Karen Kelsall 31 Jan 07 10:18 AM MST Week Five Discussion: Forces of Magnetism ~ Autonomy With more nurses seeking additional education and finding they are more comfortable with the role of leadership, we are seeing that a great deal of issues are being addressed and resolved from the staff nurse position instead of at a senior leadership level. Nurses are making decisions in regards to patients care, based on professional standards, literature and research findings to support control over nursing practice (ANCC, 2007). Autonomy is one of the Forces of Magnetism that I see evident within my facility. We have just recently started the Magnet journey and there are many unforeseen areas that will have to be addressed in order for the accreditation process to take place, however I can honestly say I see this force already in place within our facility. Our facility started with shared governance and council meetings approximately 2 years ago. Each unit has a chair and co chair that run monthly meetings. The chair and co chair are staff nurses who are in charge of the agenda for these meetings and address issues such as patient satisfaction scores, new policies that are being set in place and scheduling issues to name a few. The staff is given a time at these meetings to voice concerns and issues that they feel have direct impact on how patient care is delivered. It is the desire of the council that all issues are addressed in a manner in which everyone takes away from the table a sense that their concerns were or are being addressed in a manner that will appease those involved. By allowing the staff nurses to have input in these meetings I can see an increase in staff satisfaction along with a sense of pride in delivering high quality patient care. One example of autonomy that comes to mind directly related to staff involvement is our “Leaper” program. This is a program that was started by 3 staff nurses in the department after our safety officer noted an increase in patient falls. The program addresses identifying patients who are at high risk for falls by placing a “frog” magnet outside of the patients room and then monitoring them with either constant supervision(sitter) or an alarm device(bed check) that allows the staff to know when the patient is getting out of bed. The creativity shown by these staff nurses along with decreasing our fall rates in the department gained exposure by senior management and now the program is used throughout the institution for patients that are at a high risk for falls. This is just one example of how autonomy is alive and working well with my institution. It will prove to be enlightening as the full process of the magnet journey gets underway. I am sure I will come to see areas in which my facility needs to “buckle” down and come up to date with the times. As I review other forces I can already see that the magnet journey is just that….a journey…not a destination. American Nurses Credentialing Center. Forces of Magnetism (1/26/07). Retrieved January 31, 2007 from http://www.nursecredentialing.org/magnet/forces.html Laura Ballance 31 Jan 07 6:14 PM MST Karen, The institutions where our students do their clinical hours uses an eye. Printed under the eye is "Watchful Eye" meaning the patient is a "High Fall Risk". This was instituted years ago when their patient falls increased. At that time, it was a large increase and was noticed by JCAHO. So they had to come up with a corrective plan. The employees were the ones that designed the "Watchful Eye". It is these types of decision making given to nurses that helps foster autonomy and leads to greater job satisfaction and retention. As nurses are making decisions about their patients' care we tend to be more vested in seeing that our ideas and the implementation of those ideas do not fail. This in turn prevents the organization from failing. Thanks for sharing. Laura Ballance Florida Date Modified: 31 Jan 07 6:16 PM MST Margaret Imbrock 31 Jan 07 8:24 PM MST Karen, Thanks for sharing the frog idea. We use a stoplight tool to indicate the level of interventions in use. As you progress on your magnet journey, document your stories for easy retrieval. That was something we struggled over. We began the journey but then had to backtrack to write the stories and if you journal along the way, you have most of the work done and then only have to tweak it or chose which stories you want to include. Good luck and enjoy the journey. Betty Barrow 2 Feb 07 8:20 AM MST Hi Karen and all, Our organization, also, has a shared governance program where the nurses and care partners (non-licensed staff) have the opportunity to make decisions about how to implement new policies and design our staffing and scheduling model. Changes are much more likely to be adopted if the entire staff is involved in making the decisions about the changes. The problem we have is that not everyone can make it to the Unit Board meetings. They are held at alternating times, one month at 12:00 noon and the opposite month at 7:30 AM, so every other month there are very few night shift folks who attend as that is like asking them to get up at midnight to go to a meeting. How does your unit handle the issue of attendance at these meetings? Thanks, Betty Barrow Tennessee Karen Kelsall 2 Feb 07 10:41 AM MST Betty, Our department is a complete 12 hour staffed department. SO our night shift work 7 pm to 7 am. We often times hold meetings at 7 or 8 in the evening to accommodate their schedules as well. Or sometimes at 6 or 7 in the morning because they would still be there from the night shift. It is a little tricky but our board chair does a good job of arranging the times so that all can be involved. I can see where if your night shift is 11 pm to 7 am it would be very hard...maybe more 6 or7 am meetings to include these folks. Do you find the shared governance concept working well for your department? We all seem to like having an input in what is going to happen or at least how we are going to implement it. The one downside I have noticed is that the chair sometimes makes decisions by herself .... I know this is a big NO NO... but the excuses I have been hearing is that there was not enough time to put a meeting together before the decision had to be made...do you ever see this happening?? Thanks for sharing. Karen Kelsall PA Karen Kelsall 1 Feb 07 4:59 PM MST Laura and Margaret You two just confirmed my thoughts that most generally all hospitals are addressing the issue of "leaping" patients. It just goes to show that when nurses get together and are given the time and tools needed to solve problems they can do it very effectively. It is nice to know other areas are having the same issues and striving to solve them as well. Also thanks for the advice on the Magnet journey. I am sure to write everything down. There is nothing I dislike more than having to go back and remember something that happened a year or so ago, and then write about it. My memory is not that keen at times. Thanks again for sharing. Karen Kelsall PA Karen Kelsall 3 Feb 07 3:47 PM MST Week Five Review and Reflect. As I review the posting throughout the 14 forces of Magnetism I can see that each force definitely plays a role in the "whole" picture of obtaining a facility that "offers" it all. I believe that those facilities that are Magnet status are ones that have invested much time, resource and dedication to this project and are showing that they truly care about the facility. I maintain my belief that I am sure there are facilities out there that do not have magnet status for one reason or another that are good solid places to work for. And yes the other side of the coin is that some places out there that we are working for need some major help when it comes to "getting" it together and they would benefit nicely from the magnet journey. I have enjoyed learning from others this week exactly what their hospitals or places of employment are involved in and how they as nurses feel they fit into the big picture. It is nice to be able to share ideas and realize we are all in this together. Thanks for the great posts this week. Karen Kelsall PA