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Relationship of Nursing Excellence to Evidence Based-Practice

For many years, the American Nurses Credentialing Center (ANCC) Magnet Recognition Program® (MRP) has been synonymous with environments in which nurses prefer to practice and patients achieve the best outcomes. Nurses that are retained in a Magnet-accredited hospital are involved directly in making choices on patient care, and they are active in contributing to healthcare changes based on EBP. “A growing body of research indicates that Magnet hospitals have higher percentages of satisfied RNs, lower RN turnover and vacancy, improved clinical outcomes, excellent nurse autonomy and decision-making capabilities, and improved patient satisfaction” (Drenkard, 2010, p. 264). Brown (2009) wrote, “Evidence-based practice (EBP) is recognized by the healthcare community as the gold standard for providing safe and compassionate care. It is an essential component of any organization having achieved MRP status.”

You can think about this information when you address the need for EBP support at your facility. EBP’s central importance to nursing excellence and its flagship status at any organization deemed worthy of MRP designation indicates that EBP support should move out of the category of “nice to have” and into the category of “need to have.”

Recognizing quality patient care, nursing excellence, and innovations in professional nursing practice, the MRP program provides consumers with the ultimate benchmark to measure the quality of care they can expect to receive. When U.S. News & World Report published its annual showcase of America’s Best Hospitals, designation as an MRP facility contributed to the total score for quality of inpatient care. In 2013, 15 of the 18 medical centers on the exclusive U.S. News Best Hospitals in America Honor Roll, and all 10 of the U.S. News Best Children’s Hospital Honor Roll, are ANCC Magnet-recognized organizations (ANCC, 2014).

MRP designation is based on quality indicators and standards of nursing practice as defined by the American Nurses Association’s Scope and Standards for Nurse Administrators (2009). The Scope and Standards for Nurse Administrators and other foundational documents form the base upon which the MRP environment is built. The designation process includes the appraisal of qualitative factors in nursing, and these factors, referred to as the 14 Forces of Magnetism, were first identified through research conducted in 1983. The 14 Forces were reconfigured under 5 Model Components in 2008, which places a greater focus on measuring outcomes.

The full expression of MRP designation embodies a professional environment guided by a strong visionary nursing leader who advocates and supports development and excellence in nursing practice. As a natural outcome of this, the program elevates the reputation and standards of the nursing profession.

Source: Evidence-Based Practice Made Simple

How evidence-based practice can improve nurse satisfaction

If a nurse is unsatisfied with their career or feeling burnt out on nursing, taking an evidence-based approach can help them rediscover their passion for nursing. Robert Hess Jr., PhD, RN, FAAN and co-author of HCPro’s Shared Governance book, recently wrote a piece about EBP and nursing careers; here are some ways to apply EBP in your career:

  • Update your practices. Nursing is changing all of the time! If you feel like you’re stuck doing the same thing every day for years, you’re probably not using the most up-to-date practices. Nurse scientists and researchers are studying and updating practices for nurse specialties all of the time, and these changes can benefit patients and nurses alike. Try joining your specialty group’s professional organizations, attend professional events, and subscribe to specialty journals to keep abreast of the latest practices in nursing. Changing up your routine and increasing your engagement can bring the excitement back to your career!
  • Use EBP in your career. Evidence-based research is not just conducted on healthcare practices. There is organizational research that provides indicators for when nurses should consider a career change, such as switching roles, going back to school, or even leaving their current job. Burnout has been measured for decades, and evaluating your own signs of job fatigue can be instructive for potential career decisions. Nursing has a plethora of opportunities outside of the hospital bedroom, and feeling burnout could be your signal to explore them.
  • Evaluate your environment. Research has found the workplace satisfaction can correlate with career satisfaction. Observe your colleagues; do they seem happy? Do they participate in work group activities, both at work and outside of work? Having coworkers that are satisfied with their jobs has a positive impact on your own satisfaction, and if you’re feeling career fatigue, sometimes your coworkers can fuel your enthusiasm.

For more tips about career satisfaction and burnout, check out these articles from the Strategies for Nurse Managers’ Reading Room:

Delegation prevents nurse manager burnout

RN satisfaction survey promotes positive change


How nurse executives can help tired nurses

Featured webcast: Drug Diversion in Healthcare: Improve Security and Avoid Fines

Phcpro_live_webcast-iconreventing the theft of controlled substances at hospitals continues to be an tremendous issue even with increased security measures. Failed drug diversion programs in hospitals have led to record fines and in the midst of heightened scrutiny over drug security, hospitals must improve their processes to avoid litigation.

On Thursday, April 26 from 1–2:30 p.m. Eastern Time, join us for a live webinar with expert speaker Kimberly New, JD, a nurse, attorney, and consultant who specializes in helping hospitals prevent, detect, and respond to drug diversion.

