Getting Magnetized Service Strategies for Nursing Excellence Joy

Getting Magnetized: Service Strategies for Nursing Excellence Joy Kennedy, MLS Northwest Community Hospital Health Resource Library Based on contents created by Margaret (Peg) Allen, MLS-AHIP

Introductions • Margaret (Peg) Allen, Library Consultant, Author and CE Presenter • Joy Kennedy, Northwest Community Hospital, Health Resource Library 2

Northwest Community Hospital http: //www. nch. org

Learner settings—show of hands • Librarian and/or nurse? • Hospital/health system? – Involved in ANCC Magnet Program? – Magnet status – achieved, preparing, site visit? • • Academic – ADN, BSN, Graduate programs Nursing school faculty/library liaison Combined – hospital/nursing school setting Academic medical center – multiple programs Academic medical center, no nursing school Professional nursing society Public health Other 4

Course Objectives Participants will be able to: • Describe the ANCC Magnet initiative and its significance to hospitals and nurses. • Describe the knowledge-based information needs of nurses • Identify collaborative education and service strategies to improve knowledge-based information services for nurses • Identify opportunities for librarians and their library to partner with nurses to improve patient care and safety 5

Learning plan • ANCC Magnet Program – History of Magnet Program & its Importance to Nurses, Hospitals • “Forces of Magnetism”—was 14, now consolidated into 5 “Model Components” – For each: library opportunities • Information Needs of Nurses & Evidence-Based Nursing Practice • Evaluation: final questions; forms 6

ANCC Magnet Program Why ANCC Magnet Certification? Magnet: the Standard http: //198. 65. 134. 123/Magnet/Resource. Centers/Faculty/Magnet. Film. aspx Produced by ANCC 7

Latest Magnet Film “Magnet: the power to attract and retain” http: //nursingworld. org/media/play. asp? f=6&q=m&t= v 8

Magnet Certification ANCC Magnet Recognition Program®— Recognizing excellence in nursing services – Developed by the American Nurses Credentialing Center, part of ANA, to recognize health care organizations that provide the very best in nursing care. – “Seal of approval” for quality nursing care – Aids in nurse recruitment and retention – Rapid growth – 7 in 2000; 300+ now http: //www. nursecredentialing. org/Magnet/Program. Overview /Growthofthe. Program. aspx 9

Historical Background • In 1983, the American Academy of Nursing commissioned a Taskforce to research why some hospitals attracted and kept nurses in a time of severe nursing shortage. – Mc. Clure, MM, Poulin, M. , Sovie, M. & Wandelt, M. (1983). Magnet hospitals: Attraction and retention of professional nurses. American Academy of Nursing Task Force on Nursing Practice in Hospitals. Kansas City, MO: American Nurses Association. 10

Research Findings: Characteristics of Magnet Hospitals • Participatory Management (Shared Governance) • Nursing Autonomy & A Supportive Nursing Leadership • Career Development Opportunities for Nurses • Recognition of Importance of the Quality of Patient Care 11

Further Research on Magnet Hospitals • Magnet Hospital nurses were more satisfied with their jobs • Nurses at Magnet hospital are more likely to be certified in specialty areas, maintain continuing education & participate in community programs • Strong relationship between the degree of nursing autonomy & quality of care patients received 12

More Resources on Magnet • Nursing Center Articles: http: //www. nursingcenter. com/Career. Center/magnet. asp – Costs unless Nursing Center member $4 -$8 each • ANCC page on Medscape: http: //www. medscape. com/partners/ancc/public/ancc 13

Nursing Shortage Resources • American Association of Colleges of Nursing http: //www. aacn. nche. edu/Media/shortageresource. htm #about The Nursing Shortage: Is this cycle different? OJIN 2001 http: //tinyurl. com/2 md 5 lc • Discover Nursing http: //www. discovernursing. com/ 14

Organizational Structure American Nurses Association American Nurses Credentialing Center American Academy of Nursing Accreditation Certification Magnet Recognition Program American Nurses Foundation Institute for Credentialing Innovation Measurement Services Research Institute Commission on Magnet Recognition 15

Appraisal Review Process: Phases • • • Preparation: Self-Assessment Phase One: Application Phase Two: Written Documentation Phase Three: Site Visit by Surveyors Phase Four: Commission Vote CELEBRATE! 16

Magnet and Hospitals: How has the research translated into the Magnet program requirements? 17

Magnet Recognition Program Goals (“Core Values”) • Promoting quality in a setting that supports professional practice; • Identifying excellence in the delivery of nursing services to patients/residents; and • Disseminating “best practices” in nursing services. 18

Magnet Recognition Program Requirements Focus On: • Leadership of the Chief Nurse Executive • Work environment • Adherence to standards • Interdisciplinary collaboration • Cultural and ethnic diversity of patients and care providers is recognized by the hospital • Best nursing practices - evidence-based practice, quality improvement, research – are demonstrated • Benchmarking against quality standards in certain areas 19

