Welcome to the Downstate
Magnet™ Consortium Meeting
December 6, 2010
Exemplary Professional
Practice (EP)
Exemplary Professional Practice
 The true essence of a Magnet organization stems from exemplary
professional practice within nursing
 Exemplary professional practice
 Is the key driver of a Magnet organization
 Requires comprehensive understanding of the role of the
professional nurse
 Accountability, competence & autonomy
Exemplary Practice
 Excellence in practice and behaviors worthy of
Honor
 Being imitated
 Respect and admiration
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 Nurses have control over staffing and scheduling
practices
 Nurses work collaboratively with the other disciplines
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As a result, the quality of outcomes is better
 Nursing practice in Magnet organizations actualizes ideals &
beliefs of the profession
 Nurses are accountable for safe, ethical, evidence-based care
Exemplary Professional Practice
 Professional practice is based upon tenets
 Self-regulating
 Peer Review
 Control of practice
 Code of conduct
 Contract with society
 Nursing theory supports practice
 Requires values clarification
 Foundational documents describe principles of nursing
Exemplary Professional Practice
 Accountability
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Ownership for the consequences of one’s decisions and actions
Reflecting on actions and effectiveness
Directs future efforts
Promotes learning
(CHCM, 2009, p. 162)
 Requires ongoing education
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Lifelong learning
 Appreciative Inquiry is a skill set
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Identify what is currently working well
What it will take to build on the excellence which already exists
When we are performing at a high level, what components make this possible
Staff should recognize the excellence of co-workers
 Clarify values
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Individual caring, autonomy, sharing, improvement, inquiry
Organizational change, collegiality, consensus, communication, celebration
Exemplary Professional Practice
 Principles of Practice
 Based on standards
ANA Scope & Standards of Practice
 ANA Code of Ethics with Interpretive Statements
 Nurse Practice Act
 Professional organization standards
 Other professional standards
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Evolving
Evidence-based
Exemplary Professional Practice
 EP encompasses the following seven forces
 Professional Models of Care
 Consultation & Resources
 Autonomy
 Nurses As Teachers
 Interdisciplinary Relations
 Quality of Care: Ethics, Patient Safety & Quality Infrastructure
 Quality Improvement
Empirical Domains of Evidence (EO)
 Professional Practice Model
 Safe and Ethical Practice
 Autonomous Practice
 Quality Processes
Exemplary Professional Practice
Nine subcomponents of EP
 Professional Practice Model
 Care Delivery System
 Staffing, Scheduling & Budgeting Process
 Interdisciplinary Care
 Accountability, Competence & Autonomy
 Ethics, Privacy, Security, & Confidentiality
 Diversity & Workplace Advocacy
 Culture of Safety
 Quality Care Monitoring & Improvement
These components work together to create great nursing and outcomes
Exemplary Professional Practice
 Professional Practice Model
 Graphic description which demonstrates relationships &
supports decision making
 Aligns with the organization’s mission, vision, philosophy and
values
 Incorporates standards
 Provides consistency in practice
 Supports nursing care delivery
 Centered on the patient
Exemplary Professional Practice
 Professional Model of Care
 Magnet hospitals lead research efforts and test practice
models
 Nurses analyze data to influence decisions
 Engage staff in the budget process
 Nurses must know unit based quality data
 Measure staff effectiveness against quality outcomes
 Discuss skill mix
 Could have a good ratio but not have good outcomes
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What are the issues?
Exemplary Professional Practice
 Magnet organizations are expected to outperform the mean
of the national database used (benchmarking)
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Must submit most recent annual or biannual nurse satisfaction results
including the mean or median
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Can be displayed at single unit level, like units, or organizational level
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Narrative must include participation rates, analysis and evaluation of
data and database used
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Must follow through on action plans
Information must get back to staff
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 Must demonstrate comprehensive, not cursory, analysis of
survey results
Exemplary Professional Practice
 Care delivery system
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Integrated with the professional practice model
Based on acuity, staffing mix, best practices
Is responsive to change
Promotes consistency, efficiency, and accountability for care
Describes
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Nurses’ authority is clear
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How care is delivered
Skill set required
Authority is the right to act in areas where one is given & accepts
responsibility
Varies by unit, population
Roles are clear
Use internal consultants
Productivity is measured
Exemplary Professional Practice
 All care delivery systems address
 Staffing patterns
 Schedules
 Scope of Practice
 Assignments
 Accountabilities
 Transitions in care
 Continuity of care
Exemplary Professional Practice
 Staffing, Scheduling and Budgeting Processes
 Use of trended data to formulate staffing plan
 Consistent application of the Care Delivery System
 Nurse participation in staffing and scheduling processes
 Use of guidelines such as ANA Principles of Nurse Staffing
 How nurses analyze data to guide decisions about budget
Formulation
 Implementation
 Monitoring
 Evaluation
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Exemplary Professional Practice
 Staffing, Scheduling and Budgeting Processes
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RN competencies
Management support
Access to clinical experts
Valuing of RN contributions
Commitment to fill vacancies in creative ways
Exemplary Professional Practice
 Assignments ensure continuity, quality &
effectiveness
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Good hand off communication (use of tool)
