Getting Magnetized: Service Getting Magnetized: Service Strategies for Nursing ExcellenceStrategies for Nursing Excellence

Joy Kennedy, MLSJoy Kennedy, MLSNorthwest Community HospitalNorthwest Community HospitalHealth Resource LibraryHealth Resource Library

Based on contents created by Margaret (Peg) Allen, MLS-AHIP Based on contents created by Margaret (Peg) Allen, MLS-AHIP

Introductions

• Margaret (Peg) Allen, Library Consultant, Author and CE Presenter

• Joy Kennedy, Northwest Community Hospital, Health Resource Library

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Northwest Community Hospital

http://www.nch.org

Learner settings—show of hands

• Librarian and/or nurse?• Hospital/health system?

– Involved in ANCC Magnet Program?– Magnet status – achieved, preparing, site visit?

• Academic – ADN, BSN, Graduate programs• Nursing school faculty/library liaison• Combined – hospital/nursing school setting• Academic medical center – multiple programs• Academic medical center, no nursing school• Professional nursing society• Public health• Other 4

Course Objectives

Participants will be able to:• Describe the ANCC Magnet initiative and its

significance to hospitals and nurses.• Describe the knowledge-based information needs

of nurses• Identify collaborative education and service

strategies to improve knowledge-based information services for nurses

• Identify opportunities for librarians and their library to partner with nurses to improve patient care and safety

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Learning plan• ANCC Magnet Program

– History of Magnet Program & its Importance to Nurses, Hospitals

• “Forces of Magnetism”—was 14, now consolidated into 5 “Model Components”– For each: library opportunities

• Information Needs of Nurses & Evidence-Based Nursing Practice

• Evaluation: final questions; forms

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ANCC Magnet Program

Why ANCC Magnet Certification?

Magnet: the Standardhttp://198.65.134.123/Magnet/ResourceCenters/Faculty/

MagnetFilm.aspx

Produced by ANCC

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Latest Magnet Film

“Magnet: the power to attract and retain”

http://nursingworld.org/media/play.asp?f=6&q=m&t=v

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Magnet Certification ANCC Magnet Recognition Program®—

Recognizing excellence in nursing services– Developed by the American Nurses Credentialing

Center, part of ANA, to recognize health care organizations that provide the very best in nursing care.

– “Seal of approval” for quality nursing care– Aids in nurse recruitment and retention– Rapid growth – 7 in 2000; 300+ nowhttp://www.nursecredentialing.org/Magnet/

ProgramOverview/GrowthoftheProgram.aspx

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Historical Background• In 1983, the American Academy of

Nursing commissioned a Taskforce to research why some hospitals attracted and kept nurses in a time of severe nursing shortage.– McClure, MM, Poulin, M., Sovie, M. & Wandelt,

M. (1983). Magnet hospitals: Attraction and retention of professional nurses. American Academy of Nursing Task Force on Nursing Practice in Hospitals. Kansas City, MO: American Nurses Association.

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Research Findings: Characteristics of Magnet

Hospitals• Participatory Management (Shared

Governance)• Nursing Autonomy & A Supportive Nursing

Leadership• Career Development Opportunities for

Nurses• Recognition of Importance of the Quality of

Patient Care11

Further Research on Magnet Hospitals

• Magnet Hospital nurses were more satisfied with their jobs

• Nurses at Magnet hospital are more likely to be certified in specialty areas, maintain continuing education & participate in community programs

• Strong relationship between the degree of nursing autonomy & quality of care patients received

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More Resources on Magnet

• Nursing Center Articles: http://www.nursingcenter.com/CareerCenter/magnet.asp – Costs unless Nursing Center member $4-$8 each

• ANCC page on Medscape: http://www.medscape.com/partners/ancc/public/ancc

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Nursing Shortage Resources

• American Association of Colleges of Nursing http://www.aacn.nche.edu/Media/

shortageresource.htm#about

The Nursing Shortage: Is this cycle different? OJIN 2001

http://tinyurl.com/2md5lc

• Discover Nursing http://www.discovernursing.com/

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Organizational StructureAmerican

Nurses Association

AmericanAcademy of Nursing

American NursesCredentialing

Center

American NursesFoundation

Accreditation Certification

MagnetRecognition

Program

Institute for Credentialing

Innovation

MeasurementServices

ResearchInstitute

Commission onMagnet

Recognition

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Appraisal Review Process: Phases

• Preparation: Self-Assessment• Phase One: Application• Phase Two: Written

Documentation • Phase Three: Site Visit by Surveyors• Phase Four: Commission Vote• CELEBRATE!

