Essentials Self-Assessment and Patient Centered Care

Essentials Self-Assessment and Patient Centered Care. Chamberlain College of Nursing NR447: RN Collaborative Healthcare Week 2: The AACN Essentials of Baccalaureate Education for Professional Nursing Self-Assessment Understanding the competencies related to the AACN Essentials of Baccalaureate Education for Professional Nursing Practice provides you with valuable information as you begin to study this course. Complete this self-assessment, which is based on The Essentials of Baccalaureate Education for Professional Nursing from the American Association of Colleges of Nursing (2008) prior to posting to the discussion on this topic Place a check mark or X in the column that best describes your current level of competency or understanding of the Essential’s statement. There are no incorrect answers. After you have completed the assessment, total the number of points that you earned. Record this number in a location where you will be able to retrieve it at the end of the course, when it will serve as the basis for a future discussion. AACN (American Association of Colleges of Nursing) Baccalaureate Essentials Essential II: Basic Organizational and Systems Leadership for Quality Care and Patient Safety Apply leadership concepts, skills, and decisionmaking in the provision of high quality nursing care, healthcare team coordination, and the oversight and accountability for care delivery in a variety of settings. Demonstrate leadership and communication skills to effectively implement patient safety and quality improvement initiatives within the context of the interprofessional team. Participate in quality and patient safety initiatives, recognizing that these are complex system issues, which involve individuals, families, groups, communities, populations, and other members of the healthcare team. Employ principles of quality improvement, healthcare policy, and cost-effectiveness to assist in the development and initiation of effective plans for the microsystem and system-wide practice improvements that will improve the quality of healthcare delivery. Essential V: Healthcare Policy, Finance, and Regulatory Environments NR 447 Week 2 Self-Assessment Form.docx Poor 1 9-6-15 LMD Good 2 Very Good 3 X Excellent 4 X X X X X 1 Chamberlain College of Nursing NR447: RN Collaborative Healthcare Demonstrate basic knowledge of healthcare policy, finance, and regulatory environments, including local, state, national, and global healthcare trends. Explore the impact of sociocultural, economic, legal, and political factors influencing healthcare delivery and practice. Examine the roles and responsibilities of the regulatory agencies and their effect on patient care quality, workplace safety, and the scope of nursing and other health professionals’ practice. Advocate for consumers and the nursing profession. Essential VI: Interprofessional Communication and Collaboration for Improving Patient Health Outcomes Use inter and intrarofessional communication and collaborative skills to deliver evidence-based, patient-centered care. Incorporate effective communication techniques, including negotiation and conflict resolution to produce positive professional working relationships. Demonstrate appropriate teambuilding and collaborative strategies when working with interprofessional teams. AACN Essentials Self-Assessment and Patient Centered Care

Essentials Self-Assessment and Patient Centered Care. Advocate for high-quality and safe patient care as a member of the interprofessional team. Essential VIII: Professionalism and Professional Values Demonstrate the professional standards of moral, ethical, and legal conduct. Promote the image of nursing by modeling the values and articulating the knowledge, skills, and attitudes of the nursing profession. Reflect on one’s own beliefs and values as they relate to professional practice. Articulate the value of pursuing practice excellence, lifelong learning, and professional engagement to foster professional growth and development. Total for each column Grand total (add all columns) X X X X X X X X X X X X X X 1 5 14 Source: American Association of Colleges of Nursing (AACN). (2008). The essentials of baccalaureate education for professional nursing practice. Washington, DC: AACN. Retrieved from http://www.aacn.nche.edu/education-resources/baccessentials08.pdf/ NR 447 Week 2 Self-Assessment Form.docx 9-6-15 LMD 2 Kramer6_09pgs.qxp:77_93_Kramer6_09 5/13/09 8:26 AM Page 77 Healthy Work Environments Article 6 in a series of 8 Walk the Talk: Promoting Control of Nursing Practice and a Patient-Centered Culture PRIME POINTS • Control of nursing practice and a patientcentered culture promote the quality of nurses’ work environments and the quality of patient care. • Culture is the norma- tive glue that preserves and strengthens the group and provides the healing warmth essential to quality care. • “Walk the talk” is a best practice through which the values of unit and hospital culture are lived and control of nursing practice by nurses