter through Professional Accountability

1. Stepping Up: Ensuring the Future of the Bucks/Mont ONS Chapter through Professional Accountability 15th Anniversary Keynote Address Anne Jadwin, RN, MSN, AOCN, NE-BC (2nd Bucks/Mont ONS Chapter President -1998)

2. Purpose: • The purpose of this session will be to discuss principles of professional RN accountability as related to the profession of nursing, the health care team, the employing agency, and clients/patients. The early history of the Bucks/Mont ONS chapter will be described, highlighting key achievements during our 15 year history, and the relationship between professional accountability and the future success of the chapter. The phenomenon of Complexity Compression will be described, in conjunction with strategies to regain control over nursing practice, such as involvement in professional organizations.

3. Session objectives: • Identify the key principles of professional RN accountability, and how they impact the profession of nursing. • Demonstrate an understanding of the history and achievements of the Bucks/Mont ONS Chapter. • Describe the phenomenon of complexity compression, and strategies to regain control over professional nursing practice. • Identify ways to become more involved in your local chapter of the Oncology Nursing Society.

4. Professional Accountability 101

5. Key Definitions • Accountability – ability and willingness to assume responsibility for ones’ actions and accepting the consequences of one’s behavior • Autonomy – independence of thinking, functioning • Authority – power to do something • Responsibility – acting in a reliable, trustworthy, credible manner

6. To Whom are Nurses Accountable? • To the profession • To patients/clients/families • To other members of the health care team • To the employing agency • To self

7. Accountability to the Profession • ANA code for Nurses • ANA Standards for Nursing Practice and Education • Nursing Quality Assurance and Improvement programs –increasing emphasis on RN impact on patient outcomes • Participation in a professional organization – your involvement in ONS!

8. Accountability to Clients/Patients/Families • Clinical competence – knowing why and how things are done • Safe nursing care • Allowing clients/patients/families to participate in care planning and care activities • Respecting individual differences • Altruistic intentions – serving others without self- interest • Serving as advocates

9. ANA Official Position on Competence • Public has a right to expect registered nurses to demonstrate professional competence throughout career • The RN is individually responsible and accountable for maintaining professional competence • Your local ONS chapter can help!

10. Accountability to the Health Care Team • Bring specialized nursing knowledge and skills to the health care delivery situation • Share information with team members • Confront if potential errors may occur • Perform nursing tasks with competence • Treat team with dignity and respect

11. Accountability to the Employing Agency • Quality of work • Following agency established standards, procedures, policies • Protect against unsafe practice situations • Attitude conveyed about the work place • Use of outside agency personnel

12. Accountability to Self • Practice nursing to personal standards using professional standards of care as basis for practice • Be true to oneself • Take care of personal, physical, mental, and spiritual health needs (professional self care) • Protect self from harm • Life-long learning – again, your local ONS chapter can help!

13. Oncology Nurses. . . Exceptional People – Extraordinary Care • Official theme selected for 2011 Oncology Nursing Month is Oncology Nurses: Exceptional People, Extraordinary Care. • How do we know this is so?

14. The “Dream” of a Bucks/Mont ONS Chapter • It started with a phone call…… • Group of oncology nurses were networking to form an ONS chapter convenient for Bucks and Montgomery County residents The future belongs to those who believe in the beauty of their dreams - Eleanor Roosevelt

15. And so a “CHIP” forms • Chapter Interest Group (CHIP) formed, and had to show sustained membership/funding support, educational program development, member involvement • Application to ONS in to be recognized as an official chapter came in November 1996 • Submitted by Dr. Donna Molyneaux, our first chapter President • Chapter charter formally presented during Opening Ceremonies at 1997 ONS Congress, New Orleans, LA

16. The Early Years • Struggled with consistent membership and meeting attendance • Board members had “multiple jobs” –needed to show broader involvement in chapter • Fiscal constraints due to low membership, lack of program support to fund dinner meetings • Lack of experience in new chapter development • Much support/reliance on national ONS, and networking with local/regional chapters (joint program collaboration)

17. Were there none who were discontented with what they have, the world would never reach anything better - Florence Nightingale

