10.8 Describe program and outcomes that have resulted that have resulted from nursing collaborations/partnerships with other nursing entities in the community (e.g. nursing schools, nurse researchers, consortium work, outreach programs) or region. As the Chief Nurse and Executive Nursing Operations Team promote partnerships with community-based entities that serve to advance MGH nursing practice, these partnerships result in outcomes that promote nursing practice and support the development of youth who will be the next generation of health care providers. Force 10.1 described the programs and partnerships in place that promote and support ethics, nursing leadership, local healthcare policy and research. Following is a description of outcomes from these programs. Ethics As described in Force 6.15 and 10.1, the doctorally prepared Clinical Nurse Specialist in Ethics and the Collaborative Governance Ethics Committee has collaborated with multiple entities to advance the application of ethics into nursing practice. Following are examples of successful outcomes from these collaborative efforts. As described in Force 6.15, the Ethics Committee, in coordination with The Norman Knight Nursing Center for Clinical & Professional Development and The Stoeckle Center for Primary Care Innovation, developed and presented the Respecting Choices: Advance Care Planning Facilitator for Primary Care Program in October 2006. This groundbreaking collaborative, made possible through a grant from the Esther Rabb Foundation, certified 32 multidisciplinary clinicians as Advance Care Planning Facilitators. The program also included four nurses from the Beth Israel Deaconess Medical Center (BIDMC) in Boston and provided the education in advance directives and advance care planning for the Case Managers hired for the Medicare Care Management Demonstration Project. The Harvard Ethic Consortium a program with the Division of Medical Ethics at Harvard Medical School and the Harvard Teaching Hospitals to enhance education and collaboration around clinical ethics issues of importance. The two Staff Nurse co-chairs of Collaborative Governance Ethics Committee are invited members of this group, along with members of the MGH Optimum Care Committee, the MGH Ethics Task Force and the MGH Pediatric Ethics Committee. 200
This forum provides an opportunity for clinicians and ethics committee members to present challenging clinical ethics cases in a peer review forum. In May 2007, two Staff Nurses, the Nurse Practitioner and the Social Worker from the Respiratory Acute Care Unit presented a case about a 90 year old woman, who had been ventilated for 18 months, had dementia, and whose son was insistent upon continuing life sustaining treatment. Discussion following the presentation was beneficial to the nurses learning strategies for future cases. The nurses are writing up the case with the guidance of the Editor of the ethics column of American Journal of Nursing, Dr. Pamela Grace, Assistant Professor in Adult Medicine and Ethics from Boston College, and Nurse Scientist with an appointment in The Yvonne Munn Center for Nursing Research at MGH. In March 2003, the Interdisciplinary Ethics Resource Program (IERP) was developed and initiated at MGH. The goal of the program is to develop nurses and allied health care professionals skills in noticing and sorting out ethical issues in practice. Since its inception, the MGH Clinical Nurse Specialist in Ethics has expanded her partnerships to include the Nurse Ethicists from the Brigham and Women s Hospital, and Dana Farber Cancer Institute. In 2007, the group began collaborating with the Boston College Connell School of Nursing, as well as, the Winston Center for Health Care Leadership, which provided generous funding for the program. The IERP is held annually and rotates to each participating hospital. Membership from the Ethics in Clinical Practice Committee, practicing nurses who are not on ethics committees and allied health professionals are invited to attend. Many of the participants go on to create unit based ethics rounds after attending the program. Nursing Leadership In 2006, The Institute for Nursing Healthcare Leadership (INHL) and The National Center for Healthcare Leadership (NCHL) established the INHL/NCHL CNO Leadership Fellowship to enhance the strategic role of the CNO within the executive leadership team. The goals of this Fellowship are to: Advance the CNOs' critical executive and clinical leadership competencies, Enable CNOs to move their organizations toward improved performance. Strengthen current, newly appointed, and emerging CNOs. (From INHL website) 201
The first fellowship was awarded to a Chief Nurse Officer from a community hospital in Oakland, Michigan. Joyce C. Clifford PhD, RN, FAAN, President and CEO for the INHL is her primary mentor during the fellowship. The Chief Nurse from MGH will be meeting and working with the Fellow at various times throughout the fellowship program. Additionally, in her capacity as Senior Associate, and as a member of the Board of the Directors for the INHL, the Chief Nurse serves in an advisory and consultation role as the program develops and is evaluated. Health Care Advocacy To meet the first program goal of providing staffing that meets patient needs, MGH nursing leaders worked with MONE in 2005 and 2006 to pilot a tool that could be used to present staffing data to the public. Starting in January 2007, the staffing plans for every patient-care unit in the state have been posted on www.patientsfirstma.org. Massachusetts is the first state in the nation to voluntarily post this information for public access. In 2006 and 2007 efforts have continued to develop nursing sensitive performance measures that will also be available to the public. Soon data for fall rates, fall with injury rates and pressure ulcer incidence will also be available on the website for all hospitals in the state. The Patients First Initiative has generated national interest. In September 2006, the Chief Nurse had the opportunity to speak at The Patients First Experience: The Platform for Transparency, Staffing and Quality Conference in Boston. Research As described in Force 6 and Force 10.1, the Nurse Scientist Advancement Model has created the opportunity for nursing to develop relationships with numerous academic institutions. As a result faculty appointments have been established with nursing leaders throughout the nursing community to further support nursing practice at MGH. For example, Boston College William F. Connell School of Nursing faculty member, Pamela Grace PhD, RNCS, ANP, has a Nurse Scientist appointment in The Yvonne Munn Center for Nursing Research. As described in Force 6.15, this relationship is helping to further advance nursing practice in ethics. Further collaborations with Boston College have resulted in establishment of a pre-doctoral Fellowship, designed as an individualized mentorship program coordinated through The Yvonne Munn Center for Nursing Research. This fellowship aims at creating experiential and participatory opportunities for enrolled doctoral students by pairing the student with a defined primary mentor, 202
