The Impact of a Professional Nursing Practice
Environment in the School Setting
Presented by
Tammy Webb, BSN, RN
Julie Harris, MSN, RN, CPST
Lori Batchelor, BSN, MHA, RN, CPN, NEA-BC
The History of Magnet
1983
1990
1994
1997
1998
2000
2002
The Magnet Model: 5 components
Transformational Leadership

Emphasizes visionary strategic planning

Strong vision and well-articulated philosophy

Transformation may cause turbulence – involves
atypical approaches to solutions…ontrolled
destabilization that births new ideas and
innovations
Transformational
Leadership
Transformational Leaders not only lead people where
they want to go, they must also lead people where
they need to be to prepare them for the future
Transformational
Leadership
Transformational Leadership
Strategic Planning
 MVV
 Strategic goals
 Nursing leaders advocate for resources to support
the strategic priorities
 Improves nursing effectiveness and efficiency
Transformation
al Leadership
Transformational Leadership
Advocacy and Influence
 Nurse Leaders
influence system wide changes
 Guide periods of transition during planned and
unplanned changes
 Supports leadership development and succession
planning

Transformation
al Leadership
Transformational Leadership
Visibility, Accessibility and Communication
 Leaders are visible to direct care nurses
 Nurses have access to leaders
 Leaders use input from nurses to improve the work
environment
 Changes are made based on this input
Transformation
al Leadership
Transformational Leadership




Nurses at all levels are able to articulate a clear vision of nursing practice
All ideas are heard, respected and given equal consideration
Communication is timely, clear, moving easily both horizontally and
vertically
Nurses report that they feel up-to-date with all nursing news that impacts
their practice

Suggestions from frontline nurses are visibly incorporated into decisions

Outcome measures indicate empowerment and engagement


Frontline nursing involvement & synergy results in new, innovative, practical
ideas
Reduced turnover
Structural Empowerment


Provides the foundation of nursing services
Solid structures and processes provide an
innovative environment

Environment is flat, flexible and decentralized

Self governance and share decision making



Structural
Empowerment
Strong relationships and partnerships
developed among all types of community
organizations
Support and expectation for life long learning
Positive image of nurses as key contributors to
clinical practice and care delivery
Structural
Empowerment
Structural Empowerment

Professional engagement
 Decentralized
decision making with staff involvement
 Feedback reaches all personnel involved in decisions
more quickly
 Shared decision making shapes professional character,
structure and behavior of the nursing organization and
provides a framework for organizing the work of the
nurses
 Nurses participate in professional organizations (local,
state and national)
Structural Empowerment

Commitment to Professional Development
 Support
for formal academic education
 Sets goals for professional development, certification
and participation at conferences
 Provides continuing education for nurses
 Provides career development opportunities
The organization places high value on each and every individual’s
professional development and partners with them to provide
opportunities and resources for growth
Structural Empowerment

Teaching and role development
 Promote
the teaching role of nurses
 Facilitates the effective transition of new graduate
nurses
 Support community educational activities
 Support academic practicum experiences and serve as
preceptors, instructors and faculty
Structural Empowerment

Commitment to community involvement
 Affiliations
with schools of nursing, consortiums and
community outreach
 Supports and recognizes nurses participation in
community service
 Addresses the healthcare needs of the community and
establishes partnerships
Structural Empowerment

Recognition of Nursing
 Recognizes
the contributions of nurses
 Ensures that the community recognizes and value of
nursing at the organization
The image of nursing is “about relationships – with patients and
families, with self and with colleagues”
Exemplary Professional Practice





A comprehensive understanding of the role of
nursing exists and “lives” in the organization
The application of that role with patients,
families, communities, and the interdisciplinary
team
How nurses practice, collaborate, communicate
and develop professionally
Alignment of nursing practice to the MVV
Mutual respect among healthcare team and
recognition of nurses’ contribution
The goal of this Component is more than the
establishment of strong professional practice; it is
what that professional practice can achieve
Exemplary
Professional
Practice
Exemplary Professional Practice