Original 14 Forces of Magnetism 1. 2. 3. 4. 5. 6. 7. Quality of Nursing Leadership Organizational Structure Management Style Personnel Policies and Programs Professional Models of Care Quality Improvement 8. Consultation and Resources 9. Autonomy 10. Community and the Hospital 11. Nurses as Teachers 12. Image of Nursing 13. Interdisciplinary Relationships 14. Professional Development Magnet Hospitals: Attraction and Retention of Professional Nurses. American Academy of Nursing. Kansas City. : Taskforce on Nursing Practice in Hospitals. 1983. PMID: 6551146 20

Five “Model Components” of Magnetism 1. Transformational Leadership (TL) q q 2. Structural Empowerment (SE) q q q 3. Organizational Structure (Force #2) Personnel Policies and Programs (Force #4) Community and the Healthcare Organization (Force #10) Image of Nursing (Force #12) Professional Development (Force #14) Exemplary Professional Practice (EP) q q q 4. Quality of Nursing Leadership (Force #1) Management Style (Force #3) Professional Models of Care (Force #5) Consultation and Resources (Force #8) Autonomy (Force #9) Nurses as Teachers (Force #11) Interdisciplinary Relationships (Force #13) New Knowledge, Innovation, & Improvements (NK) Quality Improvement (Force #7) Empirical Outcomes (EO) q Quality of Care (Force #6) q 5. (http: //www. nursecredentialing. org/Magnet/New. Magnet. Model. aspx) 21

Magnet Model Components 22

The Application Each component of the new Magnet Model requires two kinds of submissions: – Evidence Documents: particular pieces of documentation such as annual reports, organizational charts, policies & procedures, tables of committees, statistics, data, etc. – Evidence Narratives: narrative statements to support the evidence with descriptions of programs, processes or services that provide examples of how each is “operationalized”

Magnet Components Explained

Transformational Leadership(TL) • Quality of Nursing Leadership – “Knowledgeable, strong, risk-taking nurse leaders follow a well-articulated, strategic and visionary philosophy in the day-to-day operations of the nursing services. Nursing Leaders, at 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. )” • Management Style – “Healthcare organizations and nursing leaders create an environment supporting 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. ” 26

Required Examples of “Sources of Evidence” for Transformational Leadership • Evidence of strategic planning by nurse-leaders • Evidence of advocacy and influence—show organizational wide changes, recognition and reward of innovation by nurses • Give examples, from several different nursing units, of advocacy by the CNO on behalf of the staff, such as requests for additional FTEs, systems, equipment, personnel support and so forth. • Evidence of visibility, accessibility and communication—show that the CNO is visible and accessible to direct-care nurses, that nurse leaders use input from direct-care nurses, and changes in the work environment and patient care based on input for direct -care nurses.

Library Collection Resources: • AONE: The American Association of Nurse Executives-http: //www. aone. org & books & Nurse Leader • Top Nursing Journals: Zone 1 1. J Nurs Adm 2. Nurs Manage 3. Nurs Econ 4. Nurs Adm Q 5. Hosp Health Netw 6. Nurs Res 7. JAMA 8. Am J Nurs 9. N Engl J Med Zone 2 (Top 10) 1. J Nurs Scholarsh 2. Med Care 3. J Adv Nurs 4. J Nurs Care Qual 5. Harv Bus Rev 6. Nurs Outlook 7. Mod Healthc 8. J Healthc Manage 9. Health Care Manage Rev 10. Nurs Educ Perspect (2002–) Galganski, Carol. (2006) Mapping the literature of nursing administration. J Med Libr Assoc 94(2) Suppl, E-87 -91. 28

Services for Transformational Leadership • Brainstorm– more ideas? New services or changes, additions or improvements to existing services?

Structural Empowerment (SE) • • • Organizational Structure Personnel Policies and Programs Community and the Healthcare Organization Image of Nursing Professional Development Description: Magnet hospital environments are “flat, flexible and decentralized. ” “Nurses throughout the organization are involved in self-governance and decision-making structures and processes that establish standards of practice and address issues of concern. ”

Required examples of “Sources of Evidence” for Structural Empowerment • Professional Engagement - show that the structure and processes of the hospital enable nurses from all setting and roles to participate in organizational decision-making groups such as committees, councils, and task forces. • Commitment to Professional Development- show the organization sets expectations and supports nurses at all levels who seek formal education (BSN, master’s, doctoral degrees. ) Continued on Next Slide

Sources of Evidence For Structural Empowerment (continued) • Teaching & role development-show it promotes the teaching role of nurses, how nurses support community education activities, how nurses support academic practicum, adjunct faculty, mentorships, etc. • Commitment to community involvement – show structure and processes to allocate resources to affiliations with nursing schools, consortiums and community outreach

Shared Governance: key concept • Shared Governance is a management model proposed & described in the nursing literature over 30 years ago. It has a specific meaning, almost an emotional context, to nurses. • Shared Governance spreads the authority and responsibility for nursing practice down to the unit level and involves nurses directly in practice decisions.

