Linda Hinnant 29 Jan 07 9:19 PM MST Forces of Magnetism: Nurses as teachers According to Cipriano, (2002) in 1994, the American Nursing Credentialing Center (ANCC) developed the Magnet Recognition Program for Excellence in Nursing Services. This program recognizes facilities that provide the very best in nursing care. The program is comprised of 14 forces of magnetism, which range from quality to leadership. The 11th force of Magnetism recognizes, “Nurses as teachers - Nurses are permitted and expected to incorporate teaching in all aspects of their practice.” Drenkard (2005) describes teaching as an activity that gives professional satisfaction to the nurse. This 11th force of magnetism also allude to the importance the nurse’s self-assessment of her own needs as well as the orientation of new nurses. In my current practice nurses are both permitted and expected to deliver relevant teaching during each patient encounter. The nurse is responsible for educating the patient on topics such as: gestational diabetic teaching, asthma teaching, immunization administration, prenatal teaching, newborn teaching, and smoking cessation. The nurse documents all patient teachings in electronic medical record. At discharge the nurse reviews and provides the patient with a printed copy of the discharge instructions. The discharge instructions summarize the patient’s visit, patient teaching, follow-up, medication changes, or other vital information. This aspect of care provides for a seamless nurse/patient encounter. On an ongoing bases nurses perform self-assessments. Based on the findings of the assessment the nurse is provided with the appropriate training. Training often ranges from an in-service to a formal course. Nurses new to the company receive a preceptor, formal training, and a checklist of required skills. The orientation equips the nurse with the necessary tools to adjust to their new healthcare environment. Thus, they can then be viewed as “Nurse as teacher.” The aforementioned factors support the alignment of my organization with the 11th force of magnetism. Reference: Cipriano, P. F., Contemporary Issues in the Health Care Workplace. In Mason, D. J., Leavitt, J. K., & Chaffee, M. W. (2002). Policy & politics in nursing and healthcare (4th ed.). St. Louis, MO: Saunders. Drenkard, K. N. (2005). Sustaining magnet keeping the forces alive. Nursing Administration, 29(3), 214-222. Kim Zolnier 31 Jan 07 2:35 PM MST Do you have special forms to document education? I have problems getting nurses to document education they have done. I know they are doing it, they just don't take time to document what they have done. We have a few special education forms to make it easier, but some still won't document the education. I think it is admirable that education is done for the patient with each encounter. With shorter lengths of stay, it is important to begin discharge teaching on admission to the hospital. Many times patients are overwhelmed with information at discharge and then do not know what to do when they arrive home. Linda Hinnant 1 Feb 07 9:17 PM MST Kim All in-house training is tracked electronically. The nurses bring in copies of outside courses they take. The form is then, filed in their office file. We do not have a formal form per say. However, it is a great idea to have a form that tracks all training. When applying for the magnet recognition a comprehensive form that tracks training would be great. Krista Winslow 31 Jan 07 8:49 PM MST Linda, It sounds like your organization is right on track with the 11th force of magnetism "nurses as teachers". My facility is very similar in our teaching philosophies. Patient education as well as ongoing nursing education are very important. It's also very important to document that patient education was done in case something were to happen, but that is one of my worst things. I don't always have time or I forget to chart my teaching. Is your facility working on magnet status or is it currently magnet? Linda Hinnant 2 Feb 07 6:34 PM MST Krista Thanks, Krista, our organization is not on the magnet road as of yet however, it was great to read the various forces of magnetism to see how my organization measured up. Teaching was one of our strengths. I too understand how the teaching aspect of what nurses do can omitted/forgotten during a busy/difficult shift/day. Though very time consuming it is vital for nurses to make every effort to document all teaching that is done. We have also implemented templates in which nurses can utilized to assist them with proper documentation. Documentation now takes seconds vs. several minutes. I hope this helps us during the magnet journey. Linda Betty Barrow 1 Feb 07 4:52 AM MST Hi Linda, Part of the standard for Nurses as Teachers is the relationship of nurses in your organization with students from nursing programs. Does your organization serve as a clinical site for any nursing schools? Is there any formal training for the preceptors in your organization, specifically to equip those preceptors to be good teachers for new nurses and students considering the learning styles of the person being oriented. It's really helpful that the nurses do a self-assessment to help the nurse consider how/what the nurse needs to learn in order to do a better job. Thanks for your posting. Betty Barrow Tennessee Linda Hinnant 2 Feb 07 6:37 PM MST Betty You raised an important question when you mentioned formal training for preceptors. We have guidelines and checklist that preceptors follow, but no formal training program from a preceptor program. Are there courses that prepare nurses as to how to precept other nurses? It would be great to know because my organization is a clinical site for nursing schools (primarily NP’s). Having a book, training on "how to precept... " would be a great tool, that documents the training aspect. Linda Margaret Imbrock 2 Feb 07 9:44 PM MST Linda, There are some canned programs on the market for precepting. HCPro is one company that comes to mind. Review of staff development books by Karen Kelly, Grif Alspach, and Patricia Benner is also a starting point. We have developed our own program by assessing what is it that preceptors need to know. We have been using our clinical educators, those promoting up the clinical ladder, as our facilitators/teachers for the program, like adult learning principles, how to validate competence in a new hire, horizontal hostility to name a few topics. I have not looked at the course curriculum in a few months. There are many articles out there on precepting and what is needed to develop a preceptor program. Carla Kimmons 3 Feb 07 9:35 AM MST Hi Linda, In our facility the nurses provide and coordinate the patient and family education. It's my favorite part of bedside nursing! We have standard discharge teaching forms which can be individualized. Patients receive the original and a copy is retained as a part of the permanent record. Our quality indicators include patient teaching so we can track our compliance. There is a follow-up call to patients, also, to determine effectiveness of our teaching format and content. How does your facility track teaching effectiveness? Measuring education outcomes continues to be a challenge for us. Linda Hinnant 2 Feb 07 7:03 PM MST Review and Reflect My current practice is not a magnet designate facility however, this lesson equipped me with the necessary tools to begin these discussions. Discussions, article reviews, and course materials have all increase my knowledge base regarding the Magnet Recognition Program for Excellence in Nursing Services. The question was asked if any studies were conducted which validate/support the effectiveness of the 14 forces/magnet designation. According to Cipriano (p. 325, 2002) “research has documented that magnet hospitals achieve better patient outcome, shorter lengths of stay, and higher nurse and patient satisfaction than comparable nonmagnet hospitals”. Since, evidence based practices, is the foundation in which nursing practices in my organization is based, research data which supports the effectiveness of magnet designate status will further influence upper managements decision to take the magnet journey. I look forward to a journey that validates good nursing care. This was a fast but enlightening week. Reference: Cipriano, P. F., Contemporary Issues in the Health Care Workplace. In Mason, D. J., Leavitt, J. K., & Chaffee, M. W. (2002). Policy & politics in nursing and healthcare (4th ed.). St. Louis, MO: Saunders. Date Modified: 2 Feb 07 7:06 PM MST