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Magnet and Hospitals: How has

the research translated into the Magnet program requirements?

Magnet Recognition Program Goals (“Core

Values”)• Promoting quality in a setting that

supports professional practice; • Identifying excellence in the delivery of

nursing services to patients/residents; and

• Disseminating “best practices” in nursing services.

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Magnet Recognition Program Requirements

Focus On:• Leadership of the Chief Nurse Executive• Work environment• Adherence to standards• Interdisciplinary collaboration• Cultural and ethnic diversity of patients and care

providers is recognized by the hospital• Best nursing practices - evidence-based practice,

quality improvement, research – are demonstrated• Benchmarking against quality standards in certain

areas19

Original 14 Forces of Magnetism

1. Quality of Nursing Leadership2. Organizational Structure3. Management Style4. Personnel Policies and

Programs5. Professional Models of Care6. Quality of Care7. Quality Improvement

8. Consultation and Resources9. Autonomy10. Community and the Hospital11. Nurses as Teachers12. Image of Nursing13. Interdisciplinary

Relationships14. Professional Development

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Magnet Hospitals: Attraction and Retention of Professional Nurses. American Academy of Nursing. Kansas City. : Taskforce on Nursing Practice in Hospitals. 1983. PMID: 6551146

Five “Model Components” of Magnetism1. Transformational Leadership (TL)

Quality of Nursing Leadership (Force #1) Management Style (Force #3)

2. Structural Empowerment (SE) Organizational Structure (Force #2) Personnel Policies and Programs (Force #4) Community and the Healthcare Organization (Force #10) Image of Nursing (Force #12) Professional Development (Force #14)

3. Exemplary Professional Practice (EP) Professional Models of Care (Force #5) Consultation and Resources (Force #8) Autonomy (Force #9) Nurses as Teachers (Force #11) Interdisciplinary Relationships (Force #13)

4. New Knowledge, Innovation, & Improvements (NK) Quality Improvement (Force #7)

5. Empirical Outcomes (EO)  Quality of Care (Force #6)

(http://www.nursecredentialing.org/Magnet/NewMagnetModel.aspx)21

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Magnet Model Components

The Application

Each component of the new Magnet Model requires two kinds of submissions:– Evidence Documents: particular pieces of

documentation such as annual reports, organizational charts, policies & procedures, tables of committees, statistics, data, etc.

– Evidence Narratives: narrative statements to support the evidence with descriptions of programs, processes or services that provide examples of how each is “operationalized”

Magnet Components Explained

Transformational Leadership(TL)

• Quality of Nursing Leadership– “Knowledgeable, strong, risk-taking nurse leaders follow a

well-articulated, strategic and visionary philosophy in the day-to-day operations of the nursing services. Nursing Leaders, at all levels of the organization, convey a strong sense of advocacy and support for the staff and for the patient. (The results of quality leadership are evident in nursing practice at the patient’s side.)”

• Management Style– “Healthcare organizations and nursing leaders create an

environment supporting participation. Feedback is encouraged and valued and is incorporated from the staff at all levels of the organization. Nurses serving in leadership positions are visible, accessible, and committed to communicating effectively with staff.”

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Required Examples of “Sources of Evidence” for Transformational Leadership• Evidence of strategic planning by nurse-leaders• Evidence of advocacy and influence—show organizational wide

changes, recognition and reward of innovation by nurses• Give examples, from several different nursing units, of advocacy

by the CNO on behalf of the staff, such as requests for additional FTEs, systems, equipment, personnel support and so forth.

• Evidence of visibility, accessibility and communication—show that the CNO is visible and accessible to direct-care nurses, that nurse leaders use input from direct-care nurses, and changes in the work environment and patient care based on input for direct-care nurses.

Library Collection Resources:

Zone 11. J Nurs Adm 2. Nurs Manage 3. Nurs Econ 4. Nurs Adm Q 5. Hosp Health Netw 6. Nurs Res 7. JAMA 8. Am J Nurs 9. N Engl J Med

Zone 2 (Top 10)1. J Nurs Scholarsh 2. Med Care 3. J Adv Nurs 4. J Nurs Care Qual 5. Harv Bus Rev 6. Nurs Outlook 7. Mod Healthc 8. J Healthc Manage 9. Health Care Manage Rev 10. Nurs Educ Perspect (2002–)

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•AONE: The American Association of Nurse Executives--http://www.aone.org & books & Nurse Leader

•Top Nursing Journals:

Galganski, Carol. (2006) Mapping the literature of nursing administration. J Med Libr Assoc 94(2) Suppl, E-87-91.