 Beside nurses should have resources 24/7
 Use of consultants (internal/external) enhance care
Exemplary Professional Practice
 Interdisciplinary Care
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Comprehensive plan of care developed through partnerships with
Patients and families
 Physicians
 Pharmacy
 Nutrition
 Rehabilitation
 Social work
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Collegial relationships evident
Mutual respect as everyone’s contributions impact the patient
experience and outcomes
Must have conflict management strategies in place
Ensure continuum of care
Exemplary Professional Practice
 Accountability, Competence & Autonomy
 Accountability means being responsible for own actions
 Competence– use of communications, technical skills, clinical
reasoning, values in daily practice for benefit of individuals and
community
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Competency assessment contributes to safe and ethical practice
Routine use of self appraisal and goal setting
Peer evaluation means other nurses give fellow nurses feedback during
performance appraisals
 Nurses need to be able to judge performance of peers with similar roles
and level of licensure
 Peer review encourages professionalism through accountability and
self-regulation of practice
Exemplary Professional Practice
 Professional Peer Review
 Constructive
 Collegial
 Systematic
 Formalized
 At all levels
 Conducted over time
Exemplary Professional Practice
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Autonomy
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Right to exercise clinical and organizational judgment within an
interdependent team in accordance with nursing discipline
 Control over nursing practice
Exemplary Professional Practice
 Ethics, Privacy, Security & Confidentiality
 How nurses address complex ethical issues
 Use ANA Code of Ethics
Make visible
 Operationalize principles
 Ongoing education
 Look for ethical issues in daily rounds
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Resolve privacy, security and confidentiality issues
Exemplary Professional Practice
 Diversity & Workplace Advocacy
 Address healthcare disparities
 Non-discriminatory climate
 Address unsafe, incompetent or unprofessional conduct
 Assess community needs
 Meet unique needs of patients
 Workplace initiatives to address
Caregiver stress
 Diversity
 Rights
 Confidentiality
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Exemplary Professional Practice
Culture of Safety
 Proactive assessment & approach
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Prevent injuries
 Innovate
 Safety initiatives incorporate national best practices
 Based on standards such as ANA’s Safe Patient
Handling and Movement
 Sufficient resources are available to respond to safety
initiatives
 Facility-wide approach
 Measure improvements in nurse workplace safety
Exemplary Professional Practice
 Nurse sensitive indicators
 Submit data for most recent 8 quarters for four nurse-sensitive
clinical indicators
Falls and pressure ulcers must be reported
 Two other indicators must be chosen
 Blood stream infection, UTI, VAP, Restraint use, pediatric
infiltration or other specialty-specific nationally benchmarked
data
 Include the median or mean of national database
 Can be displayed at single unit level (ICU for example),
by clinical groups (Med/Surg units) or at organizational level
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Exemplary Professional Practice
 Nurse
sensitive indicators
Data must be statistically valid; provided by vendor
 Majority of data must outperform the mean the majority of the
time
 Five of eight quarters must outperform mean
 Narrative must include analysis and evaluation of data
 Database to which contributed
 Must include a graphic display and table with
 Data from last eight quarters
 Benchmark mean or median for each quarter
 Axis labels
 Clarify if data point is “no data submitted” or “zero”
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Exemplary Professional Practice
Quality Care Monitoring & Improvement
 Nurses at all levels analyze data and use national
benchmarks
 Action plans are developed that lead to systematic
improvements
 Resources are allocated for quality
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Avoid data paralysis; should be direct, meaningful & simple
 Magnet hospital data demonstrates outcome
measures at or above benchmark mean in patient
and nurse sensitive indicators
Exemplary Professional Practice
 Quality Care Monitoring & Improvement
 Submit data for most recent eight quarters for four measures
of patient satisfaction with nursing
Pain
 Education
 Courtesy and respect from nurses
 Careful listening by nurses
 Response time
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Include mean or median of the database
Data can be display at unit, clinical group (like units), or
organizational level
Majority of data must outperform the mean or median the
majority of the time
Exemplary Professional Practice
 Quality Care Monitoring & Improvement
 Narrative must include analysis, evaluation and resultant
action plans
 Other requirements as outlined under nurse sensitive
indicators
Exemplary Professional Practice
Nine subcomponents of EP
 Professional Practice Model
 Care Delivery System
 Staffing, Scheduling & Budgeting Process
 Interdisciplinary Care
 Accountability, Competence & Autonomy
 Ethics, Privacy, Security, & Confidentiality
 Diversity & Workplace Advocacy
 Culture of Safety
 Quality Care Monitoring & Improvement
Exemplary Professional Practice
 Narratives should provide sufficient examples to indicate
compliance with the source of evidence (SOE)
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Demonstrate not isolated to a single group or area
Must demonstrate attribute exists throughout the organization
Should be straightforward, concise, include minimal
extraneous information
Explain clearly how SOE is present and operationalized
Illustrate dynamic/innovative focus on excellence
How integrated and internalized across breadth of
organization
References
 American Nurses Credentialing Center (2010). Exemplary
Professional Practice: Criteria For Nursing Excellence:
Magnet Recognition Program®. Silver Spring, MD: Author.
 American Nurses Credentialing Center (2008). Application
Manual: Magnet Recognition Program®. Silver Spring, MD:
Author.
 Creative Healthcare Management (2009). RelationshipBased Care Leadership Practicum. Minneapolis, MN
 http://www.nursecredentialing.org/Documents/Magnet/
2008-Manual-Updates.aspx