Professional Organization Participation

8.8 Give examples of how networking activities, professional organization participation, and use of consultants and advanced practice nurses have contributed to enhancing the practice of nurses at all levels in the organization through enhancement of their knowledge and skills. Massachusetts General Hospital is a Magnet Hospital with a philosophy of leadership that is committed to and values its employees. Regardless of a nurse s years of experience, professional and personal growth is supported and encouraged. Nurses are enabled to develop their practice through participating in classes and lectures; working with doctorally prepared nurses and Clinical Nurse Specialists; by participating in departmental, service and unit based collaborative governance committees; and most of all, through nurse leader support. Networking All levels of nurses at MGH recognize the importance of networking as a way to promote professional development and enhance leadership and decision-making skills. Participation in Collaborative Governance and interdisciplinary committees (Force 13.2) provide an opportunity for Staff Nurses to connect with their colleagues within the organization, while there are numerous opportunities to network with colleagues outside the organization by participating in professional organization and other professional development activities. For example, Force 11.6 showcases the number of MGH nurses in faculty roles throughout the area. Over eighty-six Nursing Directors, Clinical Nurse Specialists, Staff Nurses and Clinical Educators are in teaching roles at local universities and schools of nursing. This level of participation supports personal development, and in turn, provides an avenue to interact with nurses and nurse educators in the area. Attendance at conferences also provides a way for MGH nurses to network with colleagues throughout the country. Force 14.6 underscores the organization s commitment to supporting nurses attendance at conferences, as nurses have attended over 500 conferences in the past year. This gives nurses the opportunity to learn about best practices to further support professional practice. Force 14.2 describes the nursing leadership s commitment to enhancing their professional development through participation in conferences. For example, Staff Nurses from the Ethics in Clinical Practice Committee, attended the Gunderson Lutheran Respecting Choices Program for Advance Care Planning course, bringing the program back to MGH to advance clinicians expertise in advance care planning, as described in Force 6.15. To explore ways to develop clinical expertise in geriatric nursing, the Chief Nurse and two Associate Chief Nurses attended the Nurses Improving Care to Health Systems Elders 289

(NICHE) conference sponsored by The John A. Hartford Foundation Institute for Geriatric Nursing at New York University several years ago. Deciding that this program would fit the professional needs of nurses at MGH, an interdisciplinary team of twelve clinicians attended subsequent NICHE conferences to build a platform for implementing NICHE at MGH, as described in Force 7.9. The Chief Nurse, Associate Chief Nurses and Nursing Directors attended a conference on Building an Engaged, Data-Driven Nursing Organization sponsored by The Advisory Board/Nursing Executive Center, which helped foster the development of this year s focus on Nursing Informatics for The Knight Visiting Professor program (Force 11.10). In addition to networking opportunities for Staff Nurses and nursing leaders, the Department of Nursing also supports professional development for student nurses by sponsoring and hosting the Massachusetts Student Nurses Association (MaSNA) annual conference. MGH provides a forum for students to network with local nursing leaders and fellow students from across the state. As a result of this effort, at least five nurses, including two past presidents, have been hired to work at MGH in Staff Nurse or Patient Care Associate roles. Attachment 8.8.a is a copy of the MaSNA conference guide for 2006, outlining the program events and the strong participation by all levels of nurses from MGH. Professional Organization Participation MGH nurses are committed to contributing to enhancing nursing practice as evidenced by strong representation of all levels of nurses in professional organizations. Participation allows nurses to develop relationships with nursing leaders throughout the country, in order to share knowledge and bring best practices back to the organization. Force 1.4 provides a detailed list of the broad level of nurse participation in professional organizations. MGH nurses are represented in sixty-two different professional organizations at the local, national and international level. At least thirteen nurses hold leadership positions in organizations. The Clinical Nurse Specialist for Gynecology/Oncology best describes how her participation has influenced her practice. Working at a major medical center with a strong commitment to nursing has enabled me to grow the knowledge, skills, confidence, and vision to pursue a meaningful leadership experience outside of my daily work setting. The Oncology Nursing Society has provided me with untold opportunities to integrate profound experiences in day-to-day practice with national initiatives, making for a very rich professional growth trajectory. 290

