Volume 1 • Issue 6 • October 2007 NRSES
Transcript of Volume 1 • Issue 6 • October 2007 NRSES
The relationship fostered be-
tween nurse, patient and pa-
tient family is one of the main
subjects of the Magnet document
and is of the utmost importance for
care providers at Children’s Hospital
Boston. Creating an environment in
which patients can flourish takes the
entire team, and it’s often the admin-
istrative tasks that take place behind
the scenes that ensure the highest
quality of patient care.
Along with illustrating the hos-
pital’s patient care philosophy, the
Magnet document required details
about the processes Children’s has
established to ensure that our goals
are met. The hospital’s blueprint for
meeting patient needs is the Plan
for Provision of Care, which consid-
ers the many components of care,
including the:
n unique needs of each patient
and family
n improvement of quality and
safety of care in patient areas
n structure and process in
each area to identify patient
care needs
n provision of a uniform level of
care throughout the organization
“Each unit has a scope of ser-
vices statement that outlines the
patient populations served and
how their needs are met, and is
reviewed annually,” says
Herminia Shermont, MS, RN,
CNA, director of Surgical Pro-
grams. Data on unit activity,
including admissions, discharges,
transfers and lengths of stay; unit
technology; turnover and vacancy
Methods to meet patient needs
� continued�on�page�2
Volume 1 • Issue 6 • October 2007
NURSESDedicated to Excellence
It’s an excItIng tIme for children’s
Hospital Boston, as we’ve just heard
from the american nurses creden-
tialing center that our documentation
has been found to “fall within the
range of excellence” required by
the magnet recognition program. I’d
like to thank every one of you who
worked tirelessly to compile this
evidence of the exceptional quality of nursing provided here
at children’s.
One of the components of our submission was called
Journey nurses. One nurse representing each Force
of magnetism was asked to write a reflective essay on
how his or her nursing practice related to a given Force.
Fourteen nurses’ essays were featured and represent the
journeys we each embarked on as we started our nurs-
ing careers and those pivotal moments we all experience
throughout our careers.
my own journey began on a 34-bed pediatric wing at
a new Jersey hospital. there, I faced many challenges,
including competition for resources and a lack of clear
leadership. Looking back, I realize that those obstacles
shaped the nurse I am today. But to a greater extent,
it’s the interactions with my children’s colleagues that
have influenced me. When I’m asked what my greatest
contribution has been during my 18 years at children’s,
my response is simple: I’ve never done anything on my
own; it’s always taken a team. I believe we are all on this
journey together.
this issue of Dedicated�to�Excellence provides insight
into the contents of the magnet document. We look
forward to the november site visit, when we can demon-
strate our exceptional patient care to the appraisers.
Sincerely,�
Eileen�Sporing,�MSN,�RN,�CNAA,�BC
Senior�Vice�President,�Patient��Care�Operations,��
Chief�Nursing�Officer
From Eileen Sporing, MSN, RN, CNAA, BC
Magnet site visit confirmed
Herminia Shermont, MS, RN, CNA
�www.childrenshospital.org/nursing
Theoretical/practice frameworks
Children’s Hospital Boston’s
family-centered approach
to care is evident in every-
day clinical practice. the magnet
document illustrated our family-
centered approach by emphasizing
children’s firm belief that the needs
of individual patients and families
should direct the nursing care they
receive. “the goal of all nurses is
not only to promote the optimal
health and development of each
patient, but also that of the family,”
reads the document’s summary of
our nursing theoretical and practice
framework.
central to this framework is the
synergy model, which was devel-
oped by the american association
of critical care nurses in 1998.
Martha Curley, PhD, RN, FAAN,
nurse researcher, was one of the
architects of the model and helped
implement it at children’s.
In the synergy model, patients and families are active participants in their nursing
care. the nurse comes to know each patient and family and they, in turn, come to know
the nurse. When this relationship is synergistic, optimal patient outcomes are more
likely to occur. the synergy model incorporates eight competencies to help nurses reach
and maintain the skills and knowledge needed in order to offer this type of care. these
competencies are clinical judgment, clinical inquiry, caring practices, response to diversity,
advocacy, facilitation of learning, collaboration and system thinking. the magnet docu-
ment further states that these values are central to nursing’s Professional advancement
Program. Performance evaluations reflect adherence to the synergy model and stress the
importance of the eight competencies.
the combination of this practice framework and the dedication of children’s nursing
staff has helped create an environment of compassionate, family-centered care that is
one of the hallmarks of children’s nursing practice.