Services for Transformational Leadership

• Brainstorm– more ideas? New services or changes, additions or improvements to existing services?

Structural Empowerment (SE)• Organizational Structure• Personnel Policies and Programs • Community and the Healthcare Organization • Image of Nursing• Professional Development Description: Magnet hospital environments are “flat,

flexible and decentralized.” “Nurses throughout the organization are involved in self-governance and decision-making structures and processes that establish standards of practice and address issues of concern.”

Required examples of “Sources of Evidence” for Structural Empowerment

• Professional Engagement - show that the structure and processes of the hospital enable nurses from all setting and roles to participate in organizational decision-making groups such as committees, councils, and task forces.

• Commitment to Professional Development- show how the organization sets expectations and supports nurses at all levels who seek formal education (BSN, master’s, doctoral degrees.)

Continued on Next Slide

Sources of Evidence For Structural Empowerment

(continued)• Teaching & role development-show how it

promotes the teaching role of nurses, how nurses support community education activities, how nurses support academic practicum, adjunct faculty, mentorships, etc.

• Commitment to community involvement – show structure and processes to allocate resources to affiliations with nursing schools, consortiums and community outreach

Shared Governance: key concept

• Shared Governance is a management model proposed & described in the nursing literature over 30 years ago. It has a specific meaning, almost an emotional context, to nurses.

• Shared Governance spreads the authority and responsibility for nursing practice down to the unit level and involves nurses directly in practice decisions.

Shared Governance Includes

• Autonomy of Practice,• Control of Practice Environment,• Effective Nurse-Physician Relationships• Encompasses concepts such as

empowerment, autonomous decision making, accountability, collaboration, mentoring, high-quality patient care, and evidence-based, excellent professional nursing practice.

(McClure M, Hinshaw A. Magnet Hospitals Revisited: Attraction and Retention of Professional Nurses. Kansas City, Mo: American Nurses Publishing; 2002.)

Ideas for Library Services for Structural

Empowerment?

Organizational Structure—flat structure, participatoryPersonnel Policies and Programs—nurse involvement Community and the Healthcare Organization Image of Nursing—positive and professionalProfessional Development—encouraged

Remember that SE is composed of these “Forces of Magnetism”

What Library Services?

• Brainstorming?

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Exemplary Professional Practice (EP): Sources of Evidence

“Describe and demonstrate” in 9 areas:1. Professional Practice Model

2. Care Delivery System(s)

3. Staffing, Scheduling, and Budgeting Processes

4. Interdisciplinary Care

5. Accountability, Competence and Autonomy

6. Ethics, Privacy, Security, and Confidentiality

7. Diversity and Workplace Advocacy

8. Culture of Safety

9. Quality Care Monitoring and Improvement

Elements of the original Forces of Magnetism have been incorporated into Exemplary Professional Practice and reconfigured into these 9 Sources of Evidence. 39

Exemplary Professional Practice: EP

• The achievement of exemplary professional practice involves both philosophy and practice, patient/family centered care, interdisciplinary collaboration, ethical & safety considerations, and use of data and national benchmarks to improve performance and patient care.

• It is hard for me to imagine that the exemplary practice by nurses can take place in isolation from knowledge-based resources and the assistance of librarians to locate these.

• What services can you suggest or changes to current services?

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Nurses as Teachers :Resources

• Journals– J Contin Ed Nurs– J Nursing Ed– Nurs Educator– Nursing Ed Perspectives– Intl J Nurs Ed Sch(IJNES)

• Nursing Organizations– NLN– AACN

• Listservs– BIRTHED– NURSED-L– NURSENET– NURSEGRAD– NRSINGED– NURSENET

• Blogs– The Teachers corner– Nursing school blog– Mediblogopathy

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Interdisciplinary Relationships: Resources

• Institute of Medicine Studieshttp://www.iom.edu/

• COGME – NACNEP report Council on Graduate Medical Education and the

National Advisory Council on Nurse Education and Practice

http://www.cogme.gov/jointmtg.pdf

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Library services for Exemplary Professional

Practice• Brainstorming?

