As many of you may know already, members of the nursing division launched our Magnet Journey in 2009.

Magnet designation is granted by the American Nurses Credentialing Center (ANCC), a division of the American Nurses Association (ANA) to recognize organizations that have implemented the over 100 required sources of evidence and demonstrated positive outcomes as a result of this implementation.

Our Magnet journey is making us better already. The implementation of Nursing Shared Governance as one of the components of our Magnet Journey has yielded multiple exemplars of performance improvement.  Among them are increased participation in the National Database of Nursing Quality Indicators nurse satisfaction survey, notable increase in the patient satisfaction scores addressing nurse communications, improved scores on our core measure indicators and more complete documentation of nursing degrees and national certifications.

Establishing these structures and processes has already shown that we can generate positive outcomes. 

While presenting the Magnet recognition program to NorthBay Healthcare staff, the following question has been asked: "How do the patient satisfaction and nurse satisfaction survey results affect the Magnet journey?"

The answer is they are both directly related to a successful Magnet designation. According the ANCC's Magnet Recognition Program Application (2008), "patient satisfaction data ....must outperform the mean of the national database used" and "the nurse satisfaction annual survey data....must outperform the mean of the national database used.
Magnetizing NorthBay will improve awareness of our outcome data in relation to the national database and focus efforts to continuously improve our structure and processes for patient and staff satisfaction.

Excellent clinical outcomes, patient and employee satisfaction scores will help to pull patients and nurses to our organization.

Magnet-designated hospitals recruit and retain talented clinicians because they recognize the opportunities and excellence present in a Magnet  facility.

With a team of talented medical professionals, patients can expect to be cared for by knowledgeable and caring individuals at every level of service. Measures of clinical outcomes, patient and staff satisfaction are evidence that fulfilling the Magnet components leads to better organizational outcomes overall.

Our Magnet  journey is making us better.  Stay tuned.

In September, I was invited to attend the Leadership Council meeting of the California State Action Coalition for the Future of Nursing (CA AC) by Mary Dickow, M.P.A., California statewide director of the CA AC, whom I met at NorthBay's Nursing Shared Governance Day in August.

It was a well-attended meeting with more than 25 nurse leaders from all over California as well as some national nurse leaders on the conference phone.

What is the CA Action Coalition for the Future of Nursing? Where did it come from?

The Robert Wood Johnson Foundation (RWJF) in collaboration with the American Association of Retired Persons (AARP) formed The Future of Nursing: Campaign for Action, which launched in November 2010 following the release of the Institute of Medicine report "The Future of Nursing: Leading Change, Advancing Health."

It is now moving forward on national, state and local levels, building on both the report's recommendations and the long-time efforts of nurse leaders and nursing organizations. (www.thefutureofnursing.org)

The Campaign for Action is committed to using the report as a framework for future direction and action. It advances nursing through partnerships with numerous healthcare groups and healthcare professionals through the creation of state Action Coalitions.

The California Action Coalition was one of the original five state action coalitions and as of today, there are more than 15 states with active action coalitions across the country.
The CA AC has met several times since its creation in October 2010. A marketing toolbox has been created and internal structure and process have been discussed.

The larger state coalition is supporting efforts to build local Action Coalitions. Currently the tasks of the CA AC include capturing and sharing best practices, determining research needs, tracking lessons learned and identifying replicable models.

What I learned from attending this meeting was that NorthBay Healthcare nurses have the unique opportunity to be one of the first Local Action Coalitions for the CA AC. In a special presentation during NorthBay's August Nursing Shared Governance Day, Mary Dickow shared with me that she was very impressed with our group's participation in the breakout sessions.

Developing a Local Action Coalition is something to ponder since it seems that this is the future of nursing. What an incredible opportunity to contribute to the future of nursing as an organization.  

I encourage you to learn more about this important work.  One easy way to do this is to go to the Campaign for Action website at www.thefutureofnursing.org. There you will find information on the campaign. You can also go to the American Nurses Association California (ANA\C) website.  They have a dedicated page to track the work of the CA AC and provide additional links for information.  Go to http://www.anacalifornia.org/iomifncac or from the ANA\C home page there is a dropdown link under Policy Issues entitled IOM/IFN/CA AC.

The American Nurses Association (ANA) established the National Database of Nursing Quality Indicators (NDNQI) in 1998 to measure various nursing activities that identify and promote nurses' roles in care quality. Nearly 1,400 hospitals participate, with representation from six countries in addition to the United States.