Methods to meet patients needs continued�from�page�1
rates and the overall experience of the staff,
are analyzed to develop staffing plans. These
formalized staffing plans are reviewed on a
continual basis in conjunction with quality
improvement activities, utilization review,
risk management activities, changes in
patient needs and expectations and multiple
screening indicators that relate to patient
outcomes that may also impact staffing
effectiveness.
“Children’s is committed to determin-
ing and delivering the appropriate number
of nursing staff for each patient care unit
since these numbers have a direct impact
on the care delivered,” says Shermont. For
example, Children’s uses ANSOS One-Staff,
a computerized information system that
uses rules-based scheduling, incorporating
employee preferences and skill–level to
assist with staffing and scheduling.
The staffing policy is further outlined
in the Assigning Nursing Care of Patients
policy. As noted in the policy, clinical leaders
making assignments must consider multiple
variables, including the:
n frequency and intensity of nursing care
associated with each patient
n changing nature of each patient’s
condition
n nurse’s knowledge, skills and expertise
n degree of supervision required
“Safe and accurate staffing is monitored by
the charge nurse and the unit’s nursing man-
agement to ensure that every patient’s needs
are met effectively by the nurses we have on
staff,” says Shermont.
Thank you to everyone who helped us with the Magnet process:n Magnet Core Team: eileen Laband,
Lynne Hancock, Diane Hanley,
Linda connor, Jane murphy, Judy Farley
and cheryl mullan
n Magnet Champions: Way too many
to name!
n ISD: shelley norton and Jay Duda
n Nurse Leaders: eileen sporing and nec,
nurse managers, clinical coordinators
n Public Affairs: matt cyr, erin graham
and Patrick Bibbins
n Staff Development, Wolbach
Administrative staff and Media Services
Martha Curley PhD, RN, FAAN
From left, Lynne Hancock, RN, MSN, Linda Connor, RN, BA, Diane Hanley, MS, RN, BC
� nursing | October 2007
Caption
throughout her 20 year nursing
career, Cheryl Toole, MSN, RN,
nurse manager in children’s Hospital
Boston’s nIcU, has experienced many
aspects of nursing, both as a nurse and
anxious parent on the receiving end of our
nursing care. as a result, toole was chosen
to represent children’s as a Journey nurse
for Force 3 in the magnet document.
Using her experiences as nurse and parent
of a children’s patient, toole has developed a
personal management philosophy that
reflects magnet Force 3 goals: to demonstrate
how children’s work environment supports
participation and feedback. Her management
style encourages an environment in which
nurse leaders are visible, accessible and com-
mitted to communicating effectively with staff.
since joining children’s, toole has served
as a staff nurse, nurse educator and clinical
nurse specialist. Last year, she took on the
new role of nurse leader, a move she didn’t
plan on making, but one that she’s grown to
love. “children’s leadership philosophy is to
support the staff and foster enthusiasm un-
der the assumption that if the staff thrives,
then the patients thrive as well,” says toole.
“Fortunately, the nurses here are incredible
leaders, allowing me to really build upon a
foundation of excellence.”
One of the important lessons toole has
learned as a new nurse leader is to consider
every moment as a learning opportunity. “I
don’t place hierarchical limitations on who I
Children’s Hospital Boston’s focus on
safety, for both patients and nurses,
was highlighted in the Magnet docu-
ment. Part of the document reviews the many
initiatives that are in place to cover all aspects
of safety at the hospital.
The Program for Patient Safety and Quality
ensures that patients receive the best possible
care. Four times a year, the program gathers
data on 35 key outcome measures, which are
broken down into clinical, community, clini-
cal research and teaching.
Children’s Hospital Applications Maximiz-
ing Patient Safety (CHAMPS) integrates many
of the key computer-based systems used to
care for patients into an electronic medical
record. CHAMPS makes it easier and faster to
access detailed information, improving patient
care and reducing errors.
The basis of nurses’ professional care is
the Professional Behavior for Clinicians. This
series of recommendations is based on the
American Association of Critical-Care Nurses
position statement that stresses collaboration,
constant attention and nurturing through the
formal hospital channels.
Some of the services that are currently in
place to protect Children’s’ nurses include
the hospital’s Occupational Health Services
Department, which monitors work-related
injuries, and the Health Surveillance Pro-
gram, which is responsible for anesthetic
monitoring.
One common problem that nurses face
is the possibility of needle sticks, and the
Bloodborne Exposure Control Committee
(BECC) is in place to monitor these occur-
rences. The BECC has added new products,
like safety intravenous catheters, scalpels,
lancets and butterflies, to reduce needle
sticks, and has added more education and
training classes.
nursing profile: Cheryl TooleJourney nurse in magnet Force 3
can learn from or quantify the value of a learning opportunity based on the status or experi-
ence of the individual,” she says. this opportunity played out in an unexpected way when
her daughter, avery, was born with critical congenital heart disease three years ago. toole
says she was able to better understand her unique role in this institution by looking at it from
an outside perspective.
