Nursing Environment



VISION FOR NURSING

Nursing at McLaren Northern Michigan provides exceptional patient-centered, interdisciplinary, evidence-based care. We place quality-caring relationships at the center of our practice resulting in a safe, compassionate, and healing environment.

Our guiding principle is to provide care as we expect for our own family. We achieve these goals through the following models of care as well as a healthy work/life balance.

Care Delivery - click to expand

A hospital's care delivery model provides the structure that defines operational processes, such as patient assignments and care delivery. It also identifies who is accountable and responsible for clinical outcomes and explains the relationship between the nurse and the patient/family. As demonstrated in our PPM, our care delivery system places the patient and family (as well as our community) at the center of all aspects of care provision and helps us deliver the care most appropriate to our patients. The care delivery system describes:

  • The context of our care
  • The method in which care is delivered
  • How we ensure appropriate nurse skill sets, and
  • How we review patient outcomes

Context of Care

Patient-Centered Care: In 2010, the Institute for Patient- and Family-Centered Care described this philosophy as "an approach to the planning, delivery and evaluation of healthcare that is grounded in mutually beneficial partnerships among patients, families and healthcare practitioners. It is founded on the understanding that the family plays a vital role in ensuring the health and well-being of patients of all ages. The ultimate goal of patient- and family-centered care is to create partnerships among healthcare practitioners, patients and families that will lead to the best outcomes and enhance the quality and safety of healthcare."

Our philosophy is one that ensures respect for dignity, values and the cultural needs of our patients and families. The CPM Core Beliefs provide guiding principles to this end:

  • Each person has the right to safe, individualized healthcare which promotes wholeness of body, mind and spirit.
  • Continuous learning, diverse thinking and evidence-based actions are essential to maintain and improve health.
  • A health culture begins with each person's self-work and is enhanced by healthy relationships and systems support.
  • Partnerships are essential to plan coordinate, integrate, deliver and evaluate healthcare across the continuum.
  • Each person is accountable to communicate and integrate his/her contributions to healthcare.
  • Quality exists where shared purpose, vision, values, and healthy relationships are lived.

Manner in Which Care is Delivered

Assigning Nurses Based on Patient Needs: At MNM, nursing assignments are based on the needs of the patient and their family. Each nursing unit has a team leader (TL) who is responsible for the coordination of care on that unit. Part of the TL role is to oversee assignments. MNM provides TLs with tools to assist in developing patient care assignments. The Pathways Acuity Classification system is a tool that provides individual patient information to support the clinical judgment of nursing TLs when making patient care assignments.

Partnering in Bed Meetings: Three times a day, TLs from each nursing unit attend bed meetings, which last 15 to 30 minutes. At the bed meeting, TLs communicate with the house supervisor about issues related to staffing needs, patient throughput, patient acuity, or other safety issues. Input from clinical nurses is used to allocate staffing resources or influence patient placement to meet patients' needs. During the bed meeting TLs discuss the needs of specific patients as appropriate. As specific patients require increased nursing time to support family-centered care, assignments are shifted across departments to provide added resources to that unit. 

Partnering During Bedside Shift Report: Bedside shift report ensures that the Plan of Care is patient and family centered. During shift report, the off-going nurse introduces the oncoming nurse. Both nurses review with the patient and family the day's events, evaluate the effectiveness of care and update the plan of care as appropriate. The plan may include short- and long-term patient goals or new interventions to meet the goals. The nurses also conduct a safety check to ensure the patient and the environment is free of safety concerns. The patient and family are also encouraged to ask questions, provide feedback and make suggestions related to the patient's plan of care

Partnering During Rounds: Patient and family input is also encouraged during patient care rounds. Rounds are conducted in medical/surgical, acute rehab and the intensive care units. The patient care rounds are an interprofessional review of the patient progress related to the plan of care. ICU rounds are held Monday, Wednesday and Friday at 10am. Acute Rehab rounds are dependent on the date of admission and occur once per week for each patient. Medical Surgical rounds are conducted Tuesdays and Thursdays at 2pm. Physicians, social workers, care coordinators, dieticians, pharmacists, therapists, spiritual care coordinators and nurses may all be present, depending on the complexity of the patient. Families are encouraged to be present and contribute to the discussions and ask questions.