With the leadership of Kathy Richerson, R.N., M.S., Chief Nursing Officer, NorthBay Healthcare joined NDNQI in 2002 because we were interested in quality improvement and wanted data to measure our improvement initiatives. Our data for patient falls, pressure ulcers and restraint prevalence studies are submitted quarterly to NDNQI.

The University of Kansas School of Nursing manages the database. According to the NDNQI, nurses are eligible to participate in the R.N. Satisfaction Survey if they work full or part time, spend at least 50 percent of their time in direct patient care, and have been employed a minimum of three months on their unit. In 2008, the NDNQI survey was used in nearly 700 hospitals, making it the largest survey of registered nurses in the United States.

The R.N. Satisfaction Survey affords us the opportunity to benchmark our successes as well as to identify areas for improvement. Our goal is to continue to support an environment that promotes nurses to participate in improvement initiatives. The R.N. Satisfaction Survey is one method of taking the pulse of nurses with direct patient care.

The 2011 survey was completed on Aug. 21. At NorthBay, 86 percent of eligible nurses participated in the survey, significantly higher than the national response rate of 72 percent as of September 2011. In order to meet the requirements for Magnet designation our survey responses must exceed the mean a majority of the time as compared to the NDNQI national database. In late November, directors, managers and department-based councils will be sharing the results of the survey with you.

We look forward to identifying areas for opportunities for improvement and celebrating our success.

It's been an honor to blog as Magnet Mary, but now is the time to make our focus wider, and to do so, we'd like to rename this blog, "Magnetizing NorthBay."

Not only will I still be writing from the Magnet Coordinator perspective, but I'll be welcoming other writers on the Magnet Steering Committee to participate.

I'm excited about "Magnetizing NorthBay" because we'll be able to share the perspectives of Magnet Program Director Chris Stevenson, our Vice president and Chief  Nursing Officer Kathy Richerson, Nursing Operations Officer Rhonda Martin and Perioperative Services Director Susan Gornall, as well as Becky Lessler, Human Resources services manager for learning and leadership.

It will also be an opportunity to give our Magnet Champions a blogging voice.

Watch for a change in the photo and presentation of this blog coming soon.

"It is a nursing award, only nurses are involved in the Magnet program," stated an employee recently. While Magnet Recognition is awarded by a nursing organization, it is not just nurses that contribute to achieving Magnet designation.

The Magnet appraisers from the American Nurses Credentialing Center (ANCC) evaluate the nursing division first by examining 15 inches of documentation based on an application that asks for more than 70 sources of evidence.

When our document is accepted, we will have a survey visit from the Magnet Program appraisers. They will interview members of the interdisciplinary team regarding communication and collaboration with nursing.

Here is an exemplar of just how this is coming to life at NorthBay:

Althea Soto had this to say about her new role as a Magnet Champion, "Being asked to be the Magnet Champion for Diagnostic Imaging, I wondered, what I would be getting into? How much time will it take from my day? What would I be asked to do?

Attending my first meeting with a bit of apprehension, I learned that I was already on my path to being part of the Magnet journey. Being mindful of my patient's needs is my first priority. I would not be taking time away from what I enjoy most about my job, but I would be increasing the great feeling that I get from positive interaction with patients. My personal understanding of 'Magnet cooperation' helped me to see in others Magnet etiquette in practice. After experiencing "Magnet" type of cooperation from an emergency department tech, which made my day a success, I asked what knowledge she had of the Magnet program. She shared that she is on one of the committees for the Magnet journey and was working on being a model of magnet power. It works! Her positive attitude increased my energy and helped me continue the wave of positive energy into the rest of my day, keeping the patient as the focus."
The Magnet website contains information on the Magnet Recognition program and it is accessible from the intranet if you go to the following link:http://www.nbhs.org/intranet/magnet.aspx?id=12292.
 

About 18 months ago NorthBay Healthcare declared its intention to seek Magnet designation.

Our nursing members at all levels have implemented activities aimed at achieving that goal. Let me provide a brief progress report on our status:

• We have completed our gap analysis comparing our current state of practice with the Magnet components.

Magnet asks that we exceed the mean (50th percentile) as compared to a national database for these measures a majority of the time. We are meeting this in many areas.  
Nurse sensitive quality indicators identified by department: fall rates, HAPU rates, restraint rates and ventilator associated pneumonia rates are being measured against benchmarks. Again Magnet asks that we exceed the mean (50th percentile) as compared to a national database a majority of the time. We are meeting this goal in many but not all areas.

A very meaningful qualitative outcome is exemplified in a story on page 11 of the summer 2011 edition of Nurses Notes.  Althea Soto from the VVH DI Department describes how it feels to be "magnetized" by way of a very positive interaction with an ED tech.

