Download The Forces of Magnetism

W i n t e r
2 0 0 7
Nursing
A Publication for and About
the Compassionate and
Caring Nurse Colleagues of
Northern Michigan Hospital
SUMMER 2007
Dear Colleagues,
I would like to tell you about The Magnet Recognition
Program®. It was developed by the American Nurses
Credentialing Center (ANCC) to recognize healthcare
organizations that provide nursing excellence, and provides
a vehicle for disseminating successful nursing practices
and strategies. The Magnet Recognition Program is based
on quality indicators and standards of nursing practice as
defined by the American Nurses Association. The Magnet
designation process is a journey that intensely focuses
on fourteen areas in nursing. These areas are called the
“Forces of Magnetism.” Achieving Magnet Recognition
is a challenging but worthwhile road. Currently, there are
only two hundred fifty-one (251)
recognized Magnet Hospitals. There
are two in the State of Michigan,
William Beaumont Hospital,
designated in 2004, and Munson
Medical Center, designated in 2006.
Completing the Journey promotes
professional practice and a level of
nursing excellence that is a Gold
Standard in Healthcare and
the Gold Standard in Nursing.
Mary-Anne Ponti, RN, Chief Nurse Executive
The Forces of Magnetism
Mary-Anne Ponti, RN, Chief Nurse Executive
T
here are fourteen (14) Forces of Magnetism that exemplify
excellence in nursing. Meeting the requirements of all
14 forces demonstrates excellence and embodies a
professional environment. The fourteen forces are:
Force 1: Quality of Nursing Leadership Knowledgeable, strong,
risk-taking nurse leaders follow a well-articulated, strategic, and
visionary philosophy in the day-to-day operations and all levels of the
organization, convey a strong sense of advocacy and support for the
staff and for the patient. The results of quality leadership are evident
in nursing practice at the patient’s side.
Force 2: Organizational Structure Organizational
structures are generally flat, rather than tall, and decentralized
continued on page 2
Magnet Journey Open
Forums Scheduled…
Anyone interested in learning about the new
Northern Michigan Hospital initiative to achieve
Magnet status may attend any of the following
Tuesday, July 10 at 7 p.m.
Thursday, July 12 at 4 p.m.
Tuesday, July 17 at 7 a.m.
Thursday, July 19 at 4 p.m.
Saturday, July 21 at 3 p.m. and 11 p.m.
Tuesday, July 24 at 9 a.m.
A forum is scheduled for Lockwood on Thursday,
July 26 at 2 p.m.
The Forces of Magnetism
dynamic and responsive to change. Strong nursing
representation is evident in the organizational
committee structure. Executive-level nursing leaders
serve at the executive level of the organization. The
organization has a functioning and productive system
of shared decision-making.
Force 3: Management Style The organization and its
nursing leaders create an environment that supports staff
participation. Feedback is encouraged and valued and is
incorporated from the staff at all levels of the organization.
Nurses serving in leadership positions are visible, accessible,
and committed to communicating effectively with staff.
Force 4: Personnel Policies and Programs Salaries
and benefits are competitive. Creative and flexible staffing
models that support a safe and healthy work environment
are used. Personnel policies are created with direct care
nurse involvement. Significant opportunities for
professional growth exist in administrative and clinical
tracks. Personnel policies and programs support
professional nursing practice, work/life balance, and
the delivery of quality care.
Force 5: Professional Models of Care There are models
of care that give nurses the responsibility and authority for
the provision of direct patient care. Nurses are accountable
for their own practice as well as the coordination of care.
The models of care (i.e., our Clinical Practice Model,
primary nursing, case management, family-centered,
district, and holistic) provide for the continuity of care
across the continuum. The models take into consideration
patients’ unique needs and provide skilled nurses and
adequate resources to accomplish desired outcomes.
Force 6: Quality of Care Quality is the systematic
driving force for nursing and the organization. Nurses
serving in leadership positions are responsible for providing
an environment that positively influences patient outcomes.
There is a pervasive perception among nurses that they
provide high-quality care to patients.
continued on page 4
Nursing Connections
A History Behind the
Forces of Magnetism
S
o what does it mean to be a “Magnet”
Organization? To understand this, you will
need to go back in time and understand the
history of the Magnet Program. The 14 “Forces of
Magnetism” have evolved since 1983. The American
Academy of Nursing (AAN) had a task force that
conducted a study with 163 hospitals to identify criteria
and variables that created an environment that attracted
and retained nurses who promoted and encouraged
quality care within an organization. This study showed
that 41 of the 163 organizations had developed internal
processes that attracted and retained professional nurses.
The characteristics that distinguished these organizations
from other organizations became known as the “Forces
of Magnetism” and where identified as “Magnet”
organizations by the AAN.
