Latoya Hagood   	 2 Feb 07    6:15 PM MST
	The force of magnetism I chose to discuss is professional model of care. According to the American Nurses Credentialing Center (ANCC), organizations that are magnet status have models of care that gives nurses the responsibility and authority for direct patient care. The models care should provide high quality and continuity of care. These professional models of care include primary nursing, case management, family-centered, and holistic.

My organization currently uses the case method or total patient care model. In this model, nurses assume total responsibility during their time on duty. This model provides nurses with high autonomy and responsibility. The patient receives holistic care during the nurse’s time on duty. Fortunately, that care remains continuous with every change of shift and change in nurse. One disadvantage is when a nurse is inadequate to provide total patient care. My organization still employs licensed practical nurses and with their limited education, it can hard to match patient assignments with the skills of the nurse. My organization has made the decision to not hire any new licensed practical nurses, but we will continue to utilize the few we have right now.

I have found that nurses at my organization do not welcome or invite family centered care. Some nurses feel uneasy when family members are present and want to be involved in the patient’s care. My organization should include family members in patient care. We can encourage family members to be present during patient teaching and discharge planning.

Reference

American Nurses Credentialing Center (n.d). Forces of Magnetism. Retrieved February 2, 2007, from http://www.nursecredentialing.org/.

Latoya Hagood (SC)


Mary Arnold 	2 Feb 07    9:36 PM MST
	Latoya:

Even though I do not work in a hospital setting, I now work in a surgeons office. The care that is provided by the nursing staff is very autonomous and holistic. The nursing staff is only staffed by RN's, so "total responsibility" is provided by each nurse. Even though I just started in this position, it has already proven to be a great place to work. All the others have been very supportive and helpful, compared to the previous place. If clinics or offices could achieve a magnet status this surgeons office could easily apply and set the standard.

Mary Lynn, RN, BSN
IL


Margaret Imbrock 	2 Feb 07  11:18 PM MST
	Latoya,
You mentioned the LPNs but do you utilize nursing assistants also or is your facility going to an all RN staff? If family members are excluded from the patient teaching and discharge planning moments how do they learn what to do when the patient goes home? We discussed the importance of teaching disease management within the family environment to keep the patient out of the hospital last term.

Are the LPNs being encouraged to go back to school to achieve their RN or is that not an option? We have had a fair amount of success in this area because LPNs have either returned to school or are getting close to retirement. We are only hiring LPNs for certain areas or as a student until they finish their RN.
Marge


Christine Higbie 	3 Feb 07    6:25 AM MST
	Response to Latoya:
Latoya,
I am not sure of the training or curriculum in South Carolina, but as a LPN educator in Ohio, I can say that there are less and less things that a LPN cannot do. In Ohio our LPN are training in IV therapy while in school and can start IV and hang IVPB's. They can't do anything with central lines. Most are taught how to assess their patient and have excellent critical thinking skills.
They can do much more than most facilities allow them. Maybe your facility needs to look at how they are utilizing the LPN. Many facilities only use them as a higher level nursing assistant, but they can do much, much more.


Do you think that you can have any influence on changing how the nurses of the facility do their discharge education? Families are a big part a patient's care and need education too. by teaching both the patient and the family you will get better compliance and decreased readmission to the hospital, you could use those to help with change.

Chris


Latoya Hagood 	3 Feb 07  11:17 AM MST
	In South Carolina, LPNs are not taught to do IV initiation or hang IVPB, central lines, or blood transfusions during their training. When they become licensed, our organization sends LPNs to extra training courses so they can become certified to initiate IVs and hang IVPB. They are still not allowed to do anything with central lines.
I have mixed feelings with my hospitals decision regarding LPNs. I have worked closely with LPNs that have better clinical skills than RNs with far more experience. As it stands now we are moving toward an all RN staff and this is the track my hospital has taken to move us forward to magnet status.

Latoya Hagood (SC)


Christine Higbie 	3 Feb 07    1:34 PM MST
	Latoya, I se where you are coming from now. I also work with some LPN's that are better than a RN. I think it is sad when a hospital wants to replace LPN's. many time they will replace them with the UAP's verses RN's which are hard to come by. I hope that your facility doesn't do that, even if they are applying for Magnet. Does it say anywhere that a Magnet facility has to be totally staffed with RN's? Maybe I need to look into that, I think that LPn's can play a vital role in a hospital setting.

Chris