Professional Practice Model (PPM)
 Standards
of practice and standards of care
(investigate, develop, implement and evaluate)
 Nurse involvement in analyzing nurse satisfaction and
engagement
 How nurses apply, evaluate and adapt the PPM
Example: Model of Care and
Professional Practice Model
Exemplary Professional Practice

Care Delivery System
 Involves
the patient/family in care decision making
 Patient care assignments ensure continuity, quality and
effectiveness across systems
 Application of regulatory standards as applicable
 Access to internal and external resources
Staffing, scheduling and budgeting
 Interdisciplinary Care
 Ethics, Privacy, Security and Confidentiality
 Diversity and workplace advocacy

Exemplary Professional Practice

Accountability, competence and autonomy
 Ready
access to current literature, professional
standards and or other data
 Use of self-appraisal performance and peer review
 Participative management and shared leadership
 Nurses are accountable to resolve issues related patient
care and operations
 Nurses are permitted and expected to be autonomous
in their practice, the provision of patient care, within
professional standards
Exemplary Professional Practice

Culture of Safety
 Workplace
safety for nurses
 System wide approach to risk assessment and error
management
 Use of Nursing Sensitive indicator data (e.g. nosocomial
infections, pain, and PIV infiltration)

Quality Care monitoring and improvement
 Allocation
of resources to improve the quality of nursing
 Dissemination of quality data to direct care nurses
New Knowledge, Innovation
& Improvements

Integration of evidence based practice
(EBP) and research





Education for nurses
Targets for productivity and participation
Application of existing evidence and new
evidence
Visible contributions to the science of
nursing
Innovation within an empowering work
environment
Empirical
Outcomes
New
Knowledge,
Innovation, &
Improvements
New Knowledge, Innovation
& Improvements

Research
 Utilize
current research findings in practice
 Support for human rights of participants in research
protocols
 Develop, expand and advance nursing research

Evidence Based Practice (EBP)
 Existing
nursing practice is based on evidence
 Translation of new knowledge into practice

Innovation
Empirical Outcomes

The question for the future is not
“What do you do?” or “How do you do
it?” but rather, “What difference have
you made?”
 Nurses make essential contributions to:
patient, nursing workforce, organizational
and consumer outcomes
 Outcomes are dynamic
 Relationships among:
Structure
Process
Outcome
Empirical
Outcomes
Empirical
Outcomes
Empirical Outcomes
Environment where staff feel empowered
and involved with problem solving
 A reliable and Anticipatory environment
 Patient and families are actively engaged in
care and experience high satisfaction
 Standardized, streamlined and effective
processes are in place to support care
delivery

Fundamentals of Nursing
Leadership

2005 NASN position statement:
It is the position of the National Association of School Nurses
that the school nurse is the leader in the school community to
oversee school health policies and programs. The school nurse
serves in a pivotal role to provide expertise and oversight for the
provision of school health services and promotion of health
education. Using clinical knowledge and judgment, the school
nurse provides health care to students and staff, performs health
screenings and coordinates referrals to the medical home or
private healthcare provider. The school nurse serves as a liaison
between school personnel, family, community and healthcare
providers to advocate for health care and a healthy school
environment.
Role of a Nurse Leader




tackles nursing issues head on
inspires others
foresees a better future
operates according to a basic set of principles
Characteristics of a
Nurse Leader
Collaborative
 Inventive
 Skilled
 Visionary
 Mindful

Collaborative
Conveying enthusiasm about achieving
important goals
 Helping others to meet their challenges
 Expressing confidence in the abilities and
potential of others
 Giving freely of time, resources, and positive
advice
 Serving as an advocate for those facing
difficulties

Inventive
Initiating positive action without being asked to
do so
 Responding quickly and effectively to changing
conditions
 Finding new ways to accomplish desire results
 Putting cleaver ideas into action
 Providing creative solutions to stubborn
problems