18. Steady Growth in Membership!

19. Plenty to Celebrate!

20. 2003 ONS Chapter Excellence Award • 11 chapters competed for this award • Based on alignment of ONS national strategic plan with chapter goals/outcomes • Detailed application submitted by Cathy Belt, 2003 chapter president • Receipt of $4000 cash award to chapter • Plaque hanging in the national office in Pittsburgh • Recognition at Chapter Presidents’ reception in Anaheim, CA in 2004

21. 2004 ONS/SuperGen Inc Chapter Newsletter Award • Bucks/Mont ONS chapter recognized for award-winning newsletter, The Bridge • Criteria – reflects chapter activities, dynamic involvement of chapter members, creativity, strategic placement of content • Application submitted by Ann McCullough, our newsletter editor • Nineteen submissions • Recognized at ONS Congress 2004, Anaheim, CA • Cash award of $500

22. 2007 ONS Recruitment and Retention Award • Bucks/Mont chapter receives 2007 recognition from national for ONS Chapter Recruitment and Retention • Honored at the Chapter/SIG Awards reception at national Congress in Las Vegas, NV • $500 cash award

23. 2007 Recognition by National • Received one of two awards for Chapter Voting Participation in ONS national election • Bucks/Mont ballot return rate was 47.7% in ONS national election

24. 2009 Special Project Recognition by ONS • Special Project award received from national for Best of ONS Congress 2009 • Offered since 2005 – the “brainchild” of Nancy Barton (who also developed the PERKS program) • Highlights from national ONS Congress sessions presented • Enhanced educational opportunities for oncology nurses in region at reasonable cost

25. Live your beliefs and you can turn the world around - Henry David Thoreau

26. Stepping Up • Ask not, what can my chapter do for me? • But rather, what can I do for my chapter?

27. I’d like to be more involved, but who has the time?

28. Coping with Complexity Compression • 40% of RN work day is taken up by increasing demands of the healthcare delivery system • Increased documentation • New procedures – care, equipment • Process changes, new initiatives • Technology • New staff • Shorter patient lengths of stay • More complex patients • Financial constraints • Manager turnover • “Complexity Compression” – a new term used to describe this phenomenon – University of Minnesota/Minnesota Nurses’ Association study in 2003; inductive methodology - phenomenon described to groups of nurses, their responses documented, key factors ranked; themes emerged • Current expressions of complexity went beyond what nurses “expect” to happen (Krichbaum, K. et al. Complexity Compression: Nurses Under Fire, Nursing Forum, 42 (2), April-June 2007).

29. Evidence Base Supports Existence of this Phenomena for Past Two Decades • Many studies have evaluated the nursing practice environment and complex work environments • Aiken et al. 2001. Nurses’ report on hospital care in five countries. Health Affairs, 20(3), 43-53. • Aiken, Sean, Sloane, Sochalski, & Silber. 2002. Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. Journal of American Medical Association, 288(16), 1987-1993. • Blegen, M.A. (1993). Nurses’ job satisfaction: A meta analysis of related variables. Nursing Research, 42(1), 36-41. • Lashinger & Havens. 1996. Staff nurse work empowerment and perceived control over nursing practice; conditions for work effectiveness. JONA, 26(2), 27-35. • Woods, D.D. 1988 Coping with Complexity: The psychology of human behavior in complex systems. In Tasks, errors, and mental models, pgs 128-148.

30. The result? • Nurses are expected to assume additional responsibilities, often unplanned, while conducting their other multiple responsibilities, all within a condensed time frame, with expended energy. • Leads to job stress, anxiety, frustration, anger, feelings of helplessness, loss of control. (Krichbaum, K. et al. Complexity Compression: Nurses Under Fire, Nursing Forum, 42 (2), April-June 2007).

31. Simultaneity Complexity “In contrast to medicine, law, and other professions in which the client-practitioner relationship is based on sequential care to one client at a time, clinical nurses are expected to care for 2 to 5 patients simultaneously. Unlike some professions (teachers in classrooms, lawyers in class-action suits, or pastors with their parishioners) in which the client-practitioner relationship is based on groups of similar clients with similar needs, nurses must care for multiple, diverse clients with different and rapidly changing conditions and needs.” Schmalenberg, C. andKramer M.(2008).Clinical units with the healthiest work environments. Critical Care Nurse, 28: 65-77 .