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New Knowledge, Innovation, & Improvements (NK)• “Magnet organizations conscientiously integrate

evidence-based practice and research into clinical and operational processes.”

• “Magnet organizations have an ethical and professional responsibility to contribute to patient care, the organization, and the profession in terms of new knowledge, innovations and improvements.”

• “This component includes new models of care, application of existing evidence, new evidence, and visible contributions to the science of nursing.”

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Library Services for NK?

• Evidence based practice—discovering new knowledge

• If no new knowledge on a practice question, conduct your own study

• Share your research results• Obvious Magnet opportunities for library

Ideas?

Empirical Outcomes (EO)Empirical Outcomes (EO)

• The application manual states that “the empirical measurement of quality outcomes related to nursing leadership and clinical practice in Magnet organizations is imperative.”

• The component does not state any particular requirements itself but that outcome sources, indicated by EO, are requested throughout the sources of evidence.

Suggestions for Empirical Suggestions for Empirical Outcomes:Outcomes:

If you have any outcomes to report under any of the Magnet components, you should try to include:

• How the work was done, i.e. methods & approach; RN involved in planning

• Describe the measurement used to evaluate outcomes & the impact (results & significance)

• Purpose• Background• Who was involved—

CNO, staff RNs, APRNs, pharmacists, physicians, etc.

Tips for Data GatheringTips for Data Gathering• Document planning meetings, including who is

present and if they are an RN

• Have a sign-in sheet for meetings, programs, presentations, etc. and ask about RN status

• Capture as much data as possible about use of resources, statistics by status (RN, physician, staff) such as interlibrary loan, circulation, etc.

• Consider regular monitoring of quality of information services by a feedback sheet or questionnaire and capture RN status if possible.

What do librarians need to know about nurses, EBNP & nurses information Needs?

The Philosophy & Research

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Evidence-based Nursing Evidence-based Nursing Practice (EBNP), Nursing Practice (EBNP), Nursing

Research & Research & the Magnet Journeythe Magnet Journey

Margaret (Peg) Allen, pegallen67@gmail.com &Margaret (Peg) Allen, pegallen67@gmail.com &

Joy Kennedy, joykenn@gmail.comJoy Kennedy, joykenn@gmail.com

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1. Define the question

2. Collect evidence

3. Critically appraise the evidence

4. Integrate evidence into practice situation

5. Evaluate the process

Evidence Based Nursing Evidence Based Nursing ProcessProcess

5353--graphic developed by Dr. Susan Pierce from the Pravikoff, Pierce & Tanner

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Data Use in Clinical Data Use in Clinical DecisionsDecisions

Expert Personal Patient Knowledge Specific Data Published Knowledge-based Information Clinical Decision

(based on Graves JR, Corcoran S. The study of nursing informatics. Image. 1989;21:(4):227–31.)

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The practice of evidence based care seeks to make published knowledge-based information more central to the clinical decision process.

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Relationship of Information Relationship of Information Literacy, EBNP & NursingLiteracy, EBNP & Nursing

Information

Competency Based

Teaching

Research

EBPEBP

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Evidence Based Practice Evidence Based Practice CompetenciesCompetencies

““National Consensus of Essential Competencies for Evidence Based Practice of Nursing”

Developed in 2005 by the Academic Center for Evidence-Based Practice (ACE), University of Texas Health Science Center at San Antonio, available for purchase (http://www.acestar.uthscsa.edu/Competencies.htm)

Information Literacy Information Literacy

Competencies which follow reference these Competencies which follow reference these competenciescompetencies

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Information Literacy Competencies for Information Literacy Competencies for EBNPEBNP

• In 2006, Peg Allen was asked to present In 2006, Peg Allen was asked to present “Teaching Clinicians to Fish” for the annual ACE “Teaching Clinicians to Fish” for the annual ACE Star Summer Institute on Evidence Based Star Summer Institute on Evidence Based Practice Practice (http://www.acestar.uthscsa.edu/past_institutes.htm)(http://www.acestar.uthscsa.edu/past_institutes.htm)– Link above includes abstracts to past Institutes Link above includes abstracts to past Institutes

• Using the Using the ACE EBP CompetenciesACE EBP Competencies, Peg drafted:, Peg drafted:– Information literacy competencies for all Information literacy competencies for all – Nursing/clinician & researcher competenciesNursing/clinician & researcher competencies

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Basic Health Information Literacy Basic Health Information Literacy Competencies—everyone in healthcareCompetencies—everyone in healthcare