Skilled
Acquiring and mastering all necessary
skills to achieve desired results
 Continuing to sharpen vital skills
 Following important tasks through to
completion
 Using their experience
 Balancing the demands of multiple critical
tasks

Visionary
Working tirelessly to achieve important goals
 Foreseeing a better future and helping it come
to pass
 Mapping a clear path to desired goals
 Inspiring others with both actions and words
 Painting an inspiring future that motivates
others

Mindful
Making and keeping realistic promises
 Freely admitting mistakes
 Respecting the human needs of others
 Showing concern for the problems and
feelings of others
 Reflecting on the implications of past and
pending decisions

Responsibilities of a
Nurse Leader
Focus on the situation, issue, or behavior, not on
the person.
 Maintain the self confidence and self esteem
of others.
 Maintain constructive relationships.
 Take initiative to make things better.
 Lead by example.
 Think beyond the moment.

Responsibility #1: Focus on the
situation/behavior

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

Remain objective
Solve problems
Make better decisions
Maintain constructive relationships
Responsibility #2: Maintain self
confidence & self esteem of others




Avoid ridicule and negative comments
Avoid criticizing others
Show respect
Help others reach their goals
CRITICISM
Responsibility #3: Maintain
constructive relationships

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

Support others
Keep a positive attitude
Communicate
Share information
Responsibility #4: Take
initiative to make things better


Look around your area for opportunities for
improvement
Offer help
Responsibility #5: Lead
by example




Be a good example
Model appropriate behavior
Honor your commitments
Admit your mistakes
Responsibility #6: Think
beyond the moment





Remember – there are always consequences
Consider how your decision will impact others
Avoid personal gain at the expense of others
Be thoughtful in making plans and decisions
Anticipate the future
Fundamentals of Nursing
Leadership


Think about nurses who have mentored you. What
qualities made them successful? Incorporate these
qualities into your role as a school nurse.
Feeling frustrated about a situation at work –
Review the responsibilities. How can you apply them
to your situation?
Sources


AchieveGlobal, Inc. (2003). The Principles and
Qualities of Genuine Leadership.
National Association of School Nurses. (2011).
Position Statement - Role of the School Nurse.
Retrieved from
http://www.nasn.org/Default.aspx?tabid=279
Lori L. Batchelor BSN, MHA, RN, CPN, NEA-BC
Arkansas Children’s Hospital
Ambulatory Care Services Director
Nursing Leadership and the
School Nurse
 The document Nursing in the Public Schools of the
United States of America
(Maria Applewhite, RN, 2003, retrieved from
http://www.cwru.edu/med/epidbio/mphp439/School_Nursing.htm.)
Seven Specific Roles of the school nurse of the 21st Century
 Provides direct health care to students and staff
 Provides leadership for the provision of health services
 Screening and referral for health conditions
 Promotes a healthy school environment
 Promotes Health
 Serves in a leadership role for health policies and programs
 Serves as a liaison between school personnel, family, community and health
care providers.
Nursing Leadership and the
School Nurse
 LPN vs. RN does it really matter?
 Communicating with Families
 Interdisciplinary/Intercollegial Relationships
 Does a school nurse make a difference to the health and
wellness of school age children?
Nursing Leadership
LPN vs. RN does it matter?
 According to the March/April 2011 edition of American Nurse 43
(2) pg3, Karen Daley, ANA President.
“It is critically important that nurses without a BSN take advantage
of opportunities to pursue advanced education in order to become
better prepared to care for patients in an increasingly complex
health care delivery system.”
 According to the National Association of School Nurses
(retrieved from http://www.nasn.org/Default.aspx?tabid=279)
“ Educational preparation for the school nurse should be at the
baccalaureate level, and the school nurse should continue to
pursue professional development and continuing nursing
education.”
Nursing Leadership
LPN vs. RN does it matter?
 According to the American Academy of Pediatrics
(AAP)Policy Statement: Role of the School Nurse in
Providing School Health Services (Pediatrics 121(5)
2008)
 AAP supports:



