THE MAGNETIC PULL

Abstract

Children's Hospital of Michigan, Detroit, Mich.FigureFigureFounded 121 years ago, the Children's Hospital of Michigan (CHM) is the first and only hospital in the state dedicated exclusively to the treatment of children. A leader internationally in neurology and neurosurgery, cardiology, oncology, and diagnostic services, CHM is one of nine hospitals operated by the Detroit Medical Center. CHM has garnered a number of accolades for clinical excellence, including achieving Magnet Recognition®, being ranked among the nation's top 30 hospitals for children in 2008 by U.S. News & World Report, and being given the 2007 Leapfrog Group Top Hospital designation for safety and quality. In addition, more Michigan pediatricians are educated at CHM than at any other facility. Rhonda Foster, EdD, MPH, MS, RN, vice president of patient-care services, had this to say about CHM's Magnet Recognition, "Children's Magnet designation is public recognition that our nurses, in partnership with physicians and staff, provide quality patient care, promote nursing excellence, and encourage innovations in professional nursing practice. We've always known that our nurses are among the best in the country. This designation simply affirms their work and dedication to patients and families and the profession. Magnet designation has tangibly transformed the hospital culture to one that is filled with new pride and vigor." Quality of leadership The CNO is perceived as a knowledgeable, strong leader who represents nurses at the highest levels of the organization and the system and advocates on behalf of staff and patients. She was instrumental in the establishment of the Versant RN Residency program at CHM, which orients and mentors new graduate nurses. The CNO also recently advocated for the permanent appointment of a staff nurse position in palliative care. Nurses throughout the hospital have identified and advocated for additional resources to support unit goals. Staff nurses have direct influence on staffing and scheduling, unit-based supply stock and usage, and charge capturing. Organizational structure The CNO actively facilitates and supports decentralized decision making through the professional nurse advisory council (PNAC), which is at the center of all problem solving, decision making, and information sharing for nursing. The council and its members serve as conduits for information to and from nursing units, nursing leadership, and various hospital committees. Nursing leadership adjusts scheduling and ensures that nurses who participate in the PNAC are reimbursed if they come in on their day off. Personnel policies All policy and human resource information is available online via the Detroit Medical Center intranet. CHM utilizes the Promoting Excellence in Nursing program as the performance appraisal process. Nurses are evaluated in five categories of performance—customer service, patient care, communication, teamwork/leadership, and professional practice—together with years of experience and the attainment of predetermined professional and personal goals. Professional model of care CHM has adopted a family-centered care philosophy, which emphasizes the involvement of the family in the care of the hospitalized child. This includes a family-centered care rounds pilot initiative that involves physicians, nurses, medical students, case managers, parents, and children (when appropriate). As the initiative continues to develop, nurses will maintain an active role in leading the rounds and collaborating with the medical staff. Quality of care CHM has created and adopted a philosophy of "everyday excellence," which is a motivationally-based service delivery model that instills a culture of excellence by creating exceptional experiences for patients, families, and employees. Nurses at CHM continue to embrace evidence-based practice (EBP) as the framework for best practice. The two resources that help facilitate this framework are a full-time nurse researcher, who has established the EBP steering committee and the development of EBP workshops to increase nurses' confidence and knowledge of EBP, and library resources (both in-house and online) that provide an excellent enhancement to the framework. The senior information resource specialist provides information to the staff to support EBP and nursing research. In addition to being a member of the EBP steering committee, she provides assistance to committees doing policy and procedure review and to unit-based initiatives to implement practice change. To provide opportunities for nurses and the entire healthcare team to increase their knowledge of ethics, diversity, quality improvement, and practice as it relates to care of the pediatric patient and family, the Department of Nursing has established Pizza Friday Lunch & Learn. Each month an internal or external expert presents a different topic to educate nurses, social workers, chaplains, and child life specialists, among others. The class includes one contact hour for nurses. Quality improvement CHM subscribes to a singular organization-wide approach for implementing interdisciplinary and service activities. The Plan-Do-Check-Act methodology of continuous improvement is the basis of all education provided to nurses and other employees. The leadership performance improvement regulatory compliance committee is an interdisciplinary team with representatives from all services that impact patient care. The committee assists in ensuring adherence to established standards of care, maintains regulatory performance, and is at the center of the hospital's quality improvement initiatives. Management style Members of the nursing leadership team are accessible to nursing staff in person