Presented byTammy Webb, BSN, RNJulie Harris, MSN, RN, CPSTLori Batchelor, BSN, MHA, RN, CPN, NEA-BC

The Impact of a Professional Nursing Practice Environment in the School Setting

The History of Magnet

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 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

Transformational Leadership

Strategic Planning MVV Strategic goals Nursing leaders advocate for resources

to support the strategic priorities Improves nursing effectiveness and

efficiencyTransforma

tional 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

Transformational

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

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

Transformational Leadership

Structural Empower

ment

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 Empowerm

ent

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

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

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

EmpiricalOutcomes

New Knowledge

, Innovation

, & Improvem

ents 

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 ProcessOutcome

EmpiricalOutcomes

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 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.

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 aNurse 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 thesituation/behavior 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: Maintainconstructive relationships Support others Keep a positive attitude Communicate Share information

Responsibility #4: Takeinitiative to make things better Look around your area for opportunities

for improvement Offer help

Responsibility #5: Leadby example Be a good example Model appropriate behavior Honor your commitments Admit your mistakes

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

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?

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 HospitalAmbulatory Care Services Director

Nursing Leadership and the School NurseThe 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 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?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 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

Nursing LeadershipLPN vs. RN does it matter?

Why would education make that difference?Community Health/EpidemiologyNursing Research/StatisticsManagement/LeadershipAll provide for a more comprehensive knowledge

base that assists in considering all factors that influence patient illness, health or wellness.

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 bachelor’s degree of science in nursing (BSN) to 80% by 2020.

Currently BSN prepared nurses average 45-55% depending on the region.

Nursing LeadershipLPN vs. RN does it matter?National Association of School Nurses

recommends BSN preparation for School Nurses

Growing Evidence for the BSN prepared NurseLower rates of patient deathLower rates of medical errorsBetter patient outcomes

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

nationallyEvaluating 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 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 ScopeThe 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 LeadershipLPN vs. RN does it matter?KEY Differences in Practice according to the

Arkansas State Board of Nursing:

RN Practice LPN PracticeAssessment ObservationDiagnosis and Intervention InterventionSupervision TeachingDelegation

Nursing LeadershipCommunicating with FamiliesSchool Nurse Role: Leader!

You are more than a pill passer!!Planning for your students health needs in the

school settingCollaboration

Seeing families as a member of the team Seeking input Learning from their expertise Giving feedback Strategizing for solutions

Nursing LeadershipCommunicating with FamiliesA 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 LeadershipCommunicating with FamiliesRights 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 doMaintaining competencies

Seeking sources from the district Working PRN somewhere to maintain skills\

Nursing LeadershipInterdisciplinary Collegial RelationshipsResponsibilities of a Nurse Leader

Lead by exampleMaintain self confidence Maintain collaborative relationships

If you hope to lead you must behave like a leader.

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 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 LeadershipInterdisciplinary Collegial RelationshipsHow do I lead and who are my peers?

You are the resource expert on healthcareYou know CPR and First Aid SkillsYou 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.

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 LeadershipInterdisciplinary Collegial Relationships

Nursing LeadershipInterdisciplinary Collegial RelationshipsLegal Issues in School Health Services

Delegation of nursing dutiesAccording 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 LeadershipConscious

Incompetence

I know what I don’t know

Conscious Competence

I know what I know

Unconscious Incompetence

I don’t know what I don’t know

Unconscious Competence

I know it and I don’t even have to think about it.

Nursing LeadershipInterdisciplinary Collegial Relationships

ASBN Scope of Practice Decision Making Model

Five Rights of DelegationRight Task, Right Person, Right Direction,

Right Supervision, Right Circumstance

Nursing LeadershipInterdisciplinary Collegial RelationshipsHow 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 LeadershipInterdisciplinary Collegial RelationshipsTransformational 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 EmergenciesPrevent Bullying

Nursing LeadershipSchool 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 LeadershipSeek resources within your school district Join your national nursing organizationCollaborateConsider working part-time somewhere to

keep those skills sharpRead a good book on:

LeadershipNursingQuality/Accountability

Consider additional education

Nursing LeadershipAmerican 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.