• Uses quality health information portals, such as Uses quality health information portals, such as Medline Plus and librariesMedline Plus and libraries

• Searches for information in appropriate formatsSearches for information in appropriate formats• Evaluates health information resources regardless of Evaluates health information resources regardless of

format – Accuracy, Balance, Completenessformat – Accuracy, Balance, Completeness• Understands use of Boolean AND, OR and other search Understands use of Boolean AND, OR and other search

techniques for Internet search portals and layperson techniques for Internet search portals and layperson databasesdatabases

• Observes intellectual property rights – does not Observes intellectual property rights – does not plagiarizeplagiarize

• Cites sources using a standard bibliographic formatCites sources using a standard bibliographic format5858

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Clinician CompetenciesClinician Competencies• Recognize Recognize ratings of strength of evidence ratings of strength of evidence when when

reading literature, including web resourcesreading literature, including web resources– Evaluate and use resources for quick reference, Evaluate and use resources for quick reference,

including PDA toolsincluding PDA tools

• Searches core bibliographic databases Searches core bibliographic databases for for chosen health professionchosen health profession– Develop a searchable questionDevelop a searchable question– Search CINAHL & NLM/AHRQ databases using subject Search CINAHL & NLM/AHRQ databases using subject

headings, EBP filters and limitsheadings, EBP filters and limits– Evaluate citations for potential relevanceEvaluate citations for potential relevance

““Clinicians” refers to doctors, nurses, Clinicians” refers to doctors, nurses, technicians, etc.technicians, etc.

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Clinician Clinician DatabaseDatabase CompetenciesCompetencies

• Can develop a searchable questionCan develop a searchable question– ““The question is just as important as the answer. The answer you get The question is just as important as the answer. The answer you get

out is only as good as the question you put in.”* out is only as good as the question you put in.”*

• Search CINAHL & NLM/AHRQ databases using Search CINAHL & NLM/AHRQ databases using subject headings, EBP filters and limitssubject headings, EBP filters and limits– ““It's not your father's literature search… Unless I know the clinician It's not your father's literature search… Unless I know the clinician

wants to see wants to see everythingeverything, or is doing research rather than addressing , or is doing research rather than addressing an actual patient issue, I filter.”*an actual patient issue, I filter.”*

• Can evaluate citations for potential relevanceCan evaluate citations for potential relevance– Expense of retrieval, including copying or ILL, is not insignificant.Expense of retrieval, including copying or ILL, is not insignificant.

*Email comments from Marcy Brown, MLS, West Penn Hospital - Forbes *Email comments from Marcy Brown, MLS, West Penn Hospital - Forbes Campus, Monroeville PA, May 1, 2006Campus, Monroeville PA, May 1, 2006

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Clinician Competencies – Point of Clinician Competencies – Point of Care DatabasesCare Databases

• Recognize ratings of strength of evidence Recognize ratings of strength of evidence when reading literature, including web when reading literature, including web resources resources (Undergraduate, Star Point 1, #4)(Undergraduate, Star Point 1, #4)

• Evaluate and use resources for quick Evaluate and use resources for quick reference, including PDA toolsreference, including PDA tools

• Evidence-base – references?Evidence-base – references?• Relevance to clinical needs Relevance to clinical needs • Ease of useEase of use• CurrencyCurrency

• Goal: Synthesis of credible evidenceGoal: Synthesis of credible evidence6161

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Nurses as Knowledge Workers

How do Nurses Use

Information? How does their Information Needs

Differ from Others?

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Nurses as Knowledge Workers: Nurses as Knowledge Workers: Similarity of Nursing Process Steps Similarity of Nursing Process Steps

with Knowledge Worker Roleswith Knowledge Worker RolesNursing Process StepsNursing Process Steps• AssessmentAssessment• DiagnosisDiagnosis• PlanningPlanning• InterventionIntervention• Evaluation - outcomesEvaluation - outcomes

Knowledge Worker RolesKnowledge Worker Roles

• Data-gathererData-gatherer• Information UserInformation User

• Knowledge UserKnowledge User• Knowledge BuilderKnowledge Builder

Source: Sydney-Halpern R, Corcoran-Perry S, Narayan S. Developing clinical practice environments supporting the knowledge work of nurses. Computers in Nursing 2001 (Jan-Feb); 19(1):17-23.