and through pagers, cell phones, home phones, and e-mail. In addition, rounding in the units and providing informal lunch gatherings gives nurses opportunities to share concerns and discuss pertinent clinical matters. The shared decision-making structure through PNAC facilitates communication vertically and horizontally across the organization. Consequently, direct care nurses are able to initiate change to improve patient care and the practice environment. Consultation and resources CHM employs more than 60 advanced practice nurses (APNs) who work in many settings and specialties within the hospital. They serve as consultants, educators, researchers, resources, and role models and most are involved in the care of patients, especially those who are acutely ill or have special needs. CHM has a well-established relationship with 15 educational institutions throughout the Detroit metropolitan area. This has created the opportunity to place more than 1,300 nursing students a year in clinical rotations throughout the hospital. In addition, CHM has a close relationship with Wayne State University College of Nursing. As a result of this relationship, CHM established the Elizabeth Schotanus Endowed Professor of Pediatric Nursing. This joint position between the College of Nursing and CHM has created an environment that's collaborative and highly professional. A well-established medical library is on-site and available 24 hours a day with multiple websites and databases available for staff use. Library staff teach nurses on how to access library resources and perform literature searches. Autonomy Direct care nurses are encouraged to exercise independent judgment to resolve patient-care issues and practice autonomously in accordance with standards, practice guidelines, and protocols. Established in 1985, CHM's-specialized neonatal and pediatric transport team is an all RN-managed team that provides safe transport for more than 1,000 babies and children from all over the state, surrounding states, and Canada. Community involvement CHM has an immunization station on campus that serves numerous patients. Funded by a grant from the Michigan Department of Community Health, the clinic sees more than 30 children daily and operates 3 days a week. Immunizations are free to children who are Medicaid eligible, uninsured, or underinsured. Since opening in 2002, more than 20,000 children have received approximately 40,000 immunizations. One example of CHM's community impact is its community-based mobile health service, which visits residential areas of Detroit and Detroit Public Schools locations. Services are rendered regardless of insurance type or coverage, and nurse practitioners provide physical exams, lead screening, developmental screening, immunizations, and hearing and vision screening to name a few. This mobile health program assesses and treats more than 2,400 children a year throughout Detroit. Nurses as teachers The Versant RN Residency Program at CHM is essential to the transition of new graduates into practice. This 18-week program utilizes a structured orientation that includes mentoring, debriefing, looping experiences, and a combination of classroom and clinical experiences. Subject matter experts, mentors, debriefers, and preceptors collaborate with new nurses to successfully prepare for and increase their confidence in providing safe and competent care. The program's success has been demonstrated by a significant decrease in turnover (49% to 13%). The hospital provides 20 clinical faculty members who are also on staff. APNs and other nursing staff maintain adjunct faculty and clinical faculty positions with several universities and serve as guest lecturers and clinical instructors as needed. Nurses are encouraged, supported, and empowered to incorporate teaching in all aspects of their practice. Image of nursing One of the many ways the hospital celebrates and recognizes its nurses is through the Nurse of the Month program. In addition to the monthly rewards, each year during Nurses Week, the Inspiration and Excellence Awards program recognizes nurses for practice, education, research, and leadership. CHM also participates in the DAISY Award, which is presented quarterly to a nurse who provides extraordinary care based on positive patient and family feedback. Collegial relationships Nurses at CHM enjoy interdisciplinary relationships that are built on collaboration, credibility, and ongoing commitment to serving their patients. Nurses, support staff, and physicians work hand in hand to resolve patient-care issues and improve quality metrics and positive outcomes. One example is the implementation of an electronic medical record in 2006. Nurses at all levels of the organization worked with other disciplines and spent many weeks mapping out the specific processes and workflows to ensure a successful transition. Professional development The Center for Excellence in Pediatric Nursing (CEPN) promotes leadership, scholarship, professional development, and an exemplary work environment for nurses at CHM. The CEPN provides financial support to nurses for research and education. It also funds presentations, research proposals, and participation at conferences and professional meetings. A well-established Nursing Grand Rounds program provides educational opportunities for nurses each month. The nursing leadership of CHM collaborated with University of Detroit Mercy to provide an on-site postbaccalaureate certificate program in nursing leadership and financial management. Upon completion of the program, the credits may be applied toward a master's degree in nursing and health systems management. Since the program's inception, 13 members of the nursing leadership team have participated.