Partnering in Care Conferences: Care conferencing is a method of engaging the patient and his/her family in the plan of care. Care conferences may be coordinated by any member of the care team. Often, care coordinators arrange care conferences for patients whose length of stay is beyond what is expected. Nurses or support services may coordinate a care conference due to the patient response to the treatment plan. Family members may also request a care conference. Care conferences are scheduled in advance to facilitate family presence. During the care conference, the interprofessional team reviews the patient treatment progress, coordinates services, makes requests for additional services, reviews the discharge plan and updates the patient's plan of care.

Skill Sets

All nurses are required to have documentation of competency upon completion of their orientation. The Competency-Based Orientating at MNM is based on Benner's Novice to Expert model. Competencies are reviewed annually and include not only specific skills required for the patient population on the unit they were hired, but also units in which they float. To meet the fluctuating needs of nursing units, many staff are "cross-trained" to departments other than the one they are usually scheduled.  As new nurses come into the organization they must meet competency criteria for each department before they can be floated there. 

Expected Outcomes

Nurses are accountable for patient outcomes which are reviewed continuously during the patient care experience on the Plan of Care tab in the EHR. In addition, all patients are assigned a care coordinator (nurse) upon admission to the hospital. The care coordinator reviews the patient record, care orders, and meets with patients who have high risk diagnosis; such as congestive heart failure, stroke, pneumonia, sepsis, acute myocardial infarction, and diabetes. The care coordinator facilitates discharge planning to ensure appropriate care across the continuum of services both inside and outside the hospital walls. 

The organization's performance improvement department also reviews data related to patient outcomes regularly. Outcome data related to length of stay, readmissions, CMS core measures, and nursing sensitive indicators, are reported both internally and externally as required. Outcomes are reviewed at the monthly Patient Safety and Quality Committee when outcomes fall outside expected performance. In addition, outcomes specific to department performance are reviewed at unit-based council meeting.   


Philosophy & Practice Model - click to expand

VISION FOR NURSING

Nursing at McLaren Northern Michigan provides exceptional patient-centered, interdisciplinary, evidence-based care. We place quality-caring relationships at the center of our practice resulting in a safe, compassionate, and healing environment.

PROFESSIONAL PRACTICE


We acknowledge and accept the American Nurses Association (ANA) Nursing's Social Policy Statement as the foundation of our practice. "Nursing is the protection, promotion and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities and populations." (ANA, 2003)
The American Nurses Association Scope and Standards of Nursing Practice guides, defines and directs nursing in all of our settings (ANA, 2004). We use this in conjunction with the Code of Ethics for Nurses with Interpretive Statements (ANA, 2001) to guide our ethical analysis and decision making across our nursing organization.

Finally, the American Nurses Association Bill of Rights for Registered Nurses (ANA, 2001) is used as a framework to maximize the contributions McLaren Northern Michigan nurses make. The goal is to provide an environment to practice that supports dignity and autonomy in the workplace.

Nursing is committed to excellence which we incorporate into our delivery of care. Our Professional Practice Model is built upon the guiding principles of McLaren Northern Michigan, providing healthcare as we expect for our own family.

We are also committed to providing an environment that continually seeks to improve delivery of patient care, facilitates change in practice, and encourages flexibility throughout all levels of care providers. The core of our Professional Practice Model is Elsevier's Clinical Practice Model (CPM) which is used to support evidence-based practice, an interprofessional plan of care, and shared governance. Unit-Based Councils exist at a unit level and encourage Colleagues to participate in decisions affecting their practice and the clinical work environment. Collaborative interdisciplinary relationships are integral to the success of this model and regular participation by related disciplines is encouraged.

McLaren Northern Michigan embraces Elsevier CPM's Professional Practice Model. This model creates a professional practice culture that supports the development of a healing environment for both the person receiving care as well as the provider.

The Clinical Practice Model emphasizes partnership development with all those involved in patient care, including patient and family, in the delivery of holistic care that meets the needs of that patient and his/her own family, resulting in an embracing system of patient-centered care. We believe that in order to help the patient achieve his/her best possible health we must consider the whole person with all his/her physical, emotional, cultural and spiritual dimensions.


Work/Life Balance - click to expand

Testimonials to come.


Share Governance - click to expand

We believe communication is a major vehicle for the provision of quality patient care and for creating an optimal environment for patients and Colleagues. We also believe being the voice of nursing on issues that impact bedside nursing practice is essential in providing an environment that attracts top talent, best practice, and quality outcomes. Therefore, the Division of Nursing developed the Shared Governance Model.