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Needs of the Practice EnvironmentNeeds of the Practice Environment

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Medical vs. Nursing Medical vs. Nursing Concerns in Evidence-based Concerns in Evidence-based

PracticePractice

Medical ConcernsMedical Concerns– Hip replacementHip replacement– Hip pinningHip pinning– Watchful waitingWatchful waiting– Surgical risksSurgical risks– Correct prosthesisCorrect prosthesis

Nursing ConcernsNursing Concerns– PainPain– IncontinenceIncontinence– ImmobilityImmobility– ConfusionConfusion– Skin breakdownSkin breakdown– Inadequate sleepInadequate sleep

Source: Lang NM. Discipline-based approaches to evidence-based practice: a view from nursing. Joint Commission Journal on Quality Improvement 1999 (Oct); 25(10):539-44.

Same patient with broken hip, different EBP concerns. Nursing care is focused on the patient, not the disease process.

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Same Patient, Different Concerns, Different Info Needs

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Diagram courtesy of:Lisa K. Traditi, MLS, AHIPHead of Education and Learning Resources Center Denison Memorial Library University of Colorado at Denver and Health Sciences Center

Patient knowledge Patient knowledge also influences also influences

shared decisions & shared decisions & is part of “the is part of “the

evidence”.evidence”.

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Continuum of Information Continuum of Information Needs in Evidence-based Needs in Evidence-based

HealthcareHealthcarePatient-focused clinical questions –medical Patient-focused clinical questions –medical plusplus nursing/allied health implications nursing/allied health implications

Interdisciplinary guidelines – evidence-Interdisciplinary guidelines – evidence-based “best practices” based “best practices”

Based on clinical research Based on clinical research

Management and education issues – many Management and education issues – many related to Magnet components and forcesrelated to Magnet components and forces

All of these factors, all of these information needs are All of these factors, all of these information needs are involved in EBP.involved in EBP. 6666

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When is Research When is Research Utilized?:Utilized?:

When do nurses look for When do nurses look for research?research?

Let’s look at Nursing’s Research Let’s look at Nursing’s Research Utilization Models to better Utilization Models to better understand Evidence Based understand Evidence Based

Nursing Practice (EBNP)Nursing Practice (EBNP)

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Research Utilization Models: Research Utilization Models: What Causes Research to be What Causes Research to be

Used?Used?• Ottawa Model of Research UseOttawa Model of Research Use• Stetler Model of Research UtilizationStetler Model of Research Utilization

• Practitioner orientationPractitioner orientation• Two levels: individual and organizationTwo levels: individual and organization• Focus on research competenciesFocus on research competencies

• Iowa Model (Titler et al.) of Research in PracticeIowa Model (Titler et al.) of Research in Practice• Knowledge focused triggersKnowledge focused triggers: new practice standards, : new practice standards,

philosophies of care, research and meta-analysis philosophies of care, research and meta-analysis • Problem-focused triggersProblem-focused triggers: clinical questions, quality : clinical questions, quality

improvement projects, journal clubsimprovement projects, journal clubs

(Polit & Beck (2006), Using research in evidence-based practice in Essentials of Nursing Research, pgs. 457-494.) 6868

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What are the Barriers to Research What are the Barriers to Research

Utilization?Utilization? • Individual constraintsIndividual constraints– Lack of timeLack of time– Little experience/low Little experience/low

comfort level with library comfort level with library and search techniquesand search techniques

– Limited ability to Limited ability to understand/interpret understand/interpret research reportsresearch reports

– Limited exposure to to Limited exposure to to research-use strategies research-use strategies during educational during educational preparationpreparation

– Negative staff attitudes Negative staff attitudes toward researchtoward research

• Organizational constraintsOrganizational constraints– Lack of availability of Lack of availability of

pertinent research findingspertinent research findings– Limited access to journalsLimited access to journals– Lack of administrative Lack of administrative

supportsupport– Cost constraintsCost constraints– Concerns about reallocation Concerns about reallocation

of staff timeof staff time

(As summarized by Simpson B in Canadian Nurse, 1996 Nov; 92 (10): 22-5. )

6969What can librarians do to help overcome these barriers?What can librarians do to help overcome these barriers?