In June of 1990, the American Nurses Association (ANA)
decided to develop the American Nurses Credentialing
Center which would offer credentialing and other nursing
program services. Later that year, in December of
1990, the Magnet Hospital Recognition Program for
Excellence was approved by the ANA Board of
Directors. The program used the 1983 Magnet Hospital
study conducted by the AAN and developed the new
Magnet Program. It took four years before the first
hospital was awarded a Magnet status. After using five
organizations for their pilot project, the University of
Washington Medical Center in Seattle was the first to be
named by the American Nurses Credentialing Center as
a designated Magnet organization in 1994.
In 1997, the ANA changed the program name to the
Magnet Nursing Services Recognition Program. In
addition to this, the Scope and Standards for Nurse
Administrators were revised. Then in 1998, the program
had expanded to include Long Term Care facilities. By the
year 2000, the program expanded again to include
The Forces of Magnetism
Northern Michigan Hospital Findings
IP Magnet Survey – Graph 1 of 2
Nurses have the opportunity to work with other nurses
who are clinically competent (Forces 5 & 14)
Environment encourages and expects nurses to serve
as teachers (Forces 8 & 11)
Professional models of care used in the delivery
of patient care services (Force 5)
Environment encourages nurses to exercise independent
judgment consistent with their scope of practice (Force 9)
Essential providers of core health care
organization services (Forces 2 & 12)
Environment permits nurses to be autonomous
and accountable (Forces 5 & 9)
You are empowered to manage your nursing practice (Force 9)
On-going opportunities provided to meet the learning
needs of the nursing staff (Force 14)
Nurses on unit empowered to manage nursing practice (Force 5)
Nurse managers supportive of the professional
goals of nurses (Forces 1 & 14)
Concern for the patient paramount (Forces 4, 5, & 11)
Professional development highly valued (Forces 4 & 14)
Improvement activities viewed as a mechanism to
improve the quality of care (Forces 7 & 12)
0.0% 10.0 20.0 30.0 40.0 50.0 60.0 70.0 80.0 90.0 100.
%
%
%
%
%
%
%
%
%
0%
Strongly Disagree or Disagree
Strongly Agree or Agree
IP units included Acute Rehab, CVU, ICU, L2N, L2S, L3,
Float pool, IV Therapy, Mental Health, OB, Pediatrics, & NICU.
Summer 2007
3
The Forces of Magnetism
Force 7: Quality Improvement The organization has
structures and processes for the measurement of quality
and programs for improving the quality of care and services
within the organization.
Force 8: Consultation and Resources The healthcare
organization provides adequate resources, support, and
opportunities for the utilization of experts, particularly advanced practice nurses. In addition, the organization promotes
involvement of nurses in professional organizations and among
peers in the community.
Force 9: Autonomy Autonomous nursing care is the
ability of a nurse to assess and provide nursing actions as
appropriate for patient care based on competence,
professional expertise, and knowledge. The nurse is
expected to practice autonomously, consistent with
professional standards. Independent judgment is expected
to be exercised within the context of interdisciplinary and
multidisciplinary approaches to patient/resident/client care.
Force 10: Community and the Healthcare
Organization Relationships are established within and
among all types of healthcare organizations and other
community organizations, to develop strong partnerships
that support improved client outcomes and the health of
the communities they serve.
Force 11: Nurses as Teachers Professional nurses are
involved in educational activities within the organization
and community. Students from a variety of academic
programs are welcomed and supported in the organization;
contractual arrangements are mutually beneficial. There is
a development and mentoring program for staff preceptors
for all levels of students (including students, new graduates,
experienced nurses, etc.). Staff in all positions serve as
faculty and preceptors for students from a variety
of academic programs. There is a patient education program
that meets the diverse needs of patients in all of the care
settings of the organization.
continued on page 6
4
Nursing Connections
Magnetism History (continued)
all healthcare organizations abroad. Then finally in 2002,
the program was officially renamed for the third time to the
“Magnet Recognition Program.”
The current fourteen (14) Forces of Magnetism are proven
indicators for quality that help support the professional
standards of the nursing profession and help raise the level
of care within any organization. Being designated as a
Magnet facility is not just a designation, it’s not just a
journey, it is a nursing culture within an organization. This
culture supports evidenced based nursing practices and a
professional environment that is lead and coached by a
supporting visionary nursing leader who advocates
excellence within the organization she works for and
within the nursing profession.
The Magnet Recognition Program focuses on three (3) goals
when recognizing a facility. The organization under review
needs to demonstrate that they support these goals. These
goals are that an organization:
• Promotes quality in a setting that supports professional
practice. Identifies excellence in their delivery of nursing
services to patient, residence or clients. Disseminates
best practices in nursing services.