Communication between members of nursing management and Colleagues within the organization is open and encouraged. Our philosophy at McLaren Northern Michigan is that issues should be resolved at the level at which they arise and that Colleagues fully participate in system design process changes which affect them. Communication occurs on a regular basis to provide an opportunity for Colleagues and management to share ideas and discuss concerns and problems related to the delivery of patient care and overall operations of the unit. The Shared Governance Model of Nursing is based on open communication between nursing units, governance councils, and nursing leadership.

Nursing Cabinet

The Nursing Cabinet includes a cross-section of nurses from all levels of practice who provide a structured mechanism for the Division of Nursing to promote communicate, and uphold the standards of excellence related to clinical nursing practice, patient outcomes and a professional work environment. This Council serves as the governing body for the Division of Nursing and provides leadership and guidance to our four key operational Councils. These Councils include:

Nursing Clinical Education
Nursing Clinical Ladder
Nursing Quality & Evidence-Based Practice
Nursing Informatics
Nursing Quality & Evidence-Based Practice Council

The Nursing Quality & Evidence-Based Practice Council includes a cross-section of nurses from all levels of practice who provide a structured mechanism for the Division of Nursing to monitor quality outcomes and implement evidence-based practice initiatives to promote continuous performance improvement. This council oversees nursing sensitive indicators and other nursing quality initiatives. The council also developed innovations in practice to support the integration of evidence-based practices.

Nursing Clinical Ladder Council

The Nursing Clinical Ladder Council includes a cross-section of nurses from all levels and areas of practice who provide a structured mechanism for the Division of Nursing to recognize professional and clinical excellence and support clinical ladder advancement. The council oversees the clinical ladder processes, reviews clinical ladder portfolios, and makes decisions about individual advancement. The council also provides education related to clinical ladder criteria and mentors nurses through the advancement process.

Nursing Professional Development Council

The Nursing Professional Development Council includes a cross-section of nurses from all levels and areas of practice who provide a structured mechanism for the Division of Nursing to promote clinical and professional development. The council assesses educational needs within the Division of Nursing and supports the development of educational resources to meet those needs. The council also promotes specialty nursing certification through monitoring the percentage of nurses who have specialty certifications, providing certification resources and through the recognition of specialty certified nurses. In addition, the council monitors the percentage of nurses who have a BSN degree of higher within the organization.

Transformatics Council

The Transformatics Council includes a cross-section of interprofessional Colleagues all levels and areas of practice who provide a structured mechanism for the Division of Nursing to oversee and transform clinical informatics systems which support the delivery of care. The council works collaboratively with the information technology, education, and performance improvement departments to support clinical excellence and a positive work environment through electronic solutions.

Unit Based Councils

Unit Based Councils exist within each nursing department and include a cross-section of interprofessional Colleagues within the department who provide a structured mechanism for the nursing department to promote communicate, and uphold the standards of excellence related to specialty nursing practice, their patient population's outcomes and their work environment. Unit Based Councils oversee department quality metrics and support evidence-based innovations to improve practice, outcomes, and the work environment.

How can I get involved?

Every nurse has the opportunity to be involved:

By representing your colleagues on a Council
By participating at the unit level
By sharing your feedback with Council representatives and committee members

Contact Toni Moriarty-Smith for more information: tmsmith@northernhealth.org; 231-487-3066


Planning for the Future - click to expand

The Nursing Strategic Plan is a model that includes four pillars which represent each of the Magnet components: Transformational Leadership, Structural Empowerment, Exemplary Professional Practice, and New Knowledge and Innovation. Empirical Outcomes is the foundation of each pillar. The pillars rest on MNM's nursing shared governance structure. The overarching structures of the model include the Clinical Practice Model (CPM) which is used to guide our professional practice, the guiding principles of McLaren Northern Michigan," providing healthcare as we expect for our own family", the organization's SERVE values, and the organizational strategic plan. These structures guide our goals and priorities. The pillars (Magnet components) provide us with processes to achieve excellence, and the Empirical Outcomes ensure that we measure our success. Finally, the work done to accomplish our goals is done within the shared governance councils. (2014 Nursing Strategic Plan)

A nursing strategic planning meeting is held annually to review components of the strategic planning model. Organizational strategies are discussed and the professional practice model is reviewed for relevance. During the strategic planning meeting, nurses from all levels of practice identify nursing priorities which support: organizational success, integration of ANCC Magnet principles, a professional work environment and improved patient care outcomes. Strategic objectives are then assigned to the appropriate council/committee for action plan development and implementation.