The goal of professional preparation for all school nurses.
Having a full-time school nurse in every school
Pediatrician support of the school nurse
 Coordination of care
 Continuing education of school nurses
Nursing Leadership
LPN vs. RN does it matter?
 Why would education make that difference?
 Community Health/Epidemiology
 Nursing Research/Statistics
 Management/Leadership
All provide for a more comprehensive knowledge base that
assists in considering all factors that influence patient
illness, health or wellness.
Nursing Leadership
LPN vs. RN does it matter?
 Institute of Medicine findings: ‘The Future of Nursing:
Leading Change, Advancing Health’ (2011, Holmes,
A.M., Nursing Management).
 1st recommendation: increase proportion of nurses with
a bachelor’s degree of science in nursing (BSN) to 80%
by 2020.
 Currently BSN prepared nurses average 45-55%
depending on the region.
Nursing Leadership
LPN vs. RN does it matter?
 National Association of School Nurses recommends
BSN preparation for School Nurses
 Growing Evidence for the BSN prepared Nurse
 Lower rates of patient death
 Lower rates of medical errors
 Better patient outcomes
Nursing Leadership
LPN vs. RN does it matter?
 National Database of Nursing Quality Indicators
(an arm of the American Nursing Association)
 More than 1600 Hospitals participating nationally
 Evaluating patient outcomes on a variety of measures
including:


Nursing Professional Certification
Nursing Education Level:
 LPN
 RN
 RN, BSN
 RN, MSN and/or RN, PhD
Nursing Leadership
 "Education makes a people easy to lead, but
difficult to drive; easy to govern, but impossible to
enslave."
— Henry Peter Brougham,
The Present State of Law, 1828
Nursing Leadership
LPN vs. RN does it matter?
 RN Scope
 The delivery of healthcare services which require
assessment, diagnosis, intervention, and evaluation fall
within the professional nurse scope of practice.
 LPN Scope
 The delivery of healthcare services which are performed
under the direction of the professional nurse, licensed
physician, or licensed dentist, including observation,
intervention, and evaluation, fall within the LPN/LPTN
scope of practice.
Nursing Leadership
LPN vs. RN does it matter?
 KEY Differences in Practice according to the Arkansas
State Board of Nursing:
 RN Practice
Assessment
Diagnosis and Intervention
Supervision
Teaching
Delegation
LPN Practice
Observation
Intervention
Nursing Leadership
Communicating with Families
 School Nurse Role: Leader!
 You are more than a pill passer!!
 Planning for your students health needs in the school
setting
 Collaboration
 Seeing families as a member of the team




Seeking input
Learning from their expertise
Giving feedback
Strategizing for solutions
Nursing Leadership
Communicating with Families
 A quote from The Times: Tigard/Tualatin/Sherwood
(October 2010), regarding the nurses role in the school
setting
“I am a vocational nurse (aka LPN) in California and
have been hired to work as a school site nurse. I am
asked all the time to do duties outside of my job
description but to be a team player I do them, hoping to
continue to co-ordinate between the care of the
students and the other duties”.
Nursing Leadership
Communicating with Families
 Rights of all students regardless of their healthcare status
to access public education.
 Key to success…
meet with the parent/guardian before school begins.
 Staying within your scope of practice
 When and how to say no.
 Knowing what you are being asked to do
 Maintaining competencies
 Seeking sources from the district
 Working PRN somewhere to maintain skills\
Nursing Leadership
Interdisciplinary Collegial Relationships
 Responsibilities of a Nurse Leader
 Lead by example
 Maintain self confidence
 Maintain collaborative relationships
If you hope to lead you must behave like a leader.
Nursing Leadership
Interdisciplinary Collegial Relationships
 "Control is not leadership; management is not
leadership; leadership is leadership. If you seek to
lead, invest at least 50% of your time in leading
yourself—your own purpose, ethics, principles,
motivation, conduct. Invest at least 20% leading
those with authority over you and 15% leading your
peers."
— Dee Hock, Founder and CEO Emeritus, Visa
Nursing Leadership
Interdisciplinary Collegial Relationships
 How do I lead and who are my peers?
 You are the resource expert on healthcare
 You know CPR and First Aid Skills
 You are a member of the school team and you lead
change that will advance the health of your students,
their ability to learn and their safety on campus.