Shared Governance Includes • • Autonomy of Practice, Control of Practice Environment, Effective Nurse-Physician Relationships Encompasses concepts such as empowerment, autonomous decision making, accountability, collaboration, mentoring, highquality patient care, and evidence-based, excellent professional nursing practice. (Mc. Clure M, Hinshaw A. Magnet Hospitals Revisited: Attraction and Retention of Professional Nurses. Kansas City, Mo: American Nurses Publishing; 2002. )

Ideas for Library Services for Structural Empowerment? Remember that SE is composed of these “Forces of Magnetism” §Organizational Structure—flat structure, participatory §Personnel Policies and Programs—nurse involvement §Community and the Healthcare Organization §Image of Nursing—positive and professional §Professional Development—encouraged

What Library Services? • Brainstorming? 37

Exemplary Professional Practice (EP): Sources of Evidence “Describe and demonstrate” in 9 areas: 1. 2. 3. 4. 5. 6. 7. 8. 9. Professional Practice Model Care Delivery System(s) Staffing, Scheduling, and Budgeting Processes Interdisciplinary Care Accountability, Competence and Autonomy Ethics, Privacy, Security, and Confidentiality Diversity and Workplace Advocacy Culture of Safety Quality Care Monitoring and Improvement Elements of the original Forces of Magnetism have been incorporated into Exemplary Professional Practice and reconfigured into these 9 Sources of Evidence. 39

Exemplary Professional Practice: EP • The achievement of exemplary professional practice involves both philosophy and practice, patient/family centered care, interdisciplinary collaboration, ethical & safety considerations, and use of data and national benchmarks to improve performance and patient care. • It is hard for me to imagine that the exemplary practice by nurses can take place in isolation from knowledge-based resources and the assistance of librarians to locate these. • What services can you suggest or changes to current services? 40

Nurses as Teachers : Resources • Journals – – – J Contin Ed Nurs J Nursing Ed Nurs Educator Nursing Ed Perspectives Intl J Nurs Ed Sch(IJNES) • Nursing Organizations – NLN – AACN • Listservs – – – BIRTHED NURSED-L NURSENET NURSEGRAD NRSINGED NURSENET • Blogs – The Teachers corner – Nursing school blog – Mediblogopathy 41

Interdisciplinary Relationships: Resources • Institute of Medicine Studies http: //www. iom. edu/ • COGME – NACNEP report Council on Graduate Medical Education and the National Advisory Council on Nurse Education and Practice http: //www. cogme. gov/jointmtg. pdf 42

Library services for Exemplary Professional Practice • Brainstorming? 43

New Knowledge, Innovation, & Improvements (NK) • “Magnet organizations conscientiously integrate evidence-based practice and research into clinical and operational processes. ” • “Magnet organizations have an ethical and professional responsibility to contribute to patient care, the organization, and the profession in terms of new knowledge, innovations and improvements. ” • “This component includes new models of care, application of existing evidence, new evidence, and visible contributions to the science of nursing. ” 45

Library Services for NK? • Evidence based practice—discovering new knowledge • If no new knowledge on a practice question, conduct your own study • Share your research results • Obvious Magnet opportunities for library Ideas?

Empirical Outcomes (EO) • The application manual states that “the empirical measurement of quality outcomes related to nursing leadership and clinical practice in Magnet organizations is imperative. ” • The component does not state any particular requirements itself but that outcome sources, indicated by EO, are requested throughout the sources of evidence.

Suggestions for Empirical Outcomes: If you have any outcomes to report under any of the Magnet components, you should try to include: • How the work was • Purpose done, i. e. methods & • Background approach; RN involved • Who was involved— in planning CNO, staff RNs, APRNs, • Describe the pharmacists, measurement used to physicians, etc. evaluate outcomes & the impact (results & significance)

Tips for Data Gathering • Document planning meetings, including who is present and if they are an RN • Have a sign-in sheet for meetings, programs, presentations, etc. and ask about RN status • Capture as much data as possible about use of resources, statistics by status (RN, physician, staff) such as interlibrary loan, circulation, etc. • Consider regular monitoring of quality of information services by a feedback sheet or questionnaire and capture RN status if possible.

What do librarians need to know about nurses, EBNP & nurses information Needs? The Philosophy & Research

Evidence-based Nursing Practice (EBNP), Nursing Research & the Magnet Journey Margaret (Peg) Allen, pegallen 67@gmail. com & Joy Kennedy, joykenn@gmail. com 52

Evidence Based Nursing Process 1. Define the question 5. Evaluate the process 2. Collect evidence 4. Integrate evidence into practice situation 3. Critically appraise the evidence --graphic developed by Dr. Susan Pierce from the Pravikoff, Pierce & Tanner 53

Data Use in Clinical Decisions (based on Graves JR, Corcoran S. The study of nursing informatics. Image. 1989; 21: (4): 227– 31. ) The practice of evidence based care seeks to make published knowledge-based information more central to the clinical decision process. 54

Relationship of Information Literacy, EBNP & Nursing Information Research EBP Competency Based Teaching 55

