Forces of Magnetism

How the Forces Live at CMC

Magnet Force 1 - Quality of Nursing Leadership
Nursing leadership is perceived to be knowledgeable, strong risk-takers who follow an expressed philosophy in the day-to-day operations of the nursing department.  Nursing leaders also convey a strong sense of advocacy and support on behalf of the staff.

1. Nurses are supported with internal and external education
2. Retention team advocacy for increased direct patient care RN support
3. Change to EPIC from Sorian

Magnet Force 2 - Organizational Structure
The organizational structure is flat and structured to facilitate unit-based decision-making. There is strong representation of nursing in organizational committee structure. Nursing leaders serve at the executive level of the organization and the Chief Nursing Executive often reports to the CEO.

1. CMC participates in an annual RN satisfaction survey process. Individual unit data is shared with staff. Nurses assist in developing action plans related to survey data.
2. Nurses are included in decision making bodies-practice councils, product evaluation, medication subgroups and a variety of other teams
3. 55% of management team – nursing

Magnet Force 3 - Management Style
Organization and nursing administration use a participative management style and incorporate feedback from staff at all levels. Feedback is valued and encouraged. Nurses serving in leadership positions are visible, accessible and committed to communicating to the staff.

1. Open door policy of all administrative levels
2. Carilion Corporate University
3. HR conducted random staff focus groups regarding strategies for retention
4. ICU visitation policy / Pet policy

Magnet Force 4 - Personnel policies and programs
The organization’s benefits and salaries are competitive. Creative flexible staffing models are utilized and shift rotation is minimal. Personnel policies are created with staff involvement, and significant administrative and clinical promotional opportunities exist.

1. Total Rewards
2. SERVE-U initiative led by CNO
3. Adopt-a-nurse program
4. Compliance department provides policies for workplace harassment, hotline for reporting safety issues

Magnet Force 5 - Professional Models of Care
Models of care are used that give nurses the responsibility and authority for the provision of patient care. Nurses are accountable for their own practice and are the coordinator of care.

1. Ambulatory care area developed “Buddy System” for preop nurse to parented with postop nurse for more efficient patient care and workload management
2. Cardiology developed disease-specific discharge forms
3. Cardiology staff matrix change - matching nurse with NA for improved care delivery
4. 9South purchased telephones for better unit communication during shift to accommodate for unit design
5. M/B transformed their care delivery approach to the Family Care Nursing Model with pilot data indicating improved staff and patient satisfaction and decreased length of stay

Magnet Force 6 - Quality of Care
Nurses perceive that they are providing high quality care. Providing quality care is seen as an organizational priority, and nurses serving in leadership positions are viewed as responsible for developing the environment in which high-quality care can be provided.

1. NDNQI RN Satisfaction scores
2. IV catheter change to improve safety
3. VTE Charter Team
4. Rapid Response Team
5. Decrease in VAP
6. Hand Hygiene Education
7. Override initiative
8. Insulin Pens
9. Development of Chest Pain Center
10. DE and Chest Pain Center developed process with EMT to call ahead with EKG/draw blood-then seen quickly by MD- decreased time to cath lab if necessary

Magnet Force 7 - Quality Improvement
Quality Improvement activities are viewed as educational. Staff nurses participate in the quality improvement process and perceive the process as one that improves the quality of care delivered within the organization.

1. Nurse-driven Pain Council
2. Quality Plan of Care on intranet
3. Nursing Outcomes Committee
4. Rapid Wean Unit on 8 Mtn PCU
5. Recognized need for thoracic surgical unit – TSCU initiated 2007

Magnet Force 8 - Consultation and Resources
Adequate consultation and other human resources are available. Knowledgeable experts, particularly advanced practice nurses, are available and used. In addition, peer support is given within and outside the nursing division.

1. To improve cardiology nursing support at night – NP added
2. Advanced practice nurses are available for staff consultation (ex. Pain CNS, Wound Care Nurses, Diabetes CNS)
3. Ethics committee available for consults
4. Resources available via hospital libraries, internet access to journals and textbooks, librarians available to assist with supporting research
5. Vancomycin levels being adjusted with pharmacist at night

Magnet Force 9 – Autonomy
Nurses are permitted and expected to practice autonomously, consistent with professional standards, and are expected to exercise independent judgment within the context of a multidisciplinary approach to patient care.

1. Proactive screening and prevention steps implemented for DVT prophylaxis
2. Forensic Nurse Examiners in ED and available for consults
3. Multiple decision-based protocols (ex. heparin, alcohol withdrawal, arrhythmias)
4. ORS merging staff with consolidation – staff making decisions about roles

Magnet Force 10 - Community and the Healthcare Organization
Community presence is often established through ongoing, long-term outreach programs resulting in the hospital being perceived as a strong positive and productive corporate citizen. Hospitals with a strong community presence are able to recruit and retain nurses.

1. Continued utilization of HeartNet- when patients arrive, Case Management involved immediately to assess transportation needs
2. Multidisciplinary team developing plan for potential flu pandemic
3. Breast Care Center developing technology with doctor in Europe to better detect cell abnormalities
4. Many CMC nurses are registered with the VA Defense Force participation
5. Center for Healthy Aging sends NP to nursing homes
6. Breast Care Center providing financial assistance for preventive screenings through “Every Woman’s Life”

Magnet Force 11 - Nurses as Teachers
Nurses are permitted and expected to incorporate teaching into all aspects of their practice. Teaching gives them a great deal of professional satisfaction.

1. Organizational orientation being streamlined with unit education being emphasized
2. Orthopedic nurses participate in education of patients through the Joint School
3. Adopt-a-nurse program
4. Case Western established a DNP site here in Roanoke
5. Performance evaluations with orientation and annually
6. 11 West ranked number one unit for nursing students

Magnet Force 12 - Image of Nursing
Nurses are viewed as an integral part of the hospital’s ability to provide patient care. Other members of the healthcare team characterize services provided by nurses as essential.

1. Expanding nursing school opportunities for clinical experiences focusing on BSN programs
2. HRD received the Cubic Award for the development of the Carilion Corporate University
3. Override initiative included multiple disciplinary partners
4. Nurses speak at high schools/colleges regarding nursing

Magnet Force 13 - Interdisciplinary Relationships
There is a sense of mutual respect among all disciplines, resulting in positive interdisciplinary relationships

1. Charter Teams valuable interdisciplinary initiatives to improve patient outcomes: Glucose, Hand Hygiene, Central Line, Oncology, DVT
2. EPIC development with multiple disciplines providing FTEs and expertise.

Magnet Force 14 - Professional Development
Significant emphasis is placed on orientation, in-service education, continuing education, formal education, and career development. Personal and professional growth and development are valued. In addition, opportunities exist, along with the resources to maintain competency.

1. Sigma Theta Tau Chapter with JCHS has more than 50% of membership as Nurse Leaders / Jennifer Martin, Executive Director of M/S ICU/PCU, President-Elect
2. Lisa Sprinkel, Executive Director for Home Health and Hospice, has been appointed to the Healthcare Reform Commission created by Virginia Governor Tim Kaine in July 2006. 
3. Conferences sponsored by CMC:  Nursing Research Conference, Cardiology Conference, Pain Conference, NICU Conference, Pediatric Conference
4. Ambulatory Services provides educational in-service every Wednesday with every nurse rotating responsibility