- Elizabeth Johnson, RN, MSN, AOCN, AOCNS, HPCN Clinical Nurse Specialist, Chapter President, Boston Oncology Nursing Society Use of consultants Nurses at MGH have created a practice environment that fosters a spirit of inquiry and promotes professional development using a broad array of clinical and administrative resources. Nurses have access to internal consultants and outside consultants to enhance knowledge and skills impacting practice. As described in Force 7.8, the Professional Development Coordinator in The Yvonne L. Munn Center for Nursing Research consults with nurses and staff in Patient Care Services, supporting their efforts to access grants that support professional practice, such as the recent US Department of Health & Human Services grant for a Nurse Residency Program. Force 6.15 describes the role of the MGH Clinical Nurse Specialist in Ethics who works with staff to develop expertise in ethics as a component of professional practice. In addition to one-on-one consultations, she has been instrumental in developing a broad range of educational forums, including the Harvard Bioethics Course and Maintaining Compassionate Care, both described in Force 14.4. She also worked with an outside a Nurse Ethicist consultant to develop unit based ethics rounds supporting Nursing Directors, Clinical Nurse Specialist, Staff Nurses, Physicians and representatives from all allied health fields, as they further develop expertise in ethics. The Nursing Research Fair, described in Force 11.10, featured three components: research consultation, an interactive poster display, and exhibits. Prior to the fair, Staff Nurses, Clinical Nurse Specialists and Nursing Directors were asked to consider these two questions. Do you have a clinical problem or a research question that you would like to discuss with an expert? Has your staff identified a researchable clinical problem? Research consultation during the event included thirty-two, 30-minute, consultative sessions between members of the Doctoral Forum and potential investigators. Consultations focused on research questions, methodologies, and possible funding opportunities. Attachment 8.8.b is the schedule for the consulting tables. Nurses also use internal consultants to assess and enhance their own practice, while improving care for patients. Force 8.7 described the role of the Psychiatric Nursing Consultation Service in guiding staff as they improve patient outcomes. The team also plays a significant role in providing support for professional development of staff. Working with the unit-based Clinical Nurse Specialist for the two Orthopeadic units; the Psychiatric Clinical Nurse Specialists developed and implemented a study evaluating how focused education and bedside coaching can improve nurses knowledge and comfort level in managing patients with delirium. Study results indicate that 291

nurses are in a pivotal role to intervene at the bedside when a patient develops delirium. Knowledge about the disease process, tools to accurately screen for patients who are at risk, and bedside coaching may improve the experience of those nurses caring for delirious patients as well as improve patient outcomes. Attachment 8.8.c is a summary of the findings. Attachment 8.8.d is an abstract poster accepted for presentation at this year s MGH Nursing Research Fair. Another study, completed in 2006, looks at nurses professional practice model. In consultation with an Associate Nurse Scientist in the Yvonne L. Munn Center for Nursing Research, Staff Nurses and nursing leaders in the Infusion Unit developed a study project to assess their model of nursing care delivery as compared to patients perspectives about the care they received. Staff Nurses, Clinical Nurse Specialists, and the Nursing Director worked with the Associate Nurse Scientist to design a study and implement the study. One Staff Nurse played a significant role in the study, as she used it to fulfill course requirements for her graduate nursing studies. Using a patient satisfaction survey, the study looked at patients perspectives on the care they were receiving. Approximately 230 patients were queried and data was analyzed from 200 surveys. Survey results indicated that patients who receive nursing care in the Infusion Unit are highly satisfied with the quality of nursing care. On four quality subscales, nursing care received scores 99, 95, 95, and 99. Of the 200 patients asked about their preferences, 73% preferred to see the same nurse while 27% preferred to be treated on time. The findings suggest that most patients value continuity of nursing care, and that the relationships with their nurses sustained them during their treatment. The patients' comments also suggested that all staff, not solely nurses, in the Infusion Center contributed significantly to the feelings of being well care for. In addition to the vast internal consultative resources available to nurses, the Department of Nursing fully supports the use of external consultants to help develop and nurture staff. For example, the Documentation and Communication (Doc Com) Project (Force 1.3) began with an intensive seven-week assessment and recommendation process conducted by MGH staff and IBM consultants. The goal of the project was to prepare Staff Nurses for automated patient care documentation and to establish recommendations for a pilot of standardized changes in documentation and communication throughout the patient care units. Clinical experts are routinely invited to MGH to interface with nursing staff to further knowledge and skills. Examples include: Nursing leaders from around the country come to MGH during the Nurses Week celebration to talk with nurses about practice. This year s speakers included, Beverly Malone, RN, President of 292