Screenings
Education: Hand Hygiene, Wheel safety, Nutrition, Sex
Education, etc.
Health of the campus: immunization clinics for FLU,
strategies to prevent school violence and bullying, provisions
for hand hygiene, etc.
Nursing Leadership
Interdisciplinary Collegial Relationships
 Medication Policies

Delegating administration of medication to layperson
 Diastat
 Controlled substances
 Over the Counter meds
 Procedure/Skill and Scope of Practice


Competency of the person delivering care
Continuing education to maintain competencies
Nursing Leadership
Interdisciplinary Collegial Relationships
 Legal Issues in School Health Services
 Delegation of nursing duties
According to the National Association of School Nurses
‘delegation in nursing care is a legal term and a complex
skill requiring sophisticated clinical judgment and final
accountability for care of the client (NCBSN, 2005).
ANA defines nursing delegation as transferring the
responsibility of performing a nursing activity to
another person while retaining accountability for the
outcome (ANA/NCSBN, 2006).
Nursing Leadership
Conscious Incompetence Conscious Competence
I know what I don’t know
I know what I know
Unconscious Incompetence Unconscious Competence
I don’t know what I don’t know
I know it and I don’t even have to think
about it.
Nursing Leadership
Interdisciplinary Collegial Relationships
 ASBN Scope of Practice Decision Making Model
 Five Rights of Delegation
 Right Task, Right Person, Right Direction, Right
Supervision, Right Circumstance
Nursing Leadership
Interdisciplinary Collegial Relationships
 How do I lead and who are my peers?
 Peers are:

Principle, teachers, support staff and nurses on other
campuses….the people in this room.
 Health education is not limited to students.
 When did you last do education with the staff on Hand
Hygiene, Preventing Bullying, Nutrition, Cover your Cough,
etc?
 During a health crisis on campus your peers are looking
at you to lead. If you will LEAD they WILL follow with
direction and input from you. You are the resource
expert in healthcare.
Nursing Leadership
Interdisciplinary Collegial Relationships
 Transformational Leaders not only lead people
where they want to go, they must also lead people
where they need to be to prepare them for the
future.
Healthcare is transforming and more and more will move
to outpatient settings including in retail store clinics
and school settings.
Lead your campus to a state of Wellness.
Plan/Prepare for Emergencies
Prevent Bullying
Nursing Leadership
 School Nurses Job Responsibility
 Advocate for healthcare and healthy school
environment
 Liaison between school personnel, family, community
and healthcare providers.

Developing the plan to achieve shared goals for education
with students who have chronic health concerns.
 Leader in development of :
 School safety/bullying/school violence
 Campus wellness
 Emergencies
Nursing Leadership




Seek resources within your school district
Join your national nursing organization
Collaborate
Consider working part-time somewhere to keep those
skills sharp
 Read a good book on:
 Leadership
 Nursing
 Quality/Accountability
 Consider additional education
Nursing Leadership
American Public Ranks Nurses as Most Trusted Profession
 11th Year in Number One Slot in Gallup Poll
 SILVER SPRING, MD - For the 11th year, nurses were voted the
most trusted profession in America in Gallup's annual survey
that ranks professions for their honesty and ethical standards.
Eighty-one percent of Americans believe nurses’ honesty and
ethical standards are either "high" or "very high."
 Both the Accountable Care Act and the Institute of Medicine’s recently
released report on the Future of Nursing calling for a larger role for
nurses in providing patient-centered care in a reformed health care
system.
 Since being included in the Gallup poll in 1999, nurses have received
the highest ranking every year except in 2001, when fire fighters
received top honors. Results were based on telephone interviews with
more than 1,000 adults.