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From Research Utilization From Research Utilization (RU) to Evidence-Based (RU) to Evidence-Based

PracticePracticeResearch UtilizationResearch Utilization

• ComponentComponent of EBP of EBP

• Only research accepted as Only research accepted as evidenceevidence

• Critical appraisal of Critical appraisal of research reportsresearch reports

Evidence-Based PracticeEvidence-Based Practice

• Broader concept Broader concept

• Evidence other than Evidence other than research part of EBPresearch part of EBP

• Critical appraisal of Critical appraisal of allall evidenceevidence

Based on Levin, Rona F. & Harriet R Feldman, Teaching Evidence-Based Practice in Nursing: A Guide for academic and clinical settings. New York: Springer, p. 11. 7070

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National Council of State Boards of National Council of State Boards of Nursing,Nursing,

National Survey on Elements of Nursing National Survey on Elements of Nursing Education, 2006Education, 2006

“The graduates were more likely to feel adequately prepared when nursing programs:

1. taught use of information technology and evidence-evidence-based practicebased practice,

2.2. integratedintegrated pathophysiology and critical thinking throughout of curriculum…”

(https://www.ncsbn.org/RB24_06ElementsofNursing.pdf)

– – p. 37p. 37

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Interagency Council on Interagency Council on Information Resources for Nurses Information Resources for Nurses (ICIRN) Research: Six Common (ICIRN) Research: Six Common

QuestionsQuestions• Are nurses aware of the need for research-based Are nurses aware of the need for research-based information?information?

• Do nurses identify information needed for Do nurses identify information needed for research-based practice?research-based practice?

• Do nurses have the ability and availability to Do nurses have the ability and availability to electronically search for information?electronically search for information?

• Do nurses actually apply electronic information-Do nurses actually apply electronic information-seeking processes?seeking processes?

• What information do nurses use?What information do nurses use?• For what purposes do nurses use information For what purposes do nurses use information

retrieved?retrieved?7272

--Pravikoff, Tanner, Pierce--Pravikoff, Tanner, Pierce

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ICIRN Research ResultsICIRN Research Results• Pravikoff, D. S., Tanner, A. B., & Pierce, S. T. (2005). Pravikoff, D. S., Tanner, A. B., & Pierce, S. T. (2005).

Readiness of U.S. Nurses for Evidence-Based Practice? Readiness of U.S. Nurses for Evidence-Based Practice? American Journal of Nursing, 105American Journal of Nursing, 105(9), 40-51(9), 40-51. . http://tinyurl.com/35clnb

• Dee, C., & Stanley, E. (2005). Information-seeking Dee, C., & Stanley, E. (2005). Information-seeking behavior of nursing students and clinical nurses: behavior of nursing students and clinical nurses: implications for health sciences librarians. implications for health sciences librarians. Journal of Journal of the Medical Library Association, 93the Medical Library Association, 93(2), 213–222. (2), 213–222. http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&blobtype=pdf&artid=1082938

• For more information and color slides, see MLA For more information and color slides, see MLA 2003 Symposium: 2003 Symposium: Evidence-Based Nursing Practice: Evidence-Based Nursing Practice: Needs, Tools, Solutions Needs, Tools, Solutions http://nahrs.mlanet.org/resource/symposium/index.html

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ICIRN – similar conclusions in ICIRN – similar conclusions in UK & Canadian StudiesUK & Canadian Studies

• The Information Needs of Nurses, Health Care Assistants, Midwives and Health Visitors. Summary report of RNC survey (2005, April 20, 2005). (2005, April 20, 2005). http://www.rcn.org.uk/__data/assets/pdf_file/0010/78670/002780.pdf

• Canadian Nurses Association position statement Canadian Nurses Association position statement “Nursing Information and Knowledge Management” (November, 2006) (November, 2006)

http://www.cna-nurses.ca/CNA/documents/pdf/publications/PS87-Nursing-info-knowledge-e.pdf

Conclusion: "Having good access to information – via the Conclusion: "Having good access to information – via the Internet and via a physical library and via information Internet and via a physical library and via information skills – appears to have a direct effect on putting evidence skills – appears to have a direct effect on putting evidence into practice. Those with the best access to information into practice. Those with the best access to information were also more likely to both search for evidence and to were also more likely to both search for evidence and to change their nursing practice as a result of research.“ (RNC change their nursing practice as a result of research.“ (RNC survey)survey) 7474

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Nursing Values and Nursing Values and ResearchResearch

In presentations on the Pravikoff study, the In presentations on the Pravikoff study, the authors stress the need for nurses to authors stress the need for nurses to valuevalue nursing research. nursing research.