We are monitoring our outcomes carefully. See your Manager or DBC  member for information on how your unit is doing.  Stay tuned for new graphic displays of our NorthBay quality  outcomes to make our data more  accessible.

As you review your unit and overall Press Ganey data, notice that small changes in the "always" category correlate with big shifts in the percentile ranking. In other words, every patient interaction has an important effect on our  outcomes. This illustrates the power of each of us individually and all of us collectively to affect our outcomes. Thank you for your contributions!

Please forward any questions to Chris Stevenson at cstevenson@northbay.org.

I enjoy hearing these stories. A few weeks ago, Human Resources Service Manager Becky Lessler shared an empowering story during a conversation about teaching, education and the role development of staff.

The story that Becky told was about how Myra had mentored new nurses on her unit and not only precepted them but gave them an empowering strength to be kind, compassionate and professional in their new career. Myra is mentoring Rowyn Graves who is the very first new graduate nurse in the recovery room.

Rowyn and Myra have a very special relationship that sometimes develops between a new nurse and their mentor. A while back Rowyn shared with me how special Myra is to her by stating, "She is so humble and doesn't want the spotlight but I will tell you that she is the most incredible mentor and so much more to me."

As an experienced nurse, Myra, not only precepts nurses but she contributes to nursing scholarships so that nursing students can have less of a financial burden while gaining their nursing degree. She remembers that a nurse had done that for her and so she felt that it was the best way to give back to her profession.

Myra's career accomplishments and her gift of education and mentoring to our new graduate nurses is a great story for the third sub-component of Structural Empowerment, which is Teaching and Role Development. In writing this piece of the Magnet application, we must describe and demonstrate how the organization accomplishes the following items:

• The structures and processes used by the organization to promote the teaching role of nurses;
• How nursing facilitates the effective transition of new graduate nurses into the work environment;
• How nurses support community educational activities; and
• How nurses support academic practicum experiences and serve as preceptors, instructors, adjunct faculty or faculty.

The Teaching and Role Development sub-component is seen in many different facets of the organization. Nurses teach classes, in-services and educate on new equipment and processes. There are also large educational productions, such as the annual skills fair and STEMI Boot Camp opportunities for nurses to gain education. Nurses also teach their colleagues and non-nursing clinicians on structures and processes within their specific department.

The R.N. Acute Care Entry program (RACE) exemplifies the "transition of new graduate nurses into the work environment" line item. This program has given NorthBay the opportunity to recruit and retain some very excellent nurses and establish a whole group of nurses that started at NorthBay healthcare in the RACE program and are now in positions of direct care and even leadership within the nursing division.

We have several examples of nurses who are mentors to those who are currently enrolled in various programs gaining their advanced practice degrees. One recent graduate, Deborah Thorson, R.N., director of Womens and Childrens Services, just received her master's in leadership and management. Deborah was mentored by Susan Gornall, R.N., Director or Perioperative Services. There are several nurses who were recently accepted to advanced degree programs, including Barbara Abeling who was accepted into UC Davis' Master's of Nursing program and will begin classes this September.

It is an exciting time for NorthBay Nurses who are looking to advance their education and/or teach or mentor new graduate nurses who continue to be hired at NorthBay Healthcare each year. As the economy causes a lot of healthcare facilities to put their new graduate nursing programs on hold, NorthBay Healthcare has kept our new graduate nursing program going providing for clinical training and hiring into the RACE program.

It is essential to the recruitment and retention of the nursing staff to continue to promote nursing as a career and give the new nursing graduates an opportunity to begin their careers. There is no other facility that I would want to RACE to the role of a nurse - NorthBay is the very best!

My next blog will cover the 4th and 5th sub-components of Structural Empowerment - watch for them coming soon!

As your co-worker and with our shared organizational goal of excellent patient care, I commit to the following:

• I will accept responsibility for establishing and maintaining healthy interpersonal relationships with you and every other member of this team.
• I will talk to you promptly if I am having a problem with you. The only time I will discuss it with another person is when I need advice or help in deciding how to communicate with you appropriately. 

The Commitment to My Coworker commitment statements are indicative of our organization's commitment to continuing as a Great Place to Work, starting with your commitment to yourself and then your co-workers. Several of the Magnet Model components speak to commitments to different structures and processes. The commitment to co-workers is empowering to the individual and teams within our healthcare system.

My blog this week will review one more of the Structural Empowerment sub-components, Commitment to Professional Development.

