Blue Team Minutes



Blue Team Minutes

March 27, 2009

Attendees: Jan Lanier, Kathleen Morris, Cathy Patton, Craig Albers , Sonna Hardingm Sally Morgan, Joy Hamilton, Lois Garner, Sean McGlone, Darcy Hymore, Adele Duchana, Joy Lynn Daniels, Bonnie Shaeffer, Kim Hadley, Lisa McCorkle, Diana Huddle, Michele Valentino, and Lisa Klenke.

Welcome

Michele Valentino welcomed all and each attendee was asked to introduce themselves and state their facility, and interest in the culture of nursing. Jan Lanier introduced Sean McGlane the new representative from OHA who is a liaison to Nursing 2015.

Introduction of Guest Speaker

Michele introduced Lisa Klenke, President of the Ohio Board of Nursing. She has a great interest in “a Just Culture”. Ms. Klenke had handouts and discussed the concepts of a just Culture. The Board of Nursing will discuss the concept of a Just Culture at it’s April retreat and determine if the Board might adopt that philosophy. A Just Culture is a less punitive view of the world. It looks at the system first and asks what were the multiple factors involved in an error. It is focused more on coaching. It does however, place responsibility & accountability for areas of neglect . A just Culture divides errors according to 1. human error 2. negligent Conduct with no intent. 3. Knowing violations and 4. Reckless Conduct

Using the framework of a Just Culture is less punitive, and looks at errors in a different perspective. It is a more consistent approach. Also “Red Flag Rules” similar to those used in the airlines were discussed as those rules which should never be violated. A Just Culture is based on the works of David Marx, who works with high consequence environments, such as health care, air traffic, and nuclear power plants. The Just Culture website is .

Review of Current Strategies

The Blue Team was given the strategic direction “Practice Culture Conditions and Benefits Provide a Win-Win for Nurses, Consumers, and the Organizations.” Additionally, two measurable objectives had been identified for the Blue Team. The first measurable goal was “create a comprehensive frame of reference for developing appropriate staffing, including a definition of workload elements such as compliance issues and critical thinking that are not captured on traditional measurement tools or staff ratio assignments.” The second measurable objective was, “define the elements of a highly attractive practice culture, ( i.e. the forces of magnetism that are adopted by OONE/OHA/ONA) and then implement it and sustain within each organization’s sphere of influence.” The Blue team has been successful in moving through the first objective with the introduction of HB 346 and the subsequent training and toolkit development by the Blue Team to support implementation of HB 346. The group voiced a satisfaction with our success in this project and, I believe, appreciated the rest while implementation is proceeding. There is concern voiced by members for accountability as to how the hospital committees are working and developing staffing models and the effectiveness of these models and committees. One member thought there was a survey on the OONE website requesting information from staff nurses. Jan Lanier of ONA and Sean McGlone of OHA will look into a feed-back process for accountability.

Jan Lanier reviewed briefly the minutes from the GOT Conference Call from Feb. 5th, 2009 & the concentration and progress of each of the teams.

Michele reviewed the minutes from the last Blue Team Conference Callon Jan. 16th.

Violence in the Workplace

Kathleen Morris introduced to us the concepts of activities around workforce violence that the ONA is interested in promoting. The home page for ONA has resources available about workplace violence and the group was encouraged to look at that material before we meet again. Four initiatives that the ONA is proposing and which Kathleen would like us to explore include efforts in the legislation, developing education, establishing workplace standards through OCHA, and programs to support nurses who are victims of workplace violence. The group identified that these were all worthy of dialogue under the concept of culture.

Kathleen also reviewed a new program from the Center for the American Nurse , which is a conflict Engagement Portfolio. The Center is trying to roll this program out in OH in about 3 medium sized hospitals. It is a three part training session of didactic, videos, and outcome based with follow-up.

Sally Morgan reviewed a hand-out entitled “Trust: The 5 Rights of the Second Victim”. The articles proposes 5 rights of caregivers.

Economic Value of Nursing

Joylynn Daniels brought forth the concept of the economic value on nursing, a recent publication addressing outcomes. She reviewed the article “The Economic Value of Professional Nursing” in Medical Care, vol. 47, number1, January, 2009. The Blue team acknowledges the importance of the economic value of nursing ; however, the yellow team is already focusing on this aspect.

Physician/Nurse Relationship

Previously as a group we had identified that it would be necessary for nurses and physicians to continue to collaborate and communicate well and that, perhaps, we could develop a toolkit regarding that collaboration. After some discussion, it was determined that good relationships among co-workers fit with our item on culture and we will address that in the nursing culture activity as we move forward.

Prioritization

Following our brainstorming discussion, we identified one area for the Blue Team to focus on in the next six months:

* Nursing Culture – The Blue Team will focus on articulation of the “nursing culture.” We will set out to define a vision for what the appropriate culture should be utilizing the Magnet data, standards from ONA , ANA, AONE, and OONE, and reference key elements related to a culture that supports nursing practice. The vision statement will include references to a healthy work environment and the absence of violence in the workplace or lateral violence among nurses, improved communications with physicians, respect with one another, and a focus on providing a “Just Culture” for dealing with accountability.

Strategies for Maintaining the Blue Team Engagement

Michele thanked team members for attending this meeting and also a special note of thanks to those who brought new nurses to the team meeting.

Upcoming dates: The team discussed May 15 as a possible next meeting, with a second date of June 5th. Michele will check with Renae about those dates. Lisa Klenke is interested in attending the next blue team meeting.

Members were encouraged to review the material from today’s meeting, review the Forces of Magnetism, and past meeting notes to begin to articulate statements about the ideal practice culture it would like to include in a Statement. It was suggested that the Blue Team write a White Paper on Nursing Culture. The Team also discussed sharing ideas for writing a document via e-mail or using small work groups for various topics.

Respectfully submitted,

Michele Valentino, MSN, CNS, BC, NP

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