During this program, New will discuss drug diversion by healthcare personnel and present specific steps facilities can take to minimize the risk of patient harm. She will discuss fundamental components of a diversion prevention, detection, and response program through an overview of the scope of the problem, including case studies. New will also review regulatory standards and best practices relating to controlled substance security and diversion responses. She will additionally provide tips on how to promote a culture in which all employees play a significant role in the deterrence effort.

At the conclusion of this program, participants will be able to:

  • Identify risk factors and signs of employee drug diversion
  • Fully comply with regulatory requirements of the DEA and other accrediting organizations
  • Train staff on how to report suspected abuse and who to report it to
  • Create a culture of accountability and develop an effective drug diversion prevention plan

Don’t miss this opportunity to hear practical advice and have complex regulations simplified in this program suitable for your whole organization. For more information or to order the webcast on demand, call HCPro customer service at 800-650-6787 or visit the HCPro Marketplace.

How rethinking reviews can boost staff morale

Performance review time is never easy. Managers have the uncomfortable task of assessing their team, and the staff is uneasy about what a poor review could mean for their career; if a review goes poorly, it can lead to tension and dissatisfaction long after the review. A new study in The Nursing Management Journal proposes a new way of approaching performance reviews that could make the process a little easier on everyone.

A task force of nurse leaders from a Magnet® recognized hospital system sought to make their process more objective after receiving staff feedback that their performance reviews were too subjective. Previously, the nurse manager would evaluate staff based on the fulfillment of their job description, meeting performance outcomes, and following care commitment guidelines. The team revised the RN job description to better fit the staff’s responsibilities, then created performance metrics based around the revised job description. They hoped that this would provide the staff with measurable results for their performance review and tangible goals for improvement.

The staff responded to this new criteria-based model for reviews. The surveyed nurses said that the new system was more transparent and consistent, and they liked that the results were evidence-based and didn’t hinge on personal bias. Overall, 71.7% of the surveyed staff felt the new process accurately reflected their performance, versus the 37.8% under the previous method. So while performance reviews will always be a headache, perhaps moving to a criteria-based model will help ease the pain.

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Dealing with racism in patients

Nurse managers and their staff often face racism in the work place; Minority Nurse reported that almost half of minority nurses said they have experienced barriers in their career because of their race and educational background. In addition to institutional barriers, there is also the problem of patient racism, where patients refuse care based on the race or ethnicity of the provider. As a nurse, you might be put in the unenviable position of deciding how to handle one of these situations. Do you refuse care to the patient? Do you acquiesce to the patient’s unreasonable demand?

The New England Journal of Medicine published an article last week that provides some useful information about how to handle patient racism. The authors point out that there are a number of concerns to take into account, both legally and ethically. The situation pits a number of rights and laws against each other, including the patient’s right to refuse medical care, laws that require hospitals to provide medical care in emergency situations, and employment rights that dictate that hospitals cannot make staff decisions based on race. Nurses that have been reassigned based on a patient’s racial demands have successfully sued their employers, but if a patient doesn’t receive proper medical attention in a timely manner, facilities are equally liable.

The journal lays out five factors to consider when faced with this difficult situation:

  • The patient’s medical condition: If the patient is unstable, treat the patient right away, regardless of the patient’s preference. It is possible that their current condition is impairing their mental faculties.
  • The patient’s decision-making capacity: Try to assess if the patient is capable of making decisions for themselves; psychosis or dementia are important factors to consider. If the patient lacks decision-making capacity, try to persuade the patient to reconsider their request.
  • Reasons for the request: If there are clinical or ethnically appropriate reasons for reassigning staff, that should be taken into consideration. For example, if there are language barriers or religious concerns, it might be reasonable to accommodate the patient.
  • Effect on the provider: Always take into account the effect a decision might have on the employee. “For many minority health care workers, expressions of patients’ racial preferences are painful and degrading indignities, which cumulatively contribute to moral distress and burnout,” according to the article. Always try to support staff when possible, and discuss their preferences when deciding how to respond.
  • Options for responding: In some situations, staffing might dictate your decision. If the department is understaffed and you cannot provide proper coverage by reassigning, try to persuade the patient.

If faced with a non-emergency situation and a patient is deemed capable of making decisions, the article suggests that it may be best to suggest that the patient seek care elsewhere; though that also has its risks depending on the availability of other treatment.

For more information on this difficult issue, including a useful decision-making tool, read the New England Journal of Medicine’s full article.

Strategies for implementing evidence-based practices: Journal clubs

If you’re looking for ways to get your staff engaged and current on the latest evidence-based practices, then you should consider starting a journal club, a regular meeting of staff members to discuss articles from nursing journals. It’s a great way to improve your staff’s reading habits and critical thinking while promoting cooperation and teamwork.