the National League for Nursing; Patricia Yoder-Wise, RN, President of the American Nurses Credentialing Center and Cheryl Beck, RN, Professor, Coordinator of the Honors Program, and Co-coordinator of the Doctoral Program, at the University of Connecticut School of Nursing. In addition to their presentations, guest lecturers often meet with small groups of nurses for more focused discussions, giving nurses at all levels of the organization a chance to gain insight into their practice. This year, several Nursing Directors and Associate Chief Nurses had the opportunity to meet with Patricia Yoder-Wise. Following are the comments of one Nursing Director illustrating how the conversation enhanced his practice as a leader. Because Yoder-Wise's work focuses so heavily on the nurse-patient relationship, I remember that, as a group of Nursing Directors, we asked her if being present to a patient in a way that calls forth their story is a gift that you either have or don't have, or if it is a skill that can be taught. She replied that it is both. If you have the gift, it is your responsibility as a nurse to teach it to others. For me, this has impacted the focus of my conversations at annual review time. If a nurse is gifted with being present, I have asked how they pass this on to colleagues. If they do not appear particularly gifted in this area, I ask them to name colleagues who are and ask how they might learn from them. Keith Perleberg, RN. MDiv Former Nursing Director, General Medicine Director, PCS Office of Quality and Safety Dr. Yoder-Wise validated that the demographics of nursing students has changed to include second career individuals. We must foster these "older, mature" individuals when hiring into our open RN positions. These seasoned people have much to offer our profession. - Maria Winne, RN, Nursing Director Respiratory Acute Care Unit (RACU), Bigelow 9 I thought Dr. Yoder was insightful about the issues we face in creating a professional practice environment. She spoke about the steps we can take with a practicality that resonated with me. She challenged us to set examples for our staff-------in a very meaningful way. She gave us examples of how we could walk the talk Joanne LaFrancesca, R.N. Nursing Director Cancer Center Infusion Unit, Yawkey 8 To support the professional development the nurses under her supervision, the Associate Chief Nurse for Oncology, Surgery, Orthopaedics and Neurosciences has consulted with Mary J. Connaughton, RN, MS, Principal for Connaughton Consulting to assist with developing staff. 293

One example of these consulting efforts focuses on enhancing leadership skills of lessexperienced Nursing Directors on the service. The consultant has provided one-on-one coaching to four Nursing Directors to help develop leadership skills. In each case, the consultant developed a detailed coaching plan identifying behaviors that limited their success, strategies to address those behaviors and outcome measures that would demonstrate a successful change. After a few months of working with the Nursing Directors, the coaching plan and mentoring transitioned back to the Associate Chief Nurse. In all cases, the Nursing Directors have grown and demonstrated success in their roles. The TEFEN Consulting Group was hired to work with the Vincent Obstetrical Service to improve OB efficiency, analyze patient outcomes and improve practice where needed, and enhance staff and patient satisfaction. The leadership team for this project included the Chief Nurse, Associate Chief Nurse, Nursing Directors and Clinical Nurse Specialists for the service. Attachment 8.8.e is the full list of team members. As a result of this work, nursing leaders were able to benchmark their practice against other organizations and develop collaborative practice standards with the team of clinicians on the service. They developed practice standards including an induction protocol, triage protocols, and protocols for the evaluation of labor and initial evaluation of preeclampsia. They have also worked and have worked to enhance the Mother/Baby Care model to improve patient satisfaction and facilitate discharge. Nurses must have highly developed critical-thinking and physical assessment skills and the ability to effectively collaborate and communicate across disciplines to meet the complex needs of medical patients. Each year, the Medical Nursing Service celebrates the specialty of medical nursing by bringing a leading nurse experts to the hospital to work with staff as they further hone their skills. In 2006, Patricia Benner, RN, PhD, FAAN, Professor, Thelma Shobe and Chair in Ethics and Spirituality at the University of California spoke to nurses about the value of the clinical narratives as a way to uncover knowledge embedded in clinical practice. Attachments 8.8.f and 8.8.g describe Dr. Benner s visit with nursing staff. This year s speaker is Patricia Martin Arcari, PhD, RN, the Director of the Calm Mother, Happy Child Program at the Benson-Henry Mind Body Institute. Dr. Acari is a Clinical Nurse Specialist, an Associate in Medicine at the Harvard Medical School, and an 294

