NURSING EXCELLENCE - American Nurse

NURSING EXCELLENCE

2016 Magnet?-Recognized Organization

Success Stories

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Congratulations to our nurses at Centra Lynchburg General Hospital, Centra Virginia Baptist Hospital and Centra Medical Group on achieving Magnet? designation.

Dedication, professionalism and compassion are the foundation of Centra nursing.

The American Nurses Credentialing Center recognized this commitment to excellence by designating Centra Lynchburg General Hospital, Centra Virginia Baptist Hospital and Centra Medical Group as Magnet? organizations. This marks the third Magnet designation for Centra Lynchburg General and Centra Virginia Baptist hospitals and the first for Centra Medical Group. The Magnet Recognition Program? represents a commitment to excellence in nursing, innovations in professional nursing practice, and excellence in clinical care, safety and patient satisfaction. Less than seven percent of U.S. hospitals receive Magnet designation. Achieving Magnet designation for a third time places Centra Lynchburg General and Virginia Baptist hospitals in the top three percent of U.S. hospitals. Centra is focused first and foremost on its patients, providing resources and support for our nurses to ensure high-quality patient care. We thank our dedicated nurses and honor your commitment to nursing excellence in patient care, education, research and leadership.

Nursing.

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Behind the scenes at the

command center for a Magnet?

appraiser site visit

This centralized location serves as a coordination hub for expediting communications and appraiser requests.

By Susan Winslow, DNP, RN, NEA-BC; Stacey Brull, DNP, RN, NE-BC; Lynn Goodloe, MS, CNRN, NE-BC; Jennifer Hall, MSN, RN, CNL; and C.J. Robison, BSN, RN, CMRSN

For healthcare organizations, ANCC Magnet Recognition? indicates excellence in patient care and nursing as well as innovative nursing practice. Once the applicant organization meets written Magnet? document requirements, the appraisers' site visit is scheduled for about 6 weeks after notification. The purpose of the visit is to confirm, illuminate, and augment what was presented in the document. In the weeks leading up to the site visit, the staff organizes to prepare for the visit.

In this article, five Magnet Project Directors (MPDs) at organizations that have obtained Magnet recognition share a key strategy they used--establishing a command center. The command cen-

ter concept is modeled on hospital incident command systems that organize oversight and resources during emergency and nonemergency events, such as regulatory surveys and disasters.

Usually, command center planning begins well in advance of the site visit to ensure that the necessary space and human and electronic resources will be available. Key command center personnel include the MPD, one or more Magnet champions, a key administrator, and resource support personnel. Before the site visit, team members should confirm that rooms and meals are ready for all sessions, communicating with the command center as needed.



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During the site visit, the command center serves as a communication hub to coordinate numerous activities, including the appraisers' escort process, setting up session meeting rooms, and handling information requests and food delivery. It also functions as a morning and afternoon briefing area; during huddles and as escorts report off, it provides a consistent place to collect appraisers' questions and requests for additional information or resources. Typically, the command center is situated in a private but centrally located area of the building with easy access to team members and resources.

Expediting appraisers' requests Many times before and during their site visit, appraisers request additional information. Typical advance requests include the most recent data on patient and nursing satisfaction and nursing quality indicators. If questions or information still need to be resolved before the site visit, the organization sends its revisions to the appraisers in advance, along with a plan to resolve remaining questions through the command center. Providing source data during the visit is crucial, too, as the appraisers' role is to verify as well as clarify and amplify.

Access to the organization's communication mechanisms is critical in disseminating time-sensitive information to the hospital team. Electronic documents or simple paper flip charts are essential for managing the flow of requests and responses to documentation, information, and clarifications requested by appraisers.

During the visit, at the end of each day or the beginning of each morning (or both), the appraiser team leader typically updates the chief nursing officer (CNO) and MPD on which items they'll need additional information for; these requests go to the command center for coordination. For instance, appraisers select employee names randomly for personnel file review. Those files must contain at least the manager's performance review, the employee's self-evaluation, and peer reviews and specific goals for each nurse. Appraisers review files of random nurses at all levels of the organization, including leaders, advanced practice nurses, nurse educators, and clinical nurses. The command center should stay in contact with the human resources department to help gather the needed information.

Other common appraiser requests include minutes of shared governance council meetings, clinical ladder or promotional applications, an updated strategic plan, and the organization's annual report. Showcasing what your organization does well is part of the process, so take time to strategically place proof of accomplishments in areas the appraisers will visit.

Real-time updates during the site visit

To share ongoing communication, Magnet? appraiser escorts should provide real-time updates to the command center. Many organizations rely heavily on texting among team members to monitor overall progress and status of the schedule. If an appraiser is running a few minutes behind, the escorts can text this information to notify the next scheduled group, easing anxiety and frustration.