• In order for an organization to submit an application for
Magnet Recognition, some basic requirements need to
be in place first. The first is that an organization must
demonstrate more than one nursing setting with a “single
governing authority” and one individual serving as the
Chief Nursing Officer (CNO). The organization also needs
to show that the CNO is ultimately responsible for nursing supports. These areas can consist of rehab centers,
long term care units, hospice, or ambulatory centers, to
name just a few. The CNO must participate at the highest
governing decision making and strategic planning level.
• Another requirement is that the CNO must possess, at a
minimum, either a Bachelors Degree in Nursing or a
non-nursing Bachelors degree with a Master’s Degree in
Nursing. Organizations must also demonstrate that they
The Forces of Magnetism
Northern Michigan Hospital Findings
IP MAGNET SURVEY
REPORT– Graph 2 of 2
IP Magnet
Survey
GRAPH 2 OF 2
Nurses serving in leadership positions
accessible and visible (Force 3)
Support for education and other professional
development activities (Force 14)
Nurses serving in leadership positions have a
participative style & value open communication (Force 3)
Provide the level and intensity of care consistent with
the needs of the patients (Force 6)
Representation on planning and policy-making
bodies within the organization (Forces 4 & 12)
Nurses have access to clinical
experts (Forces 8 & 11)
Are quality/process improvement activities implemented with
staff nurse involvement (Forces 2 & 7)
Organizational structure cultivates a positive relationship
between clinical and administrative staff (Force 13)
Organizational structure collaborative (Force 2)
Personnel policies/programs indicative of the
employer’s concern about employees (Forces 1 & 4)
Nurse-physician relationships collegial (Force 13)
Personnel policies and programs created with
employee involvement (Force 4)
Nurse staffing adequate (Force 4)
0.0% 10.0 20.0 30.0 40.0 50.0 60.0 70.0 80.0 90.0 100.
%
%
%
%
%
%
%
%
%
0%
Strongly Disagree or Disagree
Strongly Agree or Agree
IP units included Acute Rehab, CVU, ICU, L2N, L2S, L3,
Float pool, IV Therapy, Mental Health, OB, Pediatrics, & NICU.
Summer 2007
5
The Forces of Magnetism
Force 12: Image of Nursing The services provided by
nurses are characterized as essential by other members of
the healthcare team. Nurses are viewed as integral to the
healthcare organization’s ability to provide patient care.
Nursing effectively influences system-wide processes.
Force 13: Interdisciplinary Relationships Collaborative
working relationships within and among the disciplines
are valued. Mutual respect is based on the premise that all
members of the healthcare team make essential and
meaningful contributions in the achievement of
clinical outcomes. Conflict management strategies are in
place and are used effectively, when indicated.
Force 14: Professional Development The healthcare
organization values and supports the personal and
professional growth and development of staff. In addition
to quality orientation and in-service education addressed
earlier in Force 11, Nurses as Teachers, emphasis is placed
on career development services. Programs that promote
formal education, professional certification, and career
development are evident. Competency-based clinical and
leadership/management development is promoted and
adequate human and fiscal resources for all professional
development programs are provided.
Why Become Magnet Designated? There are multiple
benefits for nurses, patients and the community, and the
healthcare system. For nurses, Magnet Designation means
you work in a place that is committed to excellence. The
quality of nursing care is exceptional and continually
measured for improvements. Interdisciplinary relationships are collegial. Magnet facilities are considered nurse
friendly organizations. Nurse satisfaction is high. There is
a strong recruitment and retention program. Staff salaries
are competitive and there is investment in ongoing nursing
education. For patients and the community, it is a seal of
approval for quality nursing care. Patients know they will
be cared for and cared for consistently well. Magnet hospitals consistently provide the highest quality of care. For the
hospital, there is excellent reputation for providing quality
nursing care and providing good patient outcomes.
continued on page 9
6
Nursing Connections
Magnetism History (continued)
have policies and procedures that allow and encourage
nurses to confidentially voice their concerns about their
professional practice environment without retribution
or retaliation by the organization or its management.
Next, an organization must demonstrate that the ANA
Scope and Standards for Nursing Administrators (2004)
has been implemented throughout nursing areas. To
continue, the organization must also prove that no unfair
labor practice involving a nurse within the three years
preceding submission of the application has been committed. This is determined by checking the credentials of the
organization through the National Labor Relations Board
(NLRB) or the state regulatory agency that has
jurisdiction over labor relations, or a review of federal,
state or international court records. Only the Commission
on Magnet may approve any exception to this rule. The
organization must also prove compliance with all local,
state and federal laws, regulations, statutes and accrediting body standards. This includes complying with the
National Patient Safety Goals recommended by JCAHO.