Evidence Based Practice Competencies “National Consensus of Essential Competencies for Evidence Based Practice of Nursing” Developed in 2005 by the Academic Center for Evidence-Based Practice (ACE), University of Texas Health Science Center at San Antonio, available for purchase (http: //www. acestar. uthscsa. edu/Competencies. htm) Information Literacy Competencies which follow reference these competencies 56

Information Literacy Competencies for EBNP • In 2006, Peg Allen was asked to present “Teaching Clinicians to Fish” for the annual ACE Star Summer Institute on Evidence Based Practice (http: //www. acestar. uthscsa. edu/past_institutes. htm) – Link above includes abstracts to past Institutes • Using the ACE EBP Competencies, Peg drafted: – Information literacy competencies for all – Nursing/clinician & researcher competencies 57

Basic Health Information Literacy Competencies—everyone in healthcare • Uses quality health information portals, such as Medline Plus and libraries • Searches for information in appropriate formats • Evaluates health information resources regardless of format – Accuracy, Balance, Completeness • Understands use of Boolean AND, OR and other search techniques for Internet search portals and layperson databases • Observes intellectual property rights – does not plagiarize • Cites sources using a standard bibliographic format 58

Clinician Competencies • Recognize ratings of strength of evidence when reading literature, including web resources – Evaluate and use resources for quick reference, including PDA tools • Searches core bibliographic databases for chosen health profession – Develop a searchable question – Search CINAHL & NLM/AHRQ databases using subject headings, EBP filters and limits – Evaluate citations for potential relevance “Clinicians” refers to doctors, nurses, technicians, etc. 59

Clinician Database Competencies • Can develop a searchable question – “The question is just as important as the answer. The answer you get out is only as good as the question you put in. ”* • Search CINAHL & NLM/AHRQ databases using subject headings, EBP filters and limits – “It's not your father's literature search… Unless I know the clinician wants to see everything, or is doing research rather than addressing an actual patient issue, I filter. ”* • Can evaluate citations for potential relevance – Expense of retrieval, including copying or ILL, is not insignificant. *Email comments from Marcy Brown, MLS, West Penn Hospital - Forbes Campus, Monroeville PA, May 1, 2006 60 60

Clinician Competencies – Point of Care Databases • Recognize ratings of strength of evidence when reading literature, including web resources (Undergraduate, Star Point 1, #4) • Evaluate and use resources for quick reference, including PDA tools • Evidence-base – references? • Relevance to clinical needs • Ease of use • Currency • Goal: Synthesis of credible evidence 61

Nurses as Knowledge Workers How do Nurses Use Information? How does their Information Needs Differ from Others? 62

Nurses as Knowledge Workers: Similarity of Nursing Process Steps with Knowledge Worker Roles Nursing Process Steps • Assessment • Diagnosis • Planning • Intervention • Evaluation - outcomes Knowledge Worker Roles • Data-gatherer • Information User • Knowledge User • Knowledge Builder Needs of the Practice Environment Source: Sydney-Halpern R, Corcoran-Perry S, Narayan S. Developing clinical practice environments supporting the knowledge work of nurses. Computers in Nursing 2001 (Jan-Feb); 19(1): 17 -23. 63

Medical vs. Nursing Concerns in Evidence-based Practice Same patient with broken hip, different EBP concerns. Nursing care is focused on the patient, not the disease process. Nursing Concerns Medical Concerns – – – Hip replacement Hip pinning Watchful waiting Surgical risks Correct prosthesis Same Patient, Different Concerns, Different Info Needs – – – Pain Incontinence Immobility Confusion Skin breakdown Inadequate sleep Source: Lang NM. Discipline-based approaches to evidence-based practice: a view from nursing. Joint Commission Journal on Quality Improvement 1999 (Oct); 25(10): 539 -44. 64

Patient knowledge also influences shared decisions & is part of “the evidence”. Diagram courtesy of: Lisa K. Traditi, MLS, AHIP Head of Education and Learning Resources Center Denison Memorial Library University of Colorado at Denver and Health Sciences Center 65

Continuum of Information Needs in Evidence-based Healthcare Patient-focused clinical questions –medical plus nursing/allied health implications Interdisciplinary guidelines – evidence-based “best practices” Based on clinical research Management and education issues – many related to Magnet components and forces All of these factors, all of these information needs are involved in EBP. 66

When is Research Utilized? : When do nurses look for research? Let’s look at Nursing’s Research Utilization Models to better understand Evidence Based Nursing Practice (EBNP) 67

Research Utilization Models: What Causes Research to be Used? • Ottawa Model of Research Use • Stetler Model of Research Utilization • • • Practitioner orientation Two levels: individual and organization Focus on research competencies • Iowa Model (Titler et al. ) of Research in Practice • Knowledge focused triggers: new practice standards, philosophies of care, research and meta-analysis • Problem-focused triggers: clinical questions, quality improvement projects, journal clubs (Polit & Beck (2006), Using research in evidence-based practice in Essentials of Nursing Research, pgs. 457 -494. ) 68