To start your club, you need to choose someone to select readings. A master’s-prepared nurse specialist or educator would be an ideal candidate to lead the group, but anyone with the proper knowledge or enthusiasm would make a fine choice. They should endeavor to select readings that are informative, relevant, and accessible to encourage nurses of all levels to participate. They should start by selecting a guide to critical reading, so everyone has the tools to discuss the articles. Once they’ve selected the article, make sure the reading is easily obtainable and give plenty of advanced notice to ensure everyone has time to read it.

The biggest hurdle for starting a journal club in a healthcare environment is finding time in your staff’s busy schedule. Ideally, you want to find a time that works for everyone, perhaps during a shared break or change of shift. If this proves too daunting, you can always create a virtual journal club. You could use a hospital intranet, email list, or even a chat forum to discuss the readings.

Once you get everyone together, encourage them to think about the article critically and ask them to evaluate it. Here’s a great list of questions to start discussions and get the group thinking about the reading.

If you find that your group has lost momentum or attendance is waning over time, try providing incentives for attendees. Small perks or competitions can be a great way to encourage attendance and let your group have some fun!

Here are some helpful links to get you started!

Running an effective journal club

From the desk of Adrianne Avillion, DEd, RN

Who should facilitate journal clubs?

Help nurses critique journal articles

Do you have a journal group at your facility? We’d love to hear about your experiences in the comments below!

Reduce clinical alarm fatigue with new HCPro webcast

hcpro webcast-liveThe problem of clinical alarm fatigue is so pervasive in hospitals that The Joint Commission created a new National Patient Safety Goal to address it. With so many device alarms going off, staff may tune them out and miss important warnings that can lead to adverse patient events.

In this webcast scheduled for Wednesday, October 4 at 1 p.m. Eastern, Deborah Whalen and Jim Piepenbrink of Boston Medical Center will explain how their facility successfully reduced alarm fatigue through process management, collaboration, and governance.

Register today for Clinical Alarm Management: Reduce Alarm Fatigue and Meet The Joint Commission’s National Patient Safety Goal and get the knowledge you need to improve alarm management in your facility.

Visit the webpage for more information or to register, here.

Evidence-Based Practice: Share your journey

Do you have an EBP story to share?

For nurses just getting started with evidence-based practice, the steps between deciding on an area to research and implementing a plan for improvement can be overwhelming. Identifying sources of qualified research, interpreting the results, translating procedures from theory to practice… It’s complicated, to say the least.

I’m looking for a few brave souls who would be willing to share what I’m calling “EBP notes from the field.” If you’ve gone through the process from start to finish, would you be willing to share ebpnotesyour story? I see these as 1-2 pages looking into the decision making process, the research you chose, the steps you took to get buy-in from management. What did you learn in the process? How did you implement your research? Have you been able to measure the results?

I’d like to include a few of these stories in an upcoming book project: a simple EBP guide for working professionals. It will be very practical, straightforward, and [more]

Assessing nursing quality and patient safety

Interest in using a variety of nursing engagement surveys as a reportable quality indicator is growing.

This article, written by Cheryl Clark, appears in the June 2015 issues of HealthLeaders magazine.

Do your hospital’s nurses feel empowered? Are nurses’ relationships with physicians strong enough that nurses can call out errors or ask questions without fear? Do they think their hospital hires enough nurses with appropriate skills and provides enough resources to provide safe and timely care? Are nurses involved in making policy?

When nurses are surveyed on these and related questions, which they increasingly are, poor scores may indicate troublesome systemic issues that could, directly or indirectly, affect quality of care, even adverse events. A drop in scores can often be tracked down to a specific hospital unit, research has shown. And poor scores may correlate to “nursing sensitive” patient outcomes, such as patient falls, lengths of stay, pressure ulcers, and infections.

Simply put, this measure is asking nurses what they think about the organization for which they work and how well they trust the care they deliver in their work environments.

Read the full article here.

Nurses Week: Your 20% sneak peek savings

HCPro is celebrating and recognizing nurses all week long with special giveaways, prizes, and promotions, but we don’t want to wait until Wednesday to start the celebration!

Starting today, you can use our special Nurses Week 2015 catalog coverdiscount code to save on any and all nursing books, videos, and webinars… Just use discount code NRSWK2015 at checkout to receive 20% off your selections.

Download and browse our 2015 catalogue of resources for nurse leaders and staff development professionals here, and visit hcmarketplace.com to place your order!

 

 

 

 

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⇒ 5/4: Who inspires you? There’s still time to submit your favorite quotes in posted comments, here.

⇒ 5/6: A thank you to our favorite nurses, from Boston. Here’s the post.