“Being on the receiving end of the phenomenal care offered here at children’s is a bit ex-
traordinary,” she says. “It’s helped me realize the impact of everything I do here and appreciate
the fact that everyone here makes a difference.”
�www.childrenshospital.org/nursing
Safe environments for patients and nurses
Children’s Hospital Boston Nurses: Dedicated to Excellence A publication of Children’s Hospital Boston Department of Nursing
Editorial Board
Diane Hanley, RN, MS
Anna Gonski
Pam Dockx, RN
Pam Gorgone, RN
Marge David, RN
Deb Krepcio, RN
Diane Stanley, RN, MS
Pam Schubert, RN
Larraine Bossi, RN
Camilla Cook, RN
Matthew Cyr
Editors
Erin Graham
Matthew Cyr
Louise Cobb
Writers
Jennifer Gundersen
Eric Bland
Designer
Carolyn Bowes
© 2007, Children’s Hospital Boston. All rights reserved.
NUR
SES
We are the Champions
From left, Patti Branowicki, Eileen Sporing, Joseph Madsen
�
Evid
ence
-bas
ed t
ips
nurses aren’t the only ones who use evidence-based practice at children’s Hospital
Boston. nursing management also bases administrative practices on the best avail-
able evidence to improve the workplace for nurses—an approach cited in the magnet
document. “changes are made when opportunities for improvement are identified,”
it reads. annual surveys are one way for nursing administration to find ways to
improve the quality of care at children’s.
changes were made in 2005 after data revealed children’s was below the national
average in two categories. When asked questions about adequate discharge plan-
ning and moving and lifting concerns on the nDnQI Rn satisfaction survey, only 28
percent and 49 percent of nurses, respectively, said they received enough help,
compared to the national average of 64 percent and 63 percent, respectively.
to raise these numbers and improve patient care, nurses identified a role focused
on discharges and charge nurses were put in facilitator roles. In 2006, the numbers
jumped dramatically—up to 95 percent satisfaction for adequate discharge planning
and 90 percent for lifting and moving.
Opportunities for change led to jumps in satisfaction scores for discharge planning and moving/lifting
Magnet Document fun facts:n It weighed
nearly 40 pounds
n It was more than 15 inches thick
n It was about 2,500 pages
n It took 10 months to write and edit
Eileen Sporing, MS, RN, CNAA, BC
senior vice president of Patient Care Operations
and chief nursing officer
Thanks to Sporing, members of our non-phy-
sician clinical staff have had this in common
for the last 18 years: a gifted and dedicated
leader. Committed to the highest standards
of care for patients, families and employees,
Sporing was integral in the planning and con-
struction of the clinical building expansion.
This expansion has been embraced by all who
step inside. “My job is to make patient care
work,” says Sporing. “Wherever it happens.”
Patti Branowicki, MS, RN, CNAA
vice president of Medicine Patient Services and
director for Nursing Patient Care Service for
Pediatric Oncology at Dana-Farber Cancer Institute
During her 27-year pediatric nursing career,
Branowicki has dramatically improved the
experience of families of children with can-
cer, especially as they face end-of-life issues.
She understands the crucial role nurses play
in defining that experience. “Nurses at the
bedside have the ability to make change,”
says Branowicki. “My role is to listen to
their ideas, eliminate barriers, and support
the passion and desire that nurses have to
provide excellent patient care.”
Joseph Madsen, MD
associate in Neurosurgery
Call him the Edison of pediatric neurosurgery.
Madsen’s six patents and numerous products
in development are changing the way physi-
cians everywhere treat neurological diseases in
children. His insights into hydrocephalus may
one day lead to a drug-only treatment. “A true
surgical innovator tries to find ways to make
surgery obsolete,” says Madsen.
As part of its annual Health Care Champion’s Awards, the Boston Business Journal
recently recognized three Children’s Hospital Boston “visionaries.” The Champions in
Health Care awards are bestowed on the best and brightest health care professionals
throughout all of Massachusetts. Congratulations to these Children’s winners:*DOn’t FORget that
the magnet site visit
will be november
14, 15 and 16. In
preparation, the
magnet
Recognition Pro-
gram is looking for
public feedback
about children’s
prior to their visit.
You can submit
your comments
by november 1 to
magnet@ana.
org, or by phone to
866-588-3301 or by
fax at 301-628-5217.
children’s looks for-
ward to this exciting
opportunity.
Magnet feedback in preparation for the site visit