What are the Barriers to Research Utilization? • Individual constraints – Lack of time – Little experience/low comfort level with library and search techniques – Limited ability to understand/interpret research reports – Limited exposure to to research-use strategies during educational preparation – Negative staff attitudes toward research • Organizational constraints – Lack of availability of pertinent research findings – Limited access to journals – Lack of administrative support – Cost constraints – Concerns about reallocation of staff time (As summarized by Simpson B in Canadian Nurse, 1996 Nov; 92 (10): 22 -5. ) What can librarians do to help overcome these barriers? 69

From Research Utilization (RU) to Evidence-Based Practice Research Utilization • Component of EBP Evidence-Based Practice • Broader concept • Only research accepted as evidence • Evidence other than research part of EBP • Critical appraisal of research reports • Critical appraisal of all evidence Based on Levin, Rona F. & Harriet R Feldman, Teaching Evidence-Based Practice in Nursing: A Guide for academic and clinical settings. New York: Springer, p. 11. 70

National Council of State Boards of Nursing, National Survey on Elements of Nursing Education, 2006 “The graduates were more likely to feel adequately prepared when nursing programs: 1. taught use of information technology and evidence-based practice, practice 2. integrated pathophysiology and critical thinking throughout of curriculum…” (https: //www. ncsbn. org/RB 24_06 Elementsof. Nursing. pdf) – p. 37 71

Interagency Council on Information Resources for Nurses (ICIRN) Research: Six Common Questions • Are nurses aware of the need for research-based information? • Do nurses identify information needed for research-based practice? • Do nurses have the ability and availability to electronically search for information? • Do nurses actually apply electronic informationseeking processes? • What information do nurses use? • For what purposes do nurses use information retrieved? 72 --Pravikoff, Tanner, Pierce

ICIRN Research Results • Pravikoff, D. S. , Tanner, A. B. , & Pierce, S. T. (2005). Readiness of U. S. Nurses for Evidence-Based Practice? American Journal of Nursing, 105(9), 40 -51. http: //tinyurl. com/35 clnb • Dee, C. , & Stanley, E. (2005). Information-seeking behavior of nursing students and clinical nurses: implications for health sciences librarians. Journal of the Medical Library Association, 93(2), 213– 222. http: //www. pubmedcentral. gov/picrender. fcgi? tool=pmcentrez&blob type=pdf&artid=1082938 • For more information and color slides, see MLA 2003 Symposium: Evidence-Based Nursing Practice: Needs, Tools, Solutions http: //nahrs. mlanet. org/resource/symposium/index. html 73

ICIRN – similar conclusions in UK & Canadian Studies • The Information Needs of Nurses, Health Care Assistants, Midwives and Health Visitors. Summary report of RNC survey (2005, April 20, 2005). http: //www. rcn. org. uk/__data/assets/pdf_file/0010/78670/002780. pdf • Canadian Nurses Association position statement “Nursing Canadian Nurses Association position statement Information and Knowledge Management” (November, 2006) http: //www. cna-nurses. ca/CNA/documents/pdf/publications/PS 87 -Nursing-infoknowledge-e. pdf Conclusion: "Having good access to information – via the Internet and via a physical library and via information skills – appears to have a direct effect on putting evidence into practice. Those with the best access to information were also more likely to both search for evidence and to change their nursing practice as a result of research. “ (RNC 74 survey)

Nursing Values and Research In presentations on the Pravikoff study, the authors stress the need for nurses to value nursing research. FYI: Article on values free from Nursing Ethics collection, http: //www. nursingcenter. com/home/Nursing. Center. Ethics. asp Other than ICIRN what other important nursing educational initiatives should librarians be aware of? 75

T. I. G. E. R. — Technology Informatics Guiding Educational Reform • http: //www. tigersummit. com/About_Us. html • Summit of major nursing organizations & 20 nursing informatics societies (& NAHRS reps) • Goal was to identify information/knowledge management best practices & effective technological capabilities of nurses • Action plan for transforming nursing practice and education to better prepare nurses to practice in an increasingly automated, informatics-rich, and consumer-driven health care environment 76

Librarians’ Role • Can librarians help address barriers to EBNP? • Can librarians help with T. I. G. E. R. initiatives? • What does research show us about the Librarian’s role ? 77

MLA & NAHRS Research Efforts • As Peg Allen, Pam Sherwill-Navarro and Susan Jacobs worked with ICIRN, the T. I. G. E. R. Summit, and students in MLA CE classes, the need evolved for learning about librarian roles in EBNP & the Magnet program. • Learning has occurred via surveys, teaching, and MLA programs at the national and local levels 78

NAHRS 2007 Magnet Coordinator survey Goal: To assess library resources and services at ANCC (American Nurses Credentialing Center) certified Magnet facilities. l Secondary goal: enhance Magnet coordinator awareness of what librarians can contribute to the Magnet journey Process l l l Developed by NAHRS Task Force to Create Standards for Nursing Information Resources and Services in Health Care Settings and Research Committee, using Survey Monkey Approved by MLA Board, with additional questions on role and value of librarian Sent to Magnet coordinators via ANCC list with cover message encouraging Magnet coordinators to get librarian help with completing survey Richard Barry, ANA Librarian (ANCC is unit of American Nurses Association) facilitated use of Magnet coordinator list 2. Follow-up mailing to Magnet coordinator list 3. DOCUSER database used to identify librarians at Magnet hospitals with no response, sending them the final request NAHRS Research page: http: //nahrs. mlanet. org/activity/mapping/research/index. html 79 1.