Finally, the organization must show that nurse sensitive
quality indicators are collected at the unit level, and
benchmark from best practice databases to support
research and quality improvement initiatives. Magnet
status has many benefits for an organization and, as
indicated by our CNO, Mary-Anne Ponti in her opening
letter, “achieving Magnet designation does not happen
overnight. It is truly a journey.” This journey definitely
will take commitment, perseverance and dedication by
the whole organization. Please help Northern Michigan
Hospital achieve this designation. Become a Magnet
supporter! We have weathered more storms than most
organizations and have come through with flying colors!
We have already proven that we are partly there as a
Magnet organization. Let’s prove that we can complete
this journey and prove that these 14 Forces are the culture
and spirit within this organization. Show that we are
committed to nursing excellence and that we provide
intensive caring!
The Forces of Magnetism
Northern Michigan Hospital Findings
OP Magnet
Survey – Graph 1 of 2
OP MAGNET SURVEY
GRAPH 1 OF 2
Environment encourages and expects nurses
to serve as teachers (Forces 8 & 11)
Nurses have the opportunity to work with other nurses
who are clinically competent (Forces 5 & 14)
Professional models of care used in the delivery
of patient care services (Force 5)
Environment encourages nurses to exercise independent
judgment consistent with their scope of practice (Force 9)
Provide the level and intensity of care consistent with the
needs of the patients (Force 6)
Concern for the patient paramount (Forces 4, 5, & 11)
Improvement activities viewed as a mechanism to
improve the quality of care (Forces 7 & 12)
Essential providers of core health care
organization services (Forces 2 & 12)
Environment permits nurses to be autonomous
and accountable (Forces 5 & 9)
You are empowered to manage your
nursing practice (Force 9)
Support for education and other professional
development activities (Force 14)
Professional development highly valued (Forces 4 & 14)
Are quality/process improvement activities implemented
with staff nurse involvement (Forces 2 & 7)
0.0% 10.0 20.0 30.0 40.0 50.0 60.0 70.0 80.0 90.0 100.
%
%
%
%
%
%
%
%
%
0%
Strongly Disagree or Disagree
Strongly Agree or Agree
OP units included Ambulatory Services, Endoscopy, Cardiac Cath Lab, Emergency, Imaging
Services, Infusion Center, Pre-Admitting, Recovery Room, Surgery, Weight Management
Program, Diabetes Center, NISUS, Health Access, Hemo Outpatient, & Radiation Therapy.
Summer 2007
7
The Forces of Magnetism
Northern Michigan Hospital Findings
OP Magnet
Survey
– Graph 2 of 2
OP MAGNET
SURVEY REPORT
GRAPH 2 OF 2
Nurses have access to clinical experts (Forces 8 & 11)
Nurses on unit empowered to manage nursing practice (Force 5)
Nurses serving in leadership positions accessible and visible (Force 3)
Representation on planning and policy-making bodies within the
organization (Forces 4 & 12)
Nurse managers supportive of the professional goals of nurses
(Forces 1 & 14)
Nurses serving in leadership positions have a participative style &
value open communication (Force 3)
Nurse-physician relationships collegial (Force 13)
On-going opportunities provided to meet the learning needs of the
nursing staff (Force 14)
Personnel policies/programs indicative of the employer’s concern
about employees (Forces 1 & 4)
Nurse staffing adequate (Force 4)
Organizational structure cultivates a positive relationship between
clinical and administrative staff (Force 13)
Organizational structure collaborative (Force 2)
Personnel policies and programs created with employee
involvement (Force 4)
0.0% 10.0 20.0 30.0 40.0 50.0
%
%
%
%
%
Strongly Disagree or Disagree
60.0 70.0 80.0 90.0 100.
%
%
%
%
0%
Strongly Agree or Agree
OP units included Ambulatory Services, Endoscopy, Cardiac Cath Lab, Emergency, Imaging Services,
Infusion Center, Pre-Admitting, Recovery Room, Surgery, Weight Management Program, Diabetes
Center, NISUS, Health Access, Hemo Outpatient, & Radiation Therapy.
8
Nursing Connections
The Forces of Magnetism
There are typically low staff nurse turnover and low vacancy
rates, decreased agency cost and an overall strong competitive
advantage.
How Do We Begin? We’ve only just begun. We have
identified a Magnet Oversight Committee. This is a six-member
nursing leadership team consisting of Michelle Adaline, Tina
Aown, Tara Conti-Kalchik, Pat Nakoneczny, Toni MoriartySmith and Jennifer Woods. In addition, each Force has a
designated nurse leader who will be responsible for overseeing
the requirements of that Force. We’d also like to have two staff
nurses from each unit (one from each shift) champion our
journey in their respective area.