FYI: FYI: Article on values Article on values freefree from Nursing Ethics collection, from Nursing Ethics collection, http://www.nursingcenter.com/home/NursingCenterEthics.asp http://www.nursingcenter.com/home/NursingCenterEthics.asp

Other than ICIRN what other important nursing educational Other than ICIRN what other important nursing educational initiatives should librarians be aware of?initiatives should librarians be aware of?

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T.I.G.E.R.—Technology Informatics Guiding

Educational Reform

• http://www.tigersummit.com/About_Us.html• Summit of major nursing organizations & 20 nursing

informatics societies (& NAHRS reps)• Goal was to identify information/knowledge management

best practices & effective technological capabilities of nurses• Action plan for transforming nursing practice and education

to better prepare nurses to practice in an increasingly automated, informatics-rich, and consumer-driven health care environment

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Librarians’ Role

• Can librarians help address barriers to EBNP?

• Can librarians help with T.I.G.E.R. initiatives? Can librarians help with T.I.G.E.R. initiatives?

• What does research show us about the Librarian’s role ?

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MLA & NAHRS Research EffortsMLA & NAHRS Research Efforts

• As Peg Allen, Pam Sherwill-Navarro and As Peg Allen, Pam Sherwill-Navarro and Susan Jacobs worked with ICIRN, the Susan Jacobs worked with ICIRN, the T.I.G.E.R. Summit, and students in MLA CE T.I.G.E.R. Summit, and students in MLA CE classes, the need evolved for learning about classes, the need evolved for learning about librarian roleslibrarian roles in EBNP & the Magnet in EBNP & the Magnet program. program.

• Learning has occurred via surveys, teaching, Learning has occurred via surveys, teaching, and MLA programs at the national and local and MLA programs at the national and local levelslevels

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NAHRS 2007 Magnet Coordinator NAHRS 2007 Magnet Coordinator surveysurvey

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GoalGoal: : To assess library resources and services at ANCC (American Nurses To assess library resources and services at ANCC (American Nurses Credentialing Center) certified Magnet facilities. Credentialing Center) certified Magnet facilities. Secondary goal: enhance Magnet coordinator awareness of what Secondary goal: enhance Magnet coordinator awareness of what

librarians can contribute to the Magnet journeylibrarians can contribute to the Magnet journey

ProcessProcess Developed by NAHRS Task Force to Create Standards for Nursing Developed by NAHRS Task Force to Create Standards for Nursing

Information Resources and Services in Health Care Settings and Information Resources and Services in Health Care Settings and Research Committee, using Survey MonkeyResearch Committee, using Survey Monkey

Approved by MLA Board, with additional questions on role and value Approved by MLA Board, with additional questions on role and value of librarianof librarian

Sent to Magnet coordinators via ANCC list with cover message Sent to Magnet coordinators via ANCC list with cover message encouraging Magnet coordinators to get librarian help with completing encouraging Magnet coordinators to get librarian help with completing survey survey

1.1. Richard Barry, ANA Librarian (ANCC is unit of American Nurses Richard Barry, ANA Librarian (ANCC is unit of American Nurses Association) facilitated use of Magnet coordinator listAssociation) facilitated use of Magnet coordinator list

2.2. Follow-up mailing to Magnet coordinator listFollow-up mailing to Magnet coordinator list3.3. DOCUSER database used to identify librarians at Magnet hospitals with DOCUSER database used to identify librarians at Magnet hospitals with

no response, sending them the final requestno response, sending them the final requestNAHRS Research page: NAHRS Research page:

http://nahrs.mlanet.org/activity/mapping/research/index.html http://nahrs.mlanet.org/activity/mapping/research/index.html

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Librarian’s Role in Magnet Librarian’s Role in Magnet Journey?Journey?

• 156 (156 (81.781.7%) %) reported librarian involvement, reported librarian involvement, including four hospitals where Magnet coordinator including four hospitals where Magnet coordinator said Yes and librarian said Nosaid Yes and librarian said No

• Types of involvementTypes of involvement– Typical library services, including teaching & searchesTypical library services, including teaching & searches– Magnet committee – often only non-nurseMagnet committee – often only non-nurse– Input on Magnet applicationInput on Magnet application

• Proof readingProof reading

– Bibliographic citation managementBibliographic citation management– EBP support for guidelines developmentEBP support for guidelines development– Nursing research committee & IRBNursing research committee & IRB– Nursing education committeeNursing education committee– Web pages; one Evidence Based Nursing BlogWeb pages; one