while providing the student the chance to collaborate with content and research expertise throughout the MGH. This approach allows the Fellow to share and build upon his/her existing nursing practice expertise while practically expanding educational opportunities; benefiting both the student and the MGH Patient Care Services community. The program s first Fellow has been in a mentored preceptorship with the Chief Nurse, giving him the opportunity to have one-on-one executive coaching to develop senior level management skills. The following is a narrative from the Fellow describing the experiences he has had. My practice interests and research experience is in executive nursing practice and clinical information systems utilization. Through the program, Jeanette Ives Erickson, MS, RN, has mentored me toward gaining first hand exposure to Nurse Executive practice within a large academic medical center. As part of the individualized program, I have been able to participate in the MGH Patient Care Services Executive Team meetings and retreats, the Center for Innovation in Care Delivery retreat and Doctoral Nursing Forum meetings. I have also attended meetings with the Transforming Care at the Bedside Program Committee, the Partners Clinical Informatics team and the Advanced Clinical Documentation Task Force. All these opportunities are helping me to further develop leadership expertise, as I further advance my career. Jeff Adams, RN, PhDc Through the ongoing relationships with the University of Massachusetts, the Department of Nursing is developing a proposal for a Dedicated Education Unit (DEU), innovative model of clinical nursing education where staff nurses, supported by university faculty, are clinical instructors. In addition, through the relationship with the Massachusetts College of Pharmacy and Health Sciences, an Accelerated BSN Program has been developed with MGH nurses with Masters Degrees and recent inpatient experience serving as faculty. These models will be described in detail in Force 11.7. Long Term Recruitment For more than 16 years, MGH has worked with the Boston Public Schools to expose underserved and underrepresented youth to opportunities in science and healthcare careers and to boost academic achievement through programming at the James P. Timilty Middle School in Roxbury, East Boston High School, and the Health Careers Academy in Boston. Leaders in the Department of Nursing have been instrumental in supporting this effort. 203
The Timilty Middle School Partnership More than 600 students have gone through this program since its inception in 1989. In the past year, thirty-six students were paired with 46 MGH mentors from 34 departments through the Science Mentoring Program and forty-three MGH/Partners employees served as judges in the school-wide Science Fair. Staff Nurses, Clinical Nurse Specialists and Nursing Directors all take active roles as mentors and judges in this program. Summer Youth for Jobs Program - The career exploration and paid summer internships program for graduating eighth grade students from the Timilty School has been a highly successful program supported by the Department of Nursing. This summer, seven students were placed in Patient Care Services areas. Two students were employed in The Norman Knight Nursing Center and one worked with Nursing Staff Specialists on special projects. ProTech - Every year, 12 new ProTech interns are identified through a competitive selection process. They are employed over a 20-month period in hospital departments, including Patient Care Services, Nursing, Pharmacy, Radiology, Endoscopy, Pathology, Pediatric Research, and the Pulmonary Associates. In addition to their work experience, the students participate in mandatory trainings, and professional development seminars. Math scores increased an average of 16.5 percentage points and English scores increased an average of 31.7 percentage points between pre- and post-tests for students participating in this program. Seventy-three percent of participating students passed both the English and Math MCAS tests, and an additional 21 percent passed either the English or the Math test. Based are the results from a recent survey that provides insight on the path of ProTech graduates in the 2004 and 2005 programs: All but one graduate interviewed (20/21 or 95%) attended college in the first year or two following ProTech graduation. Eleven of the nineteen graduates (58%), currently in school, are majoring in or taking prerequisites toward a degree in a medical related field. Of those eleven, 55% (6/11) are majoring in nursing. 204
Additionally, one intern from the class of 2006 is pursuing a career in nursing and two students from the class of 2007 were accepted into nursing programs. To date, 22 interns have successfully graduated from the ProTech program from Patient Care Services and/or the Department of Nursing, with seven interns in the current program. Job Shadowing is an outcome of the MGH/Health Careers Academy Partnership led by the Chief Nurse and the Chairman and CEO of the Mass General Physician s Organization. Since 2003, MGH has worked with the Health Careers Academy (HCA) to provide its students with summer job opportunities. In 2006, a scholarship was established by Patient Care Services at MGH and the Mass General Physician Organization to provide financial support to 10 graduating seniors pursuing higher education within a healthcare profession. Plans for 2007 include job shadowing and internship opportunities for HCA students, a CPR course for HCA teachers, and a teachers professional development symposium focusing on health disparities hosted by MGH. 205