The NetLearning survey you filled out a few weeks ago was our
first real concrete step in this journey. This Survey is the Magnet
Readiness Nurse Opinion Survey from the ANA Web site.
Thank you all who took the time to complete it! The results
of your opinions are outlined throughout this newsletter.
We have also just completed an organizational gap analysis
for each of the 14 Magnet Forces. Together, over the next
few months, we will develop concrete action plans to
address identified opportunities from your opinions as well
as the organizational analysis.
Achieving Magnet Designation does not happen overnight.
It is truly a journey. A typical Magnet Journey takes several
years. It takes dedication, commitment and perseverance.
We will need involvement and support from the whole
organization. I would like to officially begin this journey to
excellence with each and every one of you. Please join me in
our journey to excellence.
Nursing Quality Corner
Measuring Quality Nursing Care Delivery
Michele Adaline
G
ood quality nursing is always measured by customer
perception. Patients that feel they had a positive
experience tell us so regularly through our patient
perception survey. While these surveys are a joy to see
when responses are excellent, they are only opinion and offer
no way to quantify the quality of nursing care delivered at this
hospital. We need measurable data that indicates how well we
perform pure nursing functions that are the sole responsibility of
the practice of nursing. These nursing sensitive indicators reflect
nursing structure, processes and outcomes such as staffing of
units, assessments and interventions, and quality improvement
in specific areas like pressure ulcers. These indicators need to be
differentiated from medical care or institutional outcomes such as
stroke care or C-sections.
At NMH, we are using the National Database of Nursing
Quality Indicators (NDNQI) maintained by the University of
Kansas School of Nursing for the American Nurses Association
(ANA). Over 400 acute care hospitals participate in
contributing to this database. This allows for enough data to be
gathered and grouped in order to create valid data to compare
similar units to each other. This then allows an individual
department to find “like-sized” units with similar populations
to compare their results to.
The indicators that NMH participate in include: RN mix,
staffing, falls and pressure ulcers. Data is collected here at
NMH and sent to University of Kansas to be collated. It is
reported on a quarterly basis back to each individual hospital
indicating how they compare to the group they have chosen.
Once we receive the data back, it is evaluated for trends and
can be used to compare similar data relating to staff education,
budgeting, planning, retention, recruitment, satisfying
regulatory requirements and quality improvement.
Summer 2007
9
Cerner Update
Phase Two of the Clinical
Information Systems
N
orthern Michigan
Hospital is in the
second phase of
implementing an
integrated electronic health
record utilizing Cerner
Corporation as the selected
vendor. Phase one of this
project was completed in 2006
and involved Surgery, General
Laboratory, Microbiology, Blood
Bank, Pharmacy, Radiology,
Emergency, Scheduling, Clinical
Reporting, and some charge
services. Phase two of the project
will involve Registration and
Eligibility, Orders, Clinical
Documentation (centering on
nursing), ICU documentation,
Patient Charging and document scanning to populate the
electronic health record with old records. This phase will also
include the ability to interface from the patient/electronic
health record into the PACS imaging system and bring the
image forward for viewing at the bedside. The ultimate goal
is to establish the foundation and migrate toward a complete
electronic health record.
At this time, a multidisciplinary team, called the
“Transformation Team,” has been developed to assist NMH
toward the reality of an electronic health record. The goal
for implementing this EHR is May 19, 2008. This is called
the “Go Live” date. To prepare the organization for this
journey, multiple presentations were performed in June
for all three shifts educating the organization about phase
two of this process. The presentation used nursing as an
example of how the electronic medical record can improve
our documentation processes. As nurses, we know that
nursing can be very chaotic and fragmented, with many
interruptions throughout the course of a working day.
10
Nursing Connections
In a research study that was done by George Hendrich, a
random sampling of Medical-Surgical Nurses was chosen
and followed. The results of this report were outlined at
the Health Management Academy on May 20, 2004. The
report indicated that nurses have an average of 44 minutes of
overtime and that only thirty percent of their work shift was
actually performing direct patient care.
Another 2006 nursing research study published in HSR by
Tucker and Spear supported similar findings. This study
centered on operational failures and interruptions within
hospital nursing. It showed, on average, that nurses switched
patients every 11 minutes. It also showed that the average
activity time is 3.1 minutes for every patient care activity
with 8.1 operational failures every 8 hours. The operational
failures and interruptions ranged from missing medications,
missing supplies, missing orders to missing or broken
equipment. This report only showed that healthcare needs to
improve, streamline and consolidate nursing care processes.