Librarian’s Role in Magnet Journey? • 156 (81. 7%) reported librarian involvement, including four hospitals where Magnet coordinator said Yes and librarian said No • Types of involvement – – – Typical library services, including teaching & searches Magnet committee – often only non-nurse Input on Magnet application • Proof reading – – – Bibliographic citation management EBP support for guidelines development Nursing research committee & IRB Nursing education committee Web pages; one Evidence Based Nursing Blog 80

Added Value of Medical Librarian 12. If your facility or institution has a medical librarian or access to one, do you perceive that this provides added value for the institution and employees? – – – 96. 3% of (184 of 191 hospitals) said yes. Comments added by 89 hospitals for yes responses, and 2 No/no response (see separate comments list) Librarians sometimes unaware of what was valued by those in Magnet coordinator role 81

Magnet Coordinator Comments • “Our librarians are easily accessible and very willing to assist students, staff, and visitors with any questions or concerns. They have really done a nice job of welcoming research issues and expanding resources to meet our needs. ” • “We partnered with the librarians to help us set up a file management system for cataloging evidence. ” • “As employees are focusing on more evidenced-based practice and hospital-based research, medical librarian became a valuable resource to staff. ” From one without: • “We don't have access, but are recognizing the value; I have consulted a university librarian and have brought this information to my CNO – that is why we will have this service available in 2008. ” More comments available with report on NAHRS website, http: //nahrs. mlanet. org/activity/mapping/research/index. html 82

Librarian comments – value & role • • • Value of resources and services Involvement of a health sciences librarian on Magnet team Librarian involvement on committees – – Education: Staff; Nursing; Patient/Family IRB (Institutional Review Board) Nursing Research Patient Safety Example: “Librarian is a member of multidisciplinary teams, provides in- services, is closely aligned with Medical Education, Human Resource development, CME, and clinical research activities; supports information needs for patient care; manages centralized knowledge-based resource and media services for entire system of 6 hospitals and 10, 000+ employees. ” 83

“The Magnet Journey: Opportunities for Librarians to Partner with Nurses. ” • Title of article for JMLA Vital Pathways symposium issue October, 2009 • Vital Pathways for Hospital Librarians (VP) task force: official MLA response to threats faced by hospital librarians • Like Magnet, Vital Pathways focus was on outcomes • Efforts continuing by HLS & NAHRS sections now that VP taskforce ended 84

After the Class is Over: Magnet Challenge Action Plans • Analyze your organization, your nurses and nursing leadership • Think about the concepts we’ve discussed • Read some of the literature we’ve provided – search for more addressing your idea • Analyze your library’s resources and viable alternatives • Convey your willingness and eagerness to be part of the Magnet process—and your enthusiasm • Be aware that additional resources for library may not be forthcoming 85

How to Fund: Business plan or Grant proposal? • A grant proposal is like proposing a new service, except that you are going to an external funding source • In business plan, think of administrators as an “external” source with little or no knowledge of what we do – write so that they understand your request • No library jargon! • KISS principle: Keep it simple, stupid 86

Peg’s thoughts on grants: http: //www. healthknowledgeconsultants/grants. h tm • Strategic Planning Model – Strengths – why you can be trusted with their money – Weaknesses – why you need funding – Opportunities – funding organization priorities (Magnet expectations) – Threats – what will happen without funding • Find funding organizations interested in supporting your needs 87

Strategic Planning: SWOT Model Strengths Weaknesses Effective Programs Opportunities Threats Analysis of each component is foundation for success 88

Program Planning Model Strengths or Weaknesses? Knowledge sources Nurses’ needs Can you turn weaknesses into opportunities for improvement? Effective Programs Information portals Lack of librarian time Opportunities or Threats? 89

Thoughts continued… Needs assessment is vital for either grant or new service plan • Proposal Development Bibliography – a beginning De. Silets, L. (2007, May). Needs assessments: an array of possibilities. Journal of Continuing Education in Nursing, 38(3), 107 -114. Retrieved June 22, 2009, from CINAHL with Full Text database. Overview of different methods – use not limited to continuing education. Dickerson, P. (2008, October). Addressing barriers to enhance outcomes. Journal of Continuing Education in Nursing, 39(10), 437 -438. Retrieved June 22, 2009, from CINAHL with Full Text database. Barriers in context of continuing education – need to get input from the learners. Caldwell, L. , Luke, G. , & Tenofsky, L. (2007, Jan-Feb). Creating value-added linkages through creative programming: a partnership for nursing education. Journal of Continuing Education in Nursing, 38(1), 31 -36. Retrieved June 22, 2009, from CINAHL with Full Text database. Focus on collaboration and partnerships. Hospital library is mentioned as part of what the hospital supplied to on-site BSN program. Notes value of champions from each organization. 90

