Tammy Webb, BSN, RN

1
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

2
The History of Magnet
3
The Magnet Model 5 components
4
Transformational Leadership

• Emphasizes visionary strategic planning
• Strong vision and well-articulated philosophy
• Transformation may cause turbulence involves
  atypical approaches to solutionsontrolled
  destabilization that births new ideas and
  innovations
• 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
5
Transformational Leadership

• Strategic Planning
• MVV
• Strategic goals
• Nursing leaders advocate for resources to support
  the strategic priorities
• Improves nursing effectiveness and efficiency

Transformational Leadership
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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

Transformational Leadership
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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

Transformational Leadership
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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

9
Structural Empowerment
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
• 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
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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)

11
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 individuals professional development and
  partners with them to provide opportunities and
  resources for growth

12
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

13
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

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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

15
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
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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

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Example Model of Care and Professional
Practice Model
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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

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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

20
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

21
New Knowledge, Innovation Improvements
Empirical Outcomes

• 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

New Knowledge, Innovation, Improvements 
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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

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Empirical Outcomes
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
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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

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Fundamentals of NursingLeadership

• 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.

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Role of a Nurse Leader

• tackles nursing issues head on
• inspires others
• foresees a better future
• operates according to a basic set of principles

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Characteristics of aNurse Leader

• Collaborative
• Inventive
• Skilled
• Visionary
• Mindful

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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

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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

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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

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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

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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

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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.

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Responsibility 1 Focus on thesituation/behavior

• Remain objective
• Solve problems
• Make better decisions
• Maintain constructive relationships

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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
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Responsibility 3 Maintainconstructive
relationships

• Support others
• Keep a positive attitude
• Communicate
• Share information

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Responsibility 4 Takeinitiative to make things
better

• Look around your area for opportunities for
  improvement
• Offer help

Do you need help?
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Responsibility 5 Leadby example

• Be a good example
• Model appropriate behavior
• Honor your commitments
• Admit your mistakes

I made a mistake
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Responsibility 6 Thinkbeyond 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

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Fundamentals of NursingLeadership

• 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?

41
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?ta
  bid279

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Nursing LeadershipArkansas School Nursing
Association

• Lori L. Batchelor BSN, MHA, RN, CPN, NEA-BC
• Arkansas Childrens Hospital
• Ambulatory Care Services Director

43
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_Nur
  sing.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.

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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?

45
Nursing LeadershipLPN 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?tabid279)
• 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.

46
Nursing LeadershipLPN 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

47
Nursing LeadershipLPN 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.

48
Nursing LeadershipLPN 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 bachelors degree of science in nursing
  (BSN) to 80 by 2020.
• Currently BSN prepared nurses average 45-55
  depending on the region.

49
Nursing LeadershipLPN 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

50
Nursing LeadershipLPN 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

51
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

52
Nursing LeadershipLPN 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.

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Nursing LeadershipLPN vs. RN does it matter?

• KEY Differences in Practice according to the
  Arkansas State Board of Nursing
• RN Practice LPN Practice
• Assessment Observation
• Diagnosis and Intervention Intervention
• Supervision
• Teaching
• Delegation

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Nursing LeadershipCommunicating 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

55
Nursing LeadershipCommunicating 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.

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Nursing LeadershipCommunicating 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\

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Nursing LeadershipInterdisciplinary 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.

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Nursing LeadershipInterdisciplinary 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 yourselfyour 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

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Nursing LeadershipInterdisciplinary 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.

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Nursing LeadershipInterdisciplinary 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

61
Nursing LeadershipInterdisciplinary 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).

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Nursing Leadership
Conscious Incompetence I know what I dont know Conscious Competence I know what I know
Unconscious Incompetence I dont know what I dont know Unconscious Competence I know it and I dont even have to think about it.
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Nursing LeadershipInterdisciplinary Collegial
Relationships

• ASBN Scope of Practice Decision Making Model
• Five Rights of Delegation
• Right Task, Right Person, Right Direction, Right
  Supervision, Right Circumstance

64
Nursing LeadershipInterdisciplinary 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.

65
Nursing LeadershipInterdisciplinary 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

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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

67
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

68
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 Medicines 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.