can be achieved. www.ccnonline.org Marlene Kramer, RN, PhD Claudia Schmalenberg, RN, MSN Patricia Maguire, RN, MN, CNAA, BC Barbara B. Brewer, RN, PhD Rebecca Burke, RN, MS, CNAA, BC Linda Chmielewski, RN, MS, CNAA, BC Karen Cox, RN, PhD Janice Kishner, RN, MSN, MBA Mary Krugman, RN, PhD Diana Meeks-Sjostrom, RN, MSN, PhD, CS, FNP-C, ONC Mary Waldo, RN, PhD, CNS-BC T o “walk the talk”—putting values into action, leading by example, practicing what you preach—is a best practice related to 2 of the 8 attributes or work processes identified by staff nurses as essential to a healthy work environment. These 2 attributes, control of nursing practice and a culture in which concern for the patient is par amount, are the focus of this article. Another commonality of these 2 essential attributes is that they are the only 2 of the 8 that have as many departmental/hospital-wide implications as they do unit-focused implications. Nurses cannot control practice or engage in activities ©2009 American Association of CriticalCare Nurses doi: 10.4037/ccn2009586 related to a patient-centered culture at the unit level unless parallel sanction and endorsement for these activities exist at the organizational level. After clarifying and illustrating the walk-the-talk metaphor and the constructs control of nursing practice and shared governance, we present the results of research that pertain to control of nursing practice and a patient-centered culture. We then suggest ways in which clinical nurses can operationalize the walk aspect of the talk, the values and beliefs inherent in control of nursing practice and a patient-centered culture. Walk the Talk The cultural metaphor walk the talk is not new, but its use in both popular and professional literature CriticalCareNurse Vol 29, No. 3, JUNE 2009 77 Kramer6_09pgs.qxp:77_93_Kramer6_09 5/13/09 and in everyday colloquial usage is increasing.1,2 In the study that provided the data for this article, the term was freely used by all—staff nurses, managers, physicians, and other professionals—in all hospitals and in all regions of the United States. It was used in conjunction with 3 of the 8 essentials of a healthy work environment: nurse manager support, control of nursing practice, and a patient-centered culture. AACN Essentials Self-Assessment and Patient Centered Care

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Essentials Self-Assessment and Patient Centered Care. The following 2 examples illustrate use of this metaphor with respect to a patientcentered culture and control of nursing practice. The first excerpt from a 2001 staff nurse interview3 illustrates the metaphor with respect to culture. We have a responsibility to participate in research, especially being a magnet hospital! It’s part of our 8:26 AM Page 78 culture, our norms. Nursing in this hospital is “gung ho” on research . . . But it’s not enough to talk the game, there has to be action. The very least we can do to show that we value research is to fill out surveys like this. The second example illustrates use of the walk-the-talk metaphor in the control of nursing practice. One of the study hospitals that had been invited to participate in the structureidentification studies declined because of a busy schedule of upcoming activities. A week after the invitation was declined, the investigator was informed that the administrative group had been hasty in their decision and that the request was being sent to the shared governance Authors Marlene Kramer is vice president, nursing, at Health Science Research Associates, Apache Junction, Arizona. Claudia Schmalenberg is president, nursing, at Health Science Research Associates, Tahoe City, California. Patricia Maguire is a research associate and consultant at Health Sciences Research Associates, Townsend, Massachusetts. Barbara B. Brewer is the director of professional practice at John C. Lincoln Hospital, Phoenix, Arizona. Rebecca Burke is senior vice president, patient care services, and chief nursing officer at Miriam Hospital, Providence, Rhode Island. Linda Chmielewski is vice president, hospital operations, and chief nursing officer at St Cloud Hospital, St Cloud, Minnesota. Karen Cox is executive vice president and cochief operating officer at Children’s Mercy Hospitals and Clinics, Kansas City, Missouri. Janice Kishner is chief nursing officer and chief oper ating officer at East Jefferson General Hospital, New Orleans, Louisiana. Mary Krugman is director of professional resources at University of Colorado Hospital, Denver, Colorado. Diana Meeks-Sjostrom is the director of nursing research at St Joseph’s Hospital of Atlanta, Georgia. Mary Waldo is a clinical nurse specialist in outcome studies and nursing r esearch at Providence-St Vincent’s Hospital, Portland, Oregon. Corresponding author: Marlene Kramer, RN, PhD, FAAN, 3285 N Prospector Rd, Apache Junction, AZ 85219 (e-mail: mcairzona@juno.com). To purchase electronic or print reprints, contact The InnoVision Group, 101 Columbia, Aliso Viejo, CA 92656. Phone, (800) 899-1712 or (949) 362-2050 (ext 