More thoughts on proposals… • Realistic plan & budget – but double time you think you need – Keep objectives simple – don't tie to specific methods • Follow their writing instructions!!! • Meet deadlines – Build in enough time in proposal development process for last minute snafus 91

Summing up: • Collaborate with nursing to choose resources and strategies! • Map projects to Magnet model components! • Evaluate efforts, gather& analyze data – translate to outcomes! • Publish your data and share your ideas with librarians & with nurses elsewhere! 92

Summary: From ideas to action Librarians & the Magnet Program By Joy Kennedy & Peg Allen

Librarian roles in the Magnet journey Magnet components 94

Transformational Leadership Suggested Ideas from our Classes • Table of Contents Service, especially electronic TOC & RSS feeds • Collection of Nursing Certification Books • Business databases such as EBSCO’s Health Business Fulltext & databases available from local public libraries • SDIs to Administration of articles on topics such as Leadership • Library as “Learning Center” or “Continuing Ed. • Special collections developed on Innovation & Leadership, Shared Governance, Evidencebased Practice, Mentoring, Teambuilding, Budgeting • “Hot Topic” searches on Library website • Using Share. Point to share ideas, searches among leaders • Providing databases of all kinds & training • Bibliography of resources in packets for mandatory management/leadership 95 classes

Transformational Leadership More ideas • Start by meetings with nursing leaders to discuss how library can help them, especially time saving services • Searches for nursing leaders on magnet components & other topics as they lead the Magnet journey • Workshops and 1 -to-1 teaching for leaders on searching for management topics • Statistics on searches by department and unit, showing that nurses at all levels use services • Work with nurse administrator to support budget or share costs for new resources for nursing • Nursing Research: Show Me the Evidence Blog from the library at St. Joseph Hospital (Orange, California) 96

Comments on Transformation Leadership • “The library is away from their unit and provides them a quiet place to contemplate and explore new ideas. “ • “Since I am included in many Manager meetings - I do get a chance to hear some of the concerns in the organization - and many times I come back, run a search - and email the person who would most likely be interested in what the literature has to offer them. This has really impressed several individuals. ” • “I partnered with our Practice & Education Councils to visit EACH unit on day shift to promote remote access to resources and Nursing Consult in particular. We dropped off snacks to each unit's break room and did on-the-spot "speedy reviews" of what this product has to offer. We also left behind vendor-provided promotional items, reference cards, my business cards, and remote access applications with each unit's manager. Since that time, I have seen an upswing in Nursing Consult usage, and we received over 100 new Athens access applications. ” • Time saving for Administrators: “Whenever I work with a nursing administration employee on a CINAHL search, I always show them how to create an account in EBSCO; they love the fact that they can save their searches, including articles stored in their folder. “

Structural Empowerment --Suggested Ideas from our Classes • Open houses, trivia contests and raffles promoting library – let them know that library is for all staff • Promote Nurses Week as well as National Medical Librarians month • Serve as a mentor in learning the research process • Support and attend research day poster sessions – see what happened with those searches! • Workshop on creating posters for research days and • Become part of new nurse orientation – last stop on tour (with treats? ) so they can browse and see what’s available • “Extra” services – notary, test proctoring • Post/share articles written by nurses and other staff; maintain bibliography • Demonstrate that “knowledge is power” • Support for journal clubs – try online, as Moodle forum 98 • Column in nursing newsletter

Structural Empowerment More ideas • Support for updates of nursing policies & procedures through searches, ILL, etc. • Development of intranet site of Library resources; availability of Library resources inside electronic medical record • Forums, wikis & Share. Point on hospital Intranet for nurses to collaborate & share • Building relationships with local nursing students & act as resource for public library & junior college • Work with Nursing Staff Development to jointly create professional development courses for nurses • Act as consultant/searcher to nurses with new ideas for change • Supporting nurses continuing education with the collection, instruction, encouragement • Teaching nurses to search, about evidence-based practice principles, how to use databases 99

• • • Comments on Structural Empowerment “Employees are empowered where they have access to information, support, resources and opportunities to learn & grow in their work setting. ” “just getting the word out to the nurses that we are here to support their journey and what we have to offer. ” “Of course, there is more to structural empowerment than internet connectivity, but we all know information is power, right? If they are empowered to make clinical decisions based on evidence, they need access to the evidence, even beyond a packaged resource on the intranet. ” “The library will search for funding opportunities for specific research projects, specifically community nursing projects that support the hospital's community involvement. ” “Librarians who have some familiarity with public health information resources can be valuable members of a team tasked with developing a hospital's community engagement program - identifying the major health challenges in a given community, mapping strengths and weaknesses. . . “