One way of doing this is by implementation of an electronic
health documentation process.
Cerner Update
• Improves communication between departments and specialty areas
The Cerner Team has been on site reviewing our mission,
vision and values, as well as looking at our organizational
culture. Over the next year, they will be helping us look at
our current state work flows and how these work flows will
be affected in the future as we implement our electronic
health record. To do this, NMH’s Transformation Team,
which addresses development of the electronic health record,
will make four visits to Kansas City, Missouri. The four
major trips are broken down as follows:
• Builds a safety net for all clinicians around standards of care
• Is accessible from anywhere
• Continues to improve the culture of safety through
better tracking of trends and patterns
• Improves evidence based practice by knowledge
sharing in context of work flow
• Is available for all departments
(i.e. radiology, nuclear med, endoscopy)
• Reduces transcription and documentation inaccuracies
• Improves decision making times
1) Building the electronic health record (March 2007)
2)Designing what the electronic health record will look like (May 2007)
3)Testing the system (September 2007)
4) Training staff on the new system (November 2007)
This is an 18-month accelerated project and will allow us to
“go live” with a basic electronic system. This time line does
not mean that everything will be in an electronic format by
our goal date. Northern Michigan Hospital has chosen to
roll out this project in a phased approach. A phased approach
will allow us to migrate toward as much of an electronic
format as possible. In other words, it will take NMH quite
some time to convert our medical records to an electronic
format due to the fact that a process like this is very
resource dependent for both NMH and Cerner. NMH
will start with a basic medical record template and add
our own specifications to it over time. What this means
is that all of our specialty areas will require NMH to
develop, build and maintain all of our documentation
processes in any specialty areas. Therefore, it will take
some time before NMH will be completely electronic.
Despite this, having an electronic medical record will
benefit our organization and professional practices greatly!
These benefits consist of, but are not limited to:
• Automates work flow processes
• Completes the loop of care
Beyond the benefits of having an electronic health record,
other NMH goals are: consolidate, improve and streamline the
number of organizational forms, privacy issues and plans of care;
improve patient related outcomes; improve communication, and
staff assignments tracking; and identify patient acuity. The areas
that will be involved in this phase of the EHR development
include health information management, order entry, clinical
documentation for both inpatient nursing and the inpatient
EMR
AdoptionModel
Model First
Statisitics
EMR
Adoption
FirstQuarter
Quarterofof2007
2007
Statistics
©
HiMSSanalytics
2007
©HiMSSanalytics 2007
STAGE
7
% of US
Hospitals
0.0%
Medical record fully electronic; CDO able
to contribute to ICEHR as byproduct of SEHR
STAGE Physician documentation (structured templates),full CDSS
6
(variance & compliance), full PACS
STAGE
Closed loop medication administration
5
STAGE
CPOE, CDSS (clinical protocols)
4
STAGE
Clinical documentation (flow sheets), CDSS
3
(error checking), PACS available outside Radiology)
STAGE
CDR, CMV, CDSS inference
2
engine, may have Document Imaging
STAGE
Ancillaries – Lab, Rad,
1
STAGE
All Three Ancillaries Not
0
0.3%
1.3%
2.1%
21.3%
39.3%
16.3%
19.5%
• Works toward eliminating memory based practices (waiting to chart until the end of the shift)
• Standardizes documentation
Source: HIMSS Analytics Databases (derived from the Dorenfest IHDS+ DatabaseTM)
Summer 2007
11
Cerner Update
ancillary areas, registration, scheduling, and
some other acute care management areas
like Care Coordination, Social Work and
Education.
Cerners Example of the Intake and Output Screen
Cerners Example of the Intake and Output Screen
So what is the biggest challenge
regarding this new process?
It is changing our documentation process
to reflect point of care documentation.
This kind of documentation occurs at the
bedside immediately upon completion
of an assessment, treatment, procedure,
intervention, or medication administration.
Point of care documentation will be a culture
change related to our work flows processes.
This transformation is a journey toward
excellence and will help NMH improve
patient care and provide “intensive caring” to
everyone. But, the Transformation Team needs your help.
Please assist them in identifying some of your unit flow
processes. They also need your support and positive feedback
about this change. This project is the ipidemy of team work
and stress and the team will need everyone’s support. So, be
supportive and encourage everyone to work together as a
team. If you are curious about any of this, please speak with
any of the following representatives about this project.