Commitment to Professional Development sub-component of the Magnet application instructs us to document how the organization provides for the following:

• Supports nurses at all levels who seek additional formal nursing education;
• Has met goals for improvement in formal education showing an increase in the percentage of nurses that have obtained their bachelors of science in nursing over the two-year assessment period;
• Professional nursing certifications must increase over that same two-year assessment period showing that the nursing staff seek to improve their knowledge and are certified in their specialty;
• Develops and provides continuing education programs for nurses at all levels and settings;
• Provides career development opportunities for non-nurse employees and members of the community interested in becoming a nurse.

There has been a substantial increase in certifications among the nursing staff due to an increased awareness and desire to obtain certification in their specialty. At this time 11 percent of our nurses are nationally certified in their specialty. There has also been an increase in nurses going back to school to obtain their advanced degree. We believe that the nurses have been inspired and empowered by their co-workers, manager or director to increase their professional education.

Currently, 48 percent of our nursing staff has achieved their bachelor's degree in nursing and 10 percent of our nursing staff is master-prepared.

The educational programs for nurses at all levels within the organization have been compiled showing an amazing amount of educational offerings for our nursing staff from educational conferences to free online educational continuing educational programs. We have educational offerings for our non-nurse employees and have a financial loan forgiveness program that financially enables employees to go back to school to gain their nursing degree.

In my next blog, I will review the third sub-component of Structural Empowerment - Teaching and Role Development - Stay tuned and stay empowered!

The air was full of life as Mary Dickey led walkers in chants and danced along with the crowd.
Several pink clad employees and their family members road on the float that followed the large pink fire truck.

Structural Empowerment is one of the Magnet five model components and is seen when the entire organization promotes relationships among all its employees. It encourages self-governance in each employee, shared decision-making structures, and processes that establish standards of practice and address issues of concern in patient care. This creates an empowered team of healthcare professionals.

The five sub-components of the second Magnet Model component Structural Empowerment are:

• Professional Engagement
• Commitment to Professional Development
• Teaching and Role Development
• Commitment to Community Involvement
• Recognition of Nursing

Through the Professional Engagement sub-component of the Magnet application, we will show how the organization provides the following:

• The structures and processes that enable nurses from all settings and roles to actively participate in organizational decision-making groups, such as committees, councils and task forces.
• Two improvements in different practice settings because of nurse involvement in organizational decision-making groups such as committees, councils and task forces.
• The structures and processes that enable nurses at all levels of the organization to participate in professional nursing organizations at the local, state and national levels.
• Two improvements in different practice settings that occurred because of nurse involvement in a professional nursing organization.

The Professional Engagement sub-component of the Magnet application's Structural Empowerment section is seen in the nursing shared governance structure, with the inclusion of nurses on committees, councils and task forces throughout patient care.

The Stroke Alert and STEMI programs are two examples of nurse involvement in organizational decision making.

Participation in professional nursing organizations has many examples of our NorthBay nurses exemplifying their nursing knowledge through presentations, posters and published articles.

Two examples of this participation are Clinical Practice Managers, Kim Williamson and Elisa Jang who will be presenting at the June 21st American Case Management Conference on TeamSTEPPS: Strategies and Tools to Enhance Performance and Patient Safety and Trauma Program Director, Heather Venezio, R.N., will present at the National Emergency Nurses Association Convention in September on Care of the Psychiatric Patient in the Emergency Department.

The Structural Empowerment component of the Magnet program is already quite strong as we begin to write the documents to support the sub-components of the application. We are striving to make it even stronger and continue the magnetism throughout the organization to increase professionalism and education empowerment in all professions that encompass NorthBay. We are a structurally empowered healthcare system. We are NorthBay!

In my next blog, I will review one more of the five sub-components of Structural Empowerment - Stay tuned and stay empowered!

It seems that the hardest part of my job is translating the various Magnet components into easy-to-understand bits of information that do not overwhelm the audience.
Transformational Leadership is one of the components that can be overwhelming to the first-time browser of the Magnet application manual.

Transformational Leadership is defined as: "Style of Leadership in which the leader identifies the needed change, creates a vision to guide the change through inspiration, and executes the change with the commitment of the members of the group.

According to the ANCC, Transformational Leadership in Nursing has four parts and they are:

• The nursing organization is lead by a nursing leader who develops strong vision and philosophy, professional practice model and strategic and quality plans.
• Wherever nursing is practiced in the organization, the Chief Nursing Officer (CNO) develops structures, processes and expectations for staff nurse input and involvement.
• The CNO is visible, accessible and communicates effectively. As a result, nurses perceive that their voices are heard, their input valued and their practice supported.
• Nursing leaders at all levels of the organization convey a strong sense of advocacy and support on behalf of the staff and patients. 