532); fax, (949) 362-2049; e-mail, reprints@aacn.org. 78 CriticalCareNurse Vol 29, No. 3, JUNE 2009 research council for disposition. The council contacted the investigators, sought additional information, endorsed the study, and expedited the institutional review board’s review process. The chief nursing executive explained that the council structure was still relatively new and that nurses and administrators were still learning how to make decisions together, how to walk the talk and “practice what we preach.”4 Source of the Data In the spring and summer of 2006, we conducted a nationwide study4-7 in 8 strategically selected magnet hospitals. The purpose of the study was to ascertain the organizational structures and leadership practices that staff nurses identify as necessary for a healthy work environment, specifically, structures and practices that promote control of nursing practice and a patient-centered culture. To achieve this purpose, we needed to elicit the answers from staff nurses working in patient-centered cultural environments with confirmed control of nursing practice. AACN Essentials Self-Assessment and Patient Centered Care

Essentials Self-Assessment and Patient Centered Care. The Essentials of Magnetism (EOM),8-10 a tool used to measure the extent to which staff nurses confirm that they have healthy work environments, has subscales to measure control of nursing practice and patient-centered culture as well as the other 6 essentials. It has been administered to staff nurses in hundreds of hospitals, mostly magnet hospitals, since its development in 2003. The results of these EOM evaluations were used to select the hospital sample for this study. We selected the 8 magnet hospitals, according to the 8 census-tract regions of the United States, that www.ccnonline.org Kramer6_09pgs.qxp:77_93_Kramer6_09 5/13/09 had the highest or second-highest EOM scores. To obtain the interview sample, we selected the clinical units with the highest EOM scores within each hospital. The “experts” that we interviewed on these units consisted of 244 staff nurses nominated by their peers and managers, 105 nurse managers, and 97 physicians nominated by staff nurses or managers. The number of staff nurses interviewed varied by the size of the unit but usually consisted of 2 or 3 staff nurses, 1 nurse manager, and 1 physician per unit. We interviewed the chief operating officer, the chief nursing officer, and 4 to 6 representatives from professional departments such as respiratory therapy, physical therapy, dietary, and pharmacy in each hospital to obtain the perspectives of these personnel of the nursing department and the degree of interdepartmental collaboration. We also conducted “participant-observation,” a qualitative research technique,11,12 in all central and unit council meetings during the 4-day on-site visit. Control of Practice The American Nurses Credentialing Center, which governs magnet designation, refers to control of nursing practice as “shared” or “unit-based” decision making related to an environment in which administrators use a participative management style.13 The Institute of Medicine,14 in the institute’s delineation of 5 evidence-based management practices needed for a healthy work environment, define it as “involving workers in decision making pertaining to work design and work flow.” Staff nurses in magnet hospitals define control of nursing practice as a work process through www.ccnonline.org 8:26 AM Page 79 which nurses at all levels in the organization have input and make decisions on issues of importance that affect nurses, the context of nursing practice at unit, departmental, and hospital levels, and the quality of patient care provided.15 The input includes access to power and exchange of information, views, and judgments; the decision making is interdependent and shared; and the issues of importance include practices, standards, policies, and selection of equipment. Nurses wrote of control of nursing practice as follows: Control of nursing practice means two things to me. On the unit, it means that I determine the order and sequence of my work, interventions, and functions. What works best for most of my patients. It means that I have a “say-so” in how the unit is run, how we float, and do self-scheduling. . . Control of nursing practice also means that nurses as a group, all of us in this hospital, the managers and administrators, well they’ve always been responsible for making the decisions, what is new [is] that now staff nurses are involved. We are responsible and accountable for group decisions. Together, with the administrators, we control our practice and the practice environment. We are responsible and accountable for the quality of nursing in this hospital. And those aren’t just empty words. . . . We not only have “a say,” we make decisions about policies and issues and equipment. . . . Sometimes when a problem or issue is presented, it is made clear from the “get-go” that we are being asked for input only, that administration will make the decision. And that’s OK as long as we know “up front.” AACN Essentials Self-Assessment and Patient Centered Care