These representatives are:
• ED – Anne Matzka, Joanie Vargo, Pam Guess
• ICU – Lynda VanderMeulen, Michele Adaline
• CVU – Wendy Davidson, Chris Chappell
• Med-Surg (2S, 2N, L3) – Sue Keith, Shelly Germaine,
Liz Horrom, Tami Hightower
• Respiratory Therapy - Paul LeValley
• WCC – Toni Moriatry-Smith, Kim Westrick,
Denise Maunders
• HUCs – Debra Allerding
• Outpatient – Bev Bayer, Becky Sewell, Sue Nuorala,
Jennifer Woods
• Mental Health – John Libertine, Tina Aown
12
Nursing Connections
• Acute Rehab – Sharon Bryant, Dennise Grinnell
• Therapies – Karyn Dunlap, Ken Horrom, Robin Feagan
• Education – Pat Nakoneczny
• Dialysis – Sheila Roof
• IT Dept. – Elaine Whipp, John Munk, Pam Harris,
Tosca Habel, Angela Taylor, Donna Gengle
• Registration/Scheduling – Jeanne Balesky, Dawn Hiatt,
SJ Catton, Therese Coleman, Kathy Beyer
• Executive Team – Mary Anne Ponti, Reezie DeVet,
Dr. Andy Smith, Dr. Guy Golembiewski, Mark Gray
So how can we prepare ourselves for this change?
Start using PowerChart daily for looking up labs,
consultation information, radiology reports, history and
physicals, and any other information already loaded into
PowerChart. If you are not sure where to find these
documents in PowerChart, take the time to look at what
each of the tabs consist of and how you can utilize them in
your daily practice. The other suggestion is that if you are
not computer savvy and are intimidated by the computer,
enroll yourself through Netlearning in one of the library
computer classes.
Cerner Update
Some examples of classes are “Introductory to
Computer Skills” and “Introductory to Word.”
If you are still having challenges, speak with your
manager and see if you can retake the Colleague
New Orientation Cerner Training classes. Be
ready to be the best you can be and help NMH
be in the top one percent of the country when
it comes to incorporating an electronic health
record into our work processes.
Cerners Example of Electronic Patient Care Summary
Cerner Example of the Electronic
Patient Care Summary
(aka Kardex)
(aka Kardex)
Cerner Project Updates
Phase 2 of the Clinical Information System Transformation Project
Here is some additional information that is or has happened related to this project:
• NMH now has a “Physician Advisory Group” for the
implementation project of the new electronic health record.
• June 6, 2007 held the first internal marketing kickoff in the
cafeteria on all shifts.
• A competition to name/brand this project was held. Decision
on the name is pending.
• Education to managers, executive team and Board of
Trustees to occur over the summer. This will be called “Proof
of Concept.”
• Strategic Assessment for the project has been reviewed and
approved.
•The Project Charter and Scope has been reviewed and
approved. There will be amendments to the Charter as the
project continues to develop over the summer.
• Review of policies and procedures begun for possible gaps in
our processes.
• Approximately 1250 staff members will need to be educated
on the new electronic health record, starting next year sometime.
• Quality and performance measurements being identified and
are under review for future development.
Summer 2007
13
R
i v e r
S
t o r i e s
F
l o w i n g
L
i v i n g
S
t o r i e s
What Does the Northern Michigan
Hospital Mission Mean To Me? By Cindy Bodurka
T
he Northern Michigan Hospital mission,
“providing healthcare as we expect for our own
family,” means that I can sleep at night in my own
bed when or if my husband, son, grandchild, or any close
family friend is admitted into the hospital here. There will
be no need to camp out at the bedside or waiting room. It
means that I have confidence in the professional staff here
to take care of my loved ones (or myself, for that matter)
without loosing a night’s sleep.
It means I have comfort – knowing that this hospital has
the best equipment to assess, diagnose, and treat any one of
us. It means I have trust that all efforts will be undertaken
to ensure best practice of care. It means I am assured, if for
any reason, Northern Michigan Hospital cannot provide the
level of care that is needed to treat me or one of your family
members, that appropriate referrals will be undertaken. It
means support is available if needed. It means Northern
Michigan Hospital is committed – and will also be there,
just like I am always there for my own family. It means
special treatment for all – because just like family members,
Northern Michigan Hospital cares.
Colleagues Nominated for the Nightingale Awards
Nominated by their nursing Colleagues, the Northern Michigan Hospital Nightingale awards were presented to seventeen
nurses at the Nurses Annual Dinner Meeting in May. Awardees include: Michele Adaline, Dena Kilpatrick, Daphne Weston,
Michelle Murphy, Barb Smith, Liz Horrom, Irene Crandell, Sharon Coen, Roxann Fettig, Lisa Fitzpatrick, Amy Howard,
Laurie Laughbaum, Darlene Lockery, John Morgan, Beth Ness, Lee Ruemenapp and Kathy Schlehuber. Recipients are nurses
who embody the spirit of Florence Nightingale by consistently practicing and role-modeling a high level of professionalism.