Transformation Leadership is apparent in our organization as seen in the efforts of our CNO, Kathy Richerson, in coordinating and collaborating with nurses at all levels to design and develop all of the following:

• Nursing Strategic Plan
• Nursing Shared Governance structure and process
• Professional Practice model
• Delivery of Care model
  

It is a lot to digest, so the Magnet Journey Website is being updated and will have more in-depth information on all five of the Magnet Model components. Please watch for the new and improved Magnet Journey website coming soon to the intranet.

It is my sincere hope that all NorthBay Healthcare nurses had a wonderful Nurse's Day and Nurses Week and were able to celebrate their nursing career in one way or another.

Our games would last forever; it seemed that we never tired of playing outside with our whole gang. As I look back on those timeless games we played, I realize that they were giving me knowledge that I could use throughout my life about leadership.

It was a fun game and everyone who wanted to take a turn as leader was provided the opportunity. Some led with zest and power, making the path difficult and treacherous and some led using the curiosity of the followers to make the path that much more intriguing to see what was around the corner or on the other side of the gate, while some led with enthusiasm, giving the followers a ball to pass back along the line or a song to sing at the top of their lungs or a riddle to figure out while following along the path.

My favorite leader of the game was my sister, Patricia. She was a transformational leader utilizing team member's ideas and input to come up with songs, rhymes and riddles that we had to sing or recite or figure out when we followed her. Patricia went on to receive her bachelor's degree in chemical engineering and graduated at the top of her class, securing a top-level job with TRW that included working on the space shuttle. Patricia was a good example of a transformational leader in my life, she inspired me to do things in my life and encouraged me to go even further than she had, motivating me to become the person and nurse that I am today.

A child's game can teach much about leadership. How the leader is chosen? What kind of course will the leader create for those who follow them? Will they lead by just showing the course or will they walk the course first before asking their followers to walk it? Will they ask for suggestions from their followers for a better course? What will they do to make it exciting and fun in order to motivate their followers?

"The Transformational Leader inspires followers to not only perform as expected, but to exceed expectations - transformational leaders motivate followers to work for goals that go beyond immediate self-interest, where what is right and good becomes important - these leaders transform the needs, values, preferences and aspirations of followers," writes Richard Cox, MS, in "Transformational Leadership. "They do this so that the interest of the wider group replaces the self-interest of individuals within that group. Leaders and managers that take this approach are more focused on the intrinsic value of the human and the potential lying within."

Transformational leadership is one of five Magnet model components that are seen as intrinsic of Magnet-designated hospitals. As I walk through the halls of our hospitals and speak with employees, I meet a lot of transformational leaders. One day I had a conversation with Lester David, CNA, whom I believe is a transformational leader in his own right.

This young man is so charismatic and passionate about his job and his position in the hospital that he made me realize that everyone has the potential to be a transformational leader. He was focused on himself and his job first. This allowed him to influence his co-workers to be the very best they could be in their positions; by first being the very best he could be in his.

As a transformational leader, it's very important that you be yourself. Your unique and authentic way of being you creates the energy, drive, passion, or whatever you want to call it, that makes all the difference. How you engage your energy, time, integrity and power makes a massive difference to the outcome. It's like having a high-performance car, and not using the best fuel. You will never get the best performance output if one aspect is lacking. You can have all the skills in the world, but if your execution is poor, the results will be, too.

It's about how you develop and grow as a leader; the personal choices and commitments you make and break; what you will and will not stand for. As a transformational leader, you will be challenged, yet when you bring your authentic self forward, the journey becomes personalized, powerful, meaningful and more enjoyable. Others respond to the genuine nature that they see in you.

Certification in a nursing specialty supports our mission of advanced medicine as it is additional education that requires study and successful completion of a nationally administered exam.

Examples of certification include Critical Care Certified R.N. (CCRN), Certified Emergency Nurse (CEN), and Certified Nurse/Operating Room (CNOR). There are many more listed on the American Nursing Credential Center (ANCC) website. 

In December 2010, the Nursing Shared Governance Coordinating Council established a goal for national certification to reach 10 percent by the end of 2011.

We have approximately 600 registered nurses in our organization so a 2 percent increase represents an additional 12 R.N.s becoming certified. 

Leading the way is Amber Pitts, R.N., in Perioperative Services; one of our most recently certified nurses, receiving her CNOR two weeks ago. Congratulations Amber! 

Look for news in the coming weeks about a new process to support our nurses seeking specialty nursing certification. March 19, 2011, was National Nursing Certification Day. Who knew? Nurses at NorthBay will know next year, that is for sure.