Associate at Boston College School of Nursing. Her specialty areas include: mindful meditation, parenting and infertility. Force 8.7 focused on the way in which Dr. Courtney Lyder s consultation supported improved patient outcomes. As a world-renowned expert on pressure ulcers, his consultative visit also helped nurses interpret Federal regulations (F-Tags) regarding pressure ulcers. He spent a great deal of time teaching Clinical Nurses Specialists and Staff Nurses about how to document conditions, which predispose the patient to "unavoidable" pressure ulcers. Knowledge gained from his visit was integrated into the course content for the Wound Care Education Program. As the Center for Medicare and Medicaid (CMS) recently announced plans to deny reimbursement to acute care facilities in the event of five "new events," including pressure ulcers, the anticipatory planning and skills building for staff is already in place to address this issue in patient care. Advanced Practice Nurses As described in Force 8.6 and the examples above, Advanced Practice Nurses are influential as they support the professional development of staff throughout the organization. Programmatic based Clinical Nurse Specialists lead the organization in developing staff expertise in ethics, research, wound care, pain management and geriatric care, as well as, service specific specialty care. Clinical Nurse Specialists drive the process for nursing grand rounds, selecting timely topics (Force 14.14) to enhance knowledge of nurses, and often including Staff Nurse participation in rounds to help develop professional presentation skills. Clinical Nurse Specialists are also essential members of the unit-based triad responsible for staff development at the unit level. Several examples illustrating the role of the Clinical Nurse Specialist in advancing the knowledge and skills of Staff Nurses is evidenced in the following forces: Force 5.3 describes the role of the Same Day Surgical Unit s Clinical Nurse Specialist in helping Staff Nurses apply professional practice standards in perioperative nursing. Force 7.6 describes the ongoing work of the Staff Nurse Sheath Removal Team on Ellison 11, the Cardiac Access Unit, in training Staff Nurses to perform the sheath removal procedure. This Clinical Nurse Specialist led initiative has resulted in earlier sheath removals for patients with no differences in complication rates as compared to other advanced practice clinicians. 295

Force 9.5 describes the role of the Clinical Nurse Specialist in implementing a unit-based training program for assuring Staff Nurse competency in the new blood transfusion procedure. 296