32. 6 Complexity Compression Themes # 1 Personal – physical/mental exhaustion, family/individual concerns #2 Environmental • physical (tight spaces, lack of storage, many distractions), • psychosocial (interpersonal conflicts with other staff, non-collegial atmosphere, workplace incivility) • cultural (lack of trust/respect, lack of unit cohesiveness) (Krichbaum, K. et al. Complexity Compression: Nurses Under Fire, Nursing Forum, 42 (2), April-June 2007).

33. Compression Complexity Theme #3 #3 Practice • Delegation – oversight of other personnel, assignment coordination • Conflicting priorities (many equally important tasks) • Floating/cross-training – multiple roles/functions • Time – difficulty prioritizing • No safety net – lack of back-up or support for unplanned events • Patient/family issues – conflicts related to emotional, physical, spiritual concerns of patient and family members • Culture: patients and staff – additional time/attention to address cultural issues, diverse co-workers • Mentoring/precepting – additional responsibilities to mentor/precept students, new staff (Krichbaum, K. et al. Complexity Compression: Nurses Under Fire, Nursing Forum, 42 (2), April-June 2007).

34. Compression Complexity Theme #4 #4 Systems • System failures – breakdown or failure • Multi-changes – multiple, concurrent changes within the department/organization • Lack of safety net – lack of back up for system failure • Documentation – new, excessive, changing forms/methods • Regulatory/legal – state, federal regs that impact practice changes • Budget – fiscal constraints that affect patient care • Staffing – inadequacy of staffing system, lack of flexibility • Technology – new, changes in work flow, training needs (Krichbaum, K. et al. Complexity Compression: Nurses Under Fire, Nursing Forum, 42 (2), April-June 2007

35. Compression Complexity Theme #5 #5 Administration/management • Ineffective – unskilled, inexperienced • Lack of understanding – insufficient knowledge of administrators and managers about the work done by nurses • Change in upper management – numerous, unpredictable changes in leadership with impact on new initiatives, policy/procedure (Krichbaum, K. et al. Complexity Compression: Nurses Under Fire, Nursing Forum, 42 (2), April-June 2007

36. Compression Complexity Theme #6 #6 Autonomy/Control • No input into decision-making –nursing perspective is not solicited related to decisions impacting nursing practice at unit or system level • Input not valued – perspectives are solicited, but not valued • Change in upper management – changes in personnel, managerial style and philosophy, impact on policy and procedures that guide practice (Krichbaum, K. et al. Complexity Compression: Nurses Under Fire, Nursing Forum, 42 (2), April-June 2007

37. Strategies to Address the Big “CC” • Gaining control over practice – shared decision-making, staying competent in field of practice, promoting more positive work environment, conflict management, assertive communication • Professional development – gaining new skills/knowledge, cross-training, informal/formal education, specialty certification, always staying one step ahead • Staying involved/engaged – workplace committees, community groups, professional organizations (my 4th plug for getting involved in ONS!) • Prepare for the “unexpected” – develop contingency plans, teamwork (divide & conquer) • Professional self care – nutrition, exercise, sleep, preventative medical care, meditation, leisure activities, spiritual reflection, relationships, resolve conflicts, have FUN.

38. How can your local chapter help you cope with complexity compression? Group discussion period

39. Do what you can, with what you have, where you are. -Theodore Roosevelt

40. How Can I Get More Involved?I’m barely hanging on now! • Check out our chapter virtual community on the ONS web site • Join a SIG at national level • Join a chapter committee – many hands make “light work” • Attend Leadership Development Institute, attend National ONS Congress • Participate in a community outreach event, help plan an educational program, write a virtual article • Bring an oncology nurse friend to a chapter event • Network with other colleagues – meet someone new each time • Consider running for office – talk to current officers about skills needed, time commitment (its not as “bad” as you may think!)

41. Wherever you go, go with all your heart. - Confucius