When you make the decision, you are accountable for the outcomes. Staff nurses in both the United States15,16 and Canada,17 now4,18,19 and in the past, 20 concur with wellestablished precepts of a profession in distinguishing between clinical autonomy and control of nursing practice. Clinical autonomy is individual, patient-centered decision making with the patient as the primary and often sole beneficiary. In much of the nursing literature,18,19 clinical autonomy and control of nursing practice are combined, referred to simply as decision making, and are discussed as though they were the same attribute. The American Association of CriticalCare Nurses standards for maintaining and sustaining a healthy work environment21 group the 2 dimensions of autonomy under a single standard, effective decision making, but particularly note the principle of unique and combined spheres of practice that is so critical in selecting the appropriate type of decision making: independent or interdependent. Control of practice, articulated by Flexner22 almost 100 years ago in his characteristics of a profession, is the self-regulation and self-determination of professional CriticalCareNurse Vol 29, No. 3, JUNE 2009 79 Kramer6_09pgs.qxp:77_93_Kramer6_09 5/13/09 issues, practices, and standards by professionals. The following excerpt from an interview with a staff nurse illustrates the application of this definition to nursing. (All excerpts in this article are from interviews with staff nurses unless noted otherwise. NM indicates excerpts from interviews with nurse managers; MD, excerpts from interviews with physicians.) 8:26 AM Page 80 centrally but you need input from all units. But, then, there are some issues that are unit-specific and these we take care of in Unit Council. Shared Governance As in any form of self-regulation or self-determination, a structure is needed to facilitate smooth and implementation of principles such as partnership, ownership, accountability, and equity.4 Investigators and experts have noted or empirically shown that shared governance structures that are not practical and are not accompanied by best management practices will not enable nurses to control practice. Laschinger and Wong24 state that What makes shared governance structures viable and what best practices make shared governance structures effective in enabling nurses to control nursing pract ices? What MDs do in Medical Council, we do in Nursing Council.

We solve practice issues like what kind of dressing is best for the hospital to buy for PICC lines, we establish standards of practice, review quality indicators, and are responsible and accountable for the general practice of nursing in this hospital. We also have a hand in deciding skill mix and how many positions and what kind of positions go where. We worked out all the procedures for how to get flu shots to the patients and staff that needed them. . . . We decide on what should be done with new graduates who don’t pass boards . . . It doesn’t work unless there is communication and follow-through between central and unit councils. If it’s an issue affecting nurses or patients on all units, then it’s decided 80 CriticalCareNurse Vol 29, No. 3, JUNE 2009 accountable operation. In nursing, control of nursing practice is operationalized through shared governance or similar structures. Born on the heels of the participative management and decentralization themes of the early 1980s, shared governance is a nursing management innovation that legitimizes nurses’ control of nursing practice while extending the influence (input and decision making) of nurses at all levels, to administrative areas previously controlled by management.23 Shared governance is a structural configuration of councils and committees that provide formal mechanisms that ensure nurses’ responsibility, right, and power to make decisions and to control nursing practice. Whether termed shared leadership, clinical governance, collaborative governance, shared decision making, or simply the nursing council, the structure alone will not “bake the cake.” The structure must be accompanied by best management practices that make shared governance possible through “most shared governance efforts are seen by staff as chiefly structural, with staff nurses on councils and committees but without the authority to have significant control over professional practice, thus leading to cynicism and unwillingness to assume accountability for client outcomes.” Cynicism, unwillingness to be accountable, and lack of decision making were also reported in a nationwide survey25 of staff nurses working in hospitals that supposedly had shared governance systems in place. Although shared governance is not identified as a force of magnetism or listed as a source of evidence,26 it is commonly understood that shared governance or a similar structure is required for designation as a magnet hospital. However, staff nurses in some magnet hospitals …