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Attachment 8.8.b Nursing Research Fair Nurse Consultants Lillian Ananian, RN, MSN Clinical Nurse Specialist Endoscopy/Blake 4 Tel: 617 726-6658 E-mail: Lananian@partners.org Areas of Interest: Clinical outcomes of morbidly obese ICU patients; ethics Patty Martin Arcari, PhD, RN, CNS Director of the Calm Mother, Happy Child Program Benson Henry Institute for Mind Body Medicine Tel. (617) 732-9751 Email: Pmarcari@partners.org Areas of Interest: Mindfulness Meditation, Relaxation Response, Intervention Studies, Parenting, and Nursing Staff support Anne-Marie Barron, PhD, RN Clinical Nurse Specialist Hematology-Oncology/BMT, Ellison 14 Tel: 617 724-5410 E-mail: ambarron@partners.org Areas of Interest: Psychosocial and spiritual aspects of nursing practice, meaning and illness and the understanding and alleviation of suffering; therapeutic touch; end of life concerns Virginia Capasso, PhD, APRN, BC Clinical Nurse Specialist, Wound Care Program The Knight Nursing Center for Clinical and Professional Development Nurse Scientist, Munn Center for Nursing Research Co-Director, MGH Wound Care Center Instructor in Surgery, Harvard Medical School Tel: 617 726-3836 E-mail: vcapasso@partners.org Areas of Interest: Cutaneous wound healing; measurement of wound size and pro-healing milieu; pain management lived experience of topical wound therapy; care of patients with peripheral vascular disease undergoing vascular surgical and interventional radiology procedures; Cost and efficacy of wound treatments, wound assessment, wound measurement, quantitative research Diane Carroll, PhD, RN Yvonne L. Munn Nurse Researcher The Yvonne L. Munn Center for Nursing Research Tel: 617 724-4934 E-mail: dcarroll3@partners.org Areas of Interest: Cardiovascular nursing care; human research review process; clinical pathways; quality of life; alternative therapies; research design implementation and analysis; Quantitative research 305

Attachment 8.8.b continued Patricia Dykes, PhD, RN Senior Nurse Informatician Information Systems Tel. 781 416-9258 E-mail: Pdykes@partners.org Areas of Interest: Emerging technologies and infomatics tools for interactive health communication; evidence-based practice; patient education; quantitative, quasi-experimental and experimental, survey research, instrument development Susan M. Lee, PhD, RN Clinical Nurse Specialist The Knight Nursing Center for Clinical and Professional Development Tel: 617 724-3534 E-mail: Slee40@partners.org Areas of Interest: Narratives as intervention; practice environment; nurse retention; methodology; Enriching and preserving nurse/patient relationships, measuring outcomes; professional practice environment Angelleen Peters-Lewis, PhD, RN Nurse Manager Endoscopy Unit/Blake 4 Tel: 617 726-8955 E-mail: apeterslewis@partners.org Areas of Interest: Racial health disparities; qualitative research Sara E. Dolan Looby, PhD(c), RN, ANP Clinical Research Nurse Practitioner Program in Nutritional Metabolism Ph: 617 726-1423 E-mail: Sdolan@partners.org Areas of Interest: Metabolic complications in HIV-infected women, specifically bone density and cardiovascular risk; lifestyle intervention among HIV-infected women; predictors of adherence among HIV-infected women; health promotion and education for HIV-infected women; Quantitative research Laurel E. Radwin, RN, PhD Yvonne L. Munn Nurse Researcher Yvonne L. Munn Center for Nursing Research Tel. 617-726-1018; E-mail: Lradwin@partners.org Areas of Interest: Quality of Care, Patient-Centered Nursing Care, Desired Health Outcomes, Clinical Expertise Barbara Roberge, PhD, RN, CS Nurse Practitioner/Nurse Coordinator, Geriatric Nursing Adjunct Faculty, MGH Institute of Health Professions Massachusetts General Hospital Senior Health Practice Tel: 617 726-4611 E-mail: broberge@partners.org Areas of Interest: Agitation in hospitalized elders; health policy; Medicare policy 306

Attachment 8.8.b continued Donna Slicis, APRN, BC Staff Nurse PreAdmission Clinic Tel: 617 724-1668 E-mail: dslicis@partners.org Areas of Interest: Family care giving strain; literacy issues; advanced care planning and partnering with patients in health coaching; Research Design and Research Question Lynda-Tyer Viola, PhD, RNC OB Clinical Nurse Specialist/Blake 14 Tel: 617 724-3608 E-mail: ltyerviola@partners.org Areas of Interest: Co-morbid disease in pregnancy; HIV positive mothers; factors that affect maternal mortality in Africa 307