One hospital used a private-event mobile app to keep everyone informed. Staff in the main command center, all leaders, and other key individuals used the app, creating a mobile command center team. By providing real-time information, this practice eliminated the risk of misinterpretation. The app was fun to use; those using it cheered each other on with emojis, photos, and the ability to "like" a comment. Also, the command center can maintain live blog pages to update the entire organization, providing real-time feedback and excitement for the visit.

Providing consistent communication Another focus of the command center is to ensure consistent communication. Organizations need to provide a clinical nurse or direct-care provider to escort Magnet appraisers during the visit. The command center serves as home base for this essential team. Successful common practices include: ? assigning one or two escorts to each appraiser

for the entire visit, to provide familiarity and consistency to both parties ? building a close relationship between the appraisers and a single administrative support person. Developing a master communications grid, including contact numbers, can avoid conflicts and confusion during the site visit. (See Real-time updates during the site visit.)

Stocking the command center The command center is a natural place to keep staff involved in the site visit and for them to store personal belongings and essential resources, including cell-phone chargers, tissues, cafeteria vouchers, parking passes, and personalized lab coats to wear during the visit. Keeping bottled water and high-protein snacks here can provide needed hydration and energy for the long days of the site visit.

Responding to emerging needs During the site visit, backup "runners" stationed throughout the organization can respond to emerging needs, such as prepping meeting spaces and meal sessions or the occasional sick call from an escort. Runners also can help manage sign-in

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sheets, conduct ID badge checks, and direct traffic in and out of conference rooms. For meal sessions, runners oversee placement of boxed lunches outside meeting rooms for easy access to food and to maximize the time allotted for staff to speak with appraisers.

The best-laid plans often go awry, so the name of the game is flexibility. Any number of things can change the original plan, so having a team that can stay fluid helps ensure the site visit is a positive experience. Mother Nature bows to no one; weather may disrupt the ability to host sessions or may change the preestablished visit schedule. Work with escorts, support staff, and travel services to ensure the appraisal team is informed of all changes brought on by outside influences.

Site visits don't happen in a void. Normal daily operations must continue during the visit, so don't be surprised if the appraisers witness a code or other significant event. View these as opportunities to showcase your high-functioning team while escorts ensure the appraisers' observance isn't disruptive. If such unplanned events happen, ensure a mechanism for reporting them to the command center. Also, remind escorts they're nurses first and must continue to prioritize patient safety.

A site visit is a complex event. Preparing for and managing it give staff the chance to participate and celebrate this honor. It's also an opportu-

nity to capture staff members' thoughts, energy,

and innovations for future strategic planning and

sustaining excellence. Take the time to document

opportunities for improvements, special recogni-

tion, and appreciation to team members who went

above and beyond during the visit.

The site visit is also a time to celebrate and rec-

ognize the aspects of your organization and nurs-

ing practice you're most proud of--a time to cele-

brate the excellence of your organization's nursing

outcomes. When it's over, tear down the command

center and relax!

n

Susan Winslow is system director of nursing professional practice at Sentara Healthcare in Norfolk, Virginia. Stacey Brull is senior director of research, education, and Magnet at Mercy Medical Center in Baltimore, Maryland. Lynn Goodloe is director of professional practice at VCU Health System in Richmond, Virginia. Jennifer Hall is Magnet Program Manager at the University of Virginia Health System in Charlottesville. C.J. Robison is manager of professional practice at Sentara Leigh Hospital in Norfolk, Virginia.

Selected references

American Nurses Credentialing Center. 2014 Magnet? Application Manual. Silver Springs, MD:Author; 2013. MagnetApplicationManual

Tinkham MR. Preparing for a Magnet? site visit. AORN J. 2015;102(2):192-5.

Villacara AA, Lazar EJ, Regan BK. Refining the hospital incident command system to improve hospital command center management of survey activity. J Emerg Manag. 2012;10(6):449-58.

Connecting To What Really Matters:

Patients and Families

Children's National Health System is designated as a Magnet?* Hospital. Our dedicated Professional Registered Nurses have earned this designation because of their exemplary care and outcomes. Our nurses acknowledge that their practice allows the special "gift" to enter "sacred spaces" between children and their families. This relationship is part of a precious circle where trust is implicit and where professional nurses are part of the patient and family's joys and challenges.

We are proud to be a Magnet? Hospital:

? Transformational Leadership; ? Structural Empowerment; ? Exemplary Professional Practice; ? New Knowledge, Innovations, and

Improvements; ? Empirical Outcomes.

For additional information, please visit: Nursing

Equal Opportunity Employer of Minorities, Females, Protected Veterans, and Individuals with Disabilities

*Magnet status is granted by the American Nurses Credentialing Center, the world's largest nurse credentialing organization and a subsidiary of the American Nurses Association (ANA). ANCC Magnet Recognition?, Journey to Magnet Excellence?, Magnet?, Magnet Recognition Program?, and AANC National Magnet Conference? names and logos are registered trademarks of the American Nurses Credentialing Center. All rights reserved.



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