14
Nursing Connections
Inspirations
A Nurse’s Prayer
Lord, give me grace on this and everything
Professional Practice
Council Meetings
The next PPC meetings are as follows:
July 10, 2007
To do my work the best, not simplest
August 14, 2007
And to remember that in all I do
September 11, 2007
The very smallest task is seen by you.
Grant me courage, Lord, when things go wrong
October 9, 2007
May I remember that Thou too, are near.
All interested nurses please attend. These
meetings are held the second Tuesday of
each month from 1 – 3 p.m. in the Back
Doctors Dining Room. Managers and
Give me humble heart that I may know
PPC representatives will post the agenda.
To stop and think and not rush blind
And though the task I’m doing may not seem fair,
That things worthwhile are not just things that show.
The greatest gift of all is the Human Touch.
Nurse Executive
Committee Meetings
Fill me with love that I may realize
The next NEC meetings are as follows:
The suffering and the pain that around us lies,
August 7, 2007
For though efficiency and skill mean much
And grant each day, that I may see to share
The burden of the people in my care.
Lord, give me strength to help me play my part,
To make my work the essence of my life
And show me patience and true kindness, Lord,
That I may spread Thy radiance through my word.
So, when at night I come back to my home
I pray that I may feel I’ve done my best.
And Lord, at times I know I forget to pray
But please forgive and always be with me.
By Alaya M. Law
September 4, 2007
October 2, 2007
These meetings are held the first Tuesday of
each month in the Back Doctors Dining
Room from 12 – 2 p.m. This is an open
meeting. Everyone is welcome.
Nursing Connections – 2nd Quarter, 2007
Editor: Pamela Harris, RN, BSN
Submissions are welcome. Please send to
Pamela Harris, RN, BSN, at
[email protected] or call 231.487.5576.
Photos should be in digital form when possible.
Summer 2007
15
Continuing Education
Quarterly Calendar
Conferences (7:30 a.m. unless otherwise noted) 1 AMA PRA
Category 1 Credit(s)™ CHEC Rm 4 & 5
Date
16
07/18/2007
Role of Rehabilitation in the Acute Care Setting Lawrence J. Horn, MD, Associate Professor, Physical Medicine and Rehabilitation, Medical
Director, Neurosciences Services, Wayne State University, Detroit, MI.
07/25/2007
Lung Transplantation Edward R. Garrity, Jr., MD, MBA, Professor, Medicine and Vice Chair,
Clinical Operations, Center for Advanced Medicine, University of Chicago Hospitals, Chicago, IL. Educational Grant: Astellas.
08/01/2007
Advances in PET Imaging Anthony F. Shields, MD, PhD, Professor, Medicine and Oncology, Wayne State University and Associate Center Director, Clinical Research, Karmanos
Cancer Institute, Detroit, MI.
08/08/2007
Balloons, Stents, Drugs. Now Clots! Are We Back To Nitro Louis A. Cannon, MD, FACA, FCCP, FACC, FACP, Michigan Heart and Vascular Specialists, PC, Petoskey, MI.
08/15/2007 Challenges in Epilepsy Care Brien J. Smith, MD, Associate Professor, Neurology, Wayne State University and Director, Comprehensive Epilepsy
Program, Henry Ford Hospital, Detroit, MI.
08/22/2007
Childhood Obesity Claudio Duarte, MD, Pediatric Hospitalist, Northern Michigan
Hospital, Petoskey, MI.
08/29/2007
Autoimmunity as it Relates to Systemic Lupus Charles J. Huebner, MD, Rheumatology, Harbor Arthritis Center, Petoskey, MI. Educational Grant Abbott.
Nursing Connections
09/05/2007
LABOR DAY HOLIDAY
09/12/2007
Using Evidence-based Medicine at the Point of Care Todd M. Sheperd,
MD, CASQSM, Primary Care Sports Medicine, P.C., Anne Foster, MLS, Manager D.C. Burns Medical Library and Center for Creative Learning, Laura Flickema, MSLS, Librarian,
D.C. Burns Medical Library, Northern Michigan Hospital, Petoskey, MI.
09/19/2007
Methadone Dosing Made Easy
Steven J. Dupuis, DO, Associate Professor, Family & Community Medicine, Michigan State University, and Associate Medical Director, Sparrow Home Hospice Services,
Care Free Clinic Medical Director, Lansing, MI.
Educational Grant: Cephalon.
09/26/2007
Updates on the Management of Lymphoma Fredrick B. Hagemeister, Jr., MD, Professor of Medicine and Chief, Department of Lymphoma/
Myeloma, The University of
Texas, MD Anderson Cancer Center, Houston, Texas. Educational Grant: Genentech.