Exemplary Professional Practice --Suggested ideas from our Classes • Support community outreach – • help with health fairs and health career events • Teach health literacy classes at public library, working with • nurses from various specialties • • Provide handouts and resources for community events, including Medline Plus bookmarks and pens • Resources and workshops on • finding patient education resources, including those for Library services for patients as TV menu choice – hand delivering packets Support “information prescription” program Proactive sharing of articles on “hot topics” – example of article on bullying that addresses horizontal violence issues Support for nurses returning to school 101

Exemplary Professional Practice More ideas-- • Books, bibliographies or Internet Portals on nursing theory and/or conceptual framework of nursing • Teach nurses about searching for info on EBP, how to use quality measures • Keep ANA guidelines in collection • Nursing ethics resources • Serve on Interdisciplinary Research committee • Provide citation management software & support it to effect collaboration • Find out about Professional Practice Models, how to search for information about them in support of organization’s choice 102 • Be internal expert and resource for planning

Comments on Exemplary Professional Practice • “I approached our Nursing Director this morning who is also the person handling Magnet. She was extremely pleased that I am taking the initiative to find out what I can do as a librarian to support the Magnet process. She advised me that both the PPM and the Nursing Care Model are being developed. She suggested we meet this week and discuss. I am excited about developing better ties with the Nurses. ” • “I've talked to the nurse in charge of our "Journey to Magnet" and she says we don't have a Professional Practice Model yet, but that would be part of the strategic plan developed at the all-day Magnet retreat that I will be attending on Nov 23 rd. She asked if I would talk for 5 -10 minutes about this online Magnet course and how the library can help in the pursuit of Magnet. With all the information I've learned so far, that won't be a problem. ” • “through a literature search, [library can] provide reviews and updates, standards, trends, and changes as they relate to nursing practice issues”

Typical comment: • “We often say that it seems as though all the nurses here at the hospital are going to school! We do support them in every sense since we feel that we are their "home" library and that they are here more than they are at school, especially for those who are taking online courses. One of the most recent things we did was to create a Resources for Local Nursing Programs link (http: //www 4. umdnj. edu/camlbweb/nursingschool s. html) from the Academic Resources -- Nursing Education section of our library page. We tell the nurses that we will even try to help them troubleshoot using the resources from their nursing schools. Also, since we have these links from the library page, the sites are not arbitrarily blocked by 104

New Knowledge, Innovations, and Improvement --Suggested Ideas from our Classes • Add CINAHL (or another nursing database) • Add more full text – Joanna Briggs, Cochrane Library, nursing research and specialty journals • Involve nurses in decisions on new library resources • Diversity collection – links • Facilitate new product demonstrations • Support for new technologies, including handheld devices • Rounding with nurses on different units • Use nursing staff to help with training 105

New Knowledge, Innovations, and Improvement —More ideas • Provide information on how to find EBP articles, several EB nursing pages including PICO samples, and a link to the EB pyramid • Provide literature searches, provide Linkout from Pub. Med, additional electronic resources • Teach evaluating the literature • Help them really understand EBP • Put policies in APA format • Collaborating with nurses to provide online EBP course, training classes on PICO clinical questions • Provide point-of-care information products • RSS feed to AHRQ Healthcare Innovations Exchange & OJIN • Overhaul the nursing journal collection • Provide “tips” under email signature re new web resource, search tip, etc. 106

Comments on New Knowledge, Innovations, Improvement • “help the nurses ensure their practices are evidence-based by participating in the Nursing Policy & Procedure Committee; I encourage them to find updated references when reviewing/revising p&ps, and I conduct literature searches, ideally with them but often on my own, to find the highest level evidence possible” • “providing a sample research problem and giving nurses a PICO worksheet or something to work through to really "get" how PICOs are developed. ” • “I prepared over 40 clinical disease Power. Point presentations along with EB/full-text articles for academic medicine. It is now the goal of the library to provide these clinical modules to the nurses as supplemental resources for self-directed learning. The bibliographies will be expanded to include nursing literature and, where necessary, the Power. Point Presentations will be edited to reflect nursing's unique approach to disease treatment and management. ”

Empirical Outcomes --Suggested Ideas from our Classes • “We keep track of the nursing searches and one on ones that we do and what type of nurse the patron is (admin, staff, educator, etc) and provide those numbers to the leadership. …This is a concrete way the library can show that nurses are learning more about searching and using the literature in clinical practice. ” • Using Google docs for quizzes, evaluations & feedback on searches – shorter surveys are best • Capture stories of how services, especially searches, made a difference in patient care • Capture statistics on use of electronic resources, including title specific data for nursing journals • Publications list kept by library is part of the evidence for Magnet 108

Empirical Outcomes --More ideas • Tying library services to outcomes both quantitative and qualitative • Provide evidence that library education & efforts are effective as well as use statistics by type of user • Provide searches and information in support of National Patient Safety Goals • Benchmarking data for QI department • Provide guidelines (guidelines. gov) and statistics 109

Questions? Evaluation--Complete MLA form • Certificates returned forms Thank you! Joy Kennedy, MLS joykenn@gmail. com 110