Attachment 8.8.b continued Nursing Research Fair Consultation Time Booth 1 Booth 2 Booth 3 Booth 4 Consultant 1 Consultant 2 Consultant 3 Consultant 4 12:00 12:30 Linder Tyer- Viola Patty Arcari Donna Slicis Laurel Radwin 12:30 1:00 Linder Tyer- Viola Patty Arcari Patricia Dykes Laurel Radwin Time Consultant 5 Consultant 6 Consultant 7 Consultant 8 1:00 1:30 Linder Tyer- Viola Diane Carroll Sara Dolan Looby Laurel Radwin 1:30 2:00 Anne-Marie Barron Diane Carroll Sara Dolan Looby Laurel Radwin Time Consultant 9 Consultant 10 Consultant 11 Consultant 12 2:00 2:30 Susan Lee Diane Carroll 2:30 3:00 Susan Lee Diane Carroll Angelleen Peters-Lewis Angelleen Peters-Lewis Laurel Radwin Laurel Radwin Time Consultant 13 Consultant 14 Consultant 15 Consultant 16 3:00 3:30 Ginger Capasso Lillian Ananian Barbara Roberge Laurel Radwin 3:30 4:00 Ginger Capasso Lillian Ananian Barbara Roberge Laurel Radwin 308

Attachment 8.8.c Delirium in the Orthopedic Patient Orthopedics and Psychiatric Nursing Consultation Service QI Study MGH Orthopedic Patients Diagnosed with Delirium FY2002 41 patients FY2003 38 patients FY2004 36 patients Delirium A common, reversible syndrome in hospitalized patients characterized by a rapid onset of change in mental status and behavior Physiologic consequence of a medical condition Often accompanied by confusion, fear and agitation 309

Attachment 8.8.c continued QI Study RNs on EL6/WH6 completed pre and post survey PCNS provided in-service education on delirium Folstein mini mental state exam (MMSE) PCNS provided consultations and bedside coaching Results: Nurse Survey 7% increase in correct responses When caring for delirious patients, the number of nurses Felt most confident doubled from 33% to 66% Felt most comfortable increased from 54% to 73% Results: Safety Assaults on staff decreased from 3 in the pre-study period (9/05-12/05) to none during the study (1/06-4/06) Restraints decreased by approximately 22% Observer/Sitter usage decreased by over 52% 310

Attachment 8.8.c continued Results: LOS Decreased by 0.11 days from the pre study period to the study period Recommendations Continue to provide education, consultation and bed side coaching Consider minimizing the numbers of drugs ordered for patients routinely Consider administering MMSE routinely during pre admission testing 311

Attachment 8.8.d 312

Attachment 8.8.e TEFEN /Obstetrics Management Team OB Leadership Team Isaac Schiff M.D. Chief Vincent OB/GYN Fredrick Frigoletto M.D. Associate Chief Vincent OB/GYN Jeanette Ives Erickson, RN Senior Vice President, Patient Care Services & Chief Nurse Dan Ginsburg Senior Vice President, Cancer and Women s Programs MGH Laura Riley M.D. Medical Director of Labor & Delivery Michael Greene M.D. Chief of OB William Barth M.D. Chief of Maternal Fetal Medicine Marie Henderson C.N.M. Chief Nurse Midwife Debbie Burke R.N. Associate Chief Nurse, Nursing Practice Sue Caffrey R.N. Nurse Manager, Labor and Delivery Lori Pugsley R.N. Nurse Manager, Newborn Family Units Lynda Tyer-Viola RN Clinical Nurse Specialist Pat Connors RN Perinatal Clinical Nurse Specialist Caryn Wilson Administrative Director Vincent OB/GYN Mary Witkowski Research Associate Vincent OB/GYN 6 313

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Attachment 8.8.g The Medical Nursing Service proudly presents Celebrating Medical Nursing as a Specialty 2006 Wednesday, November 15 th 10:00am 2:00pm O Keeffe Auditorium Featuring: Patricia Benner, RN, PhD, FAAN, Professor, Thelma Shobe Endowed Chair in Ethics and Spirituality Chair, Department of Social and Behavioral Sciences, Joint Appointment, Department of Physiological Nursing Morning Session: 10:30am 12:00pm The Art and Science of Medical Nursing as Viewed Through the Clinical Narrative Afternoon Session: 1:00pm 2:00pm Interdisciplinary Case Presentation Poster Session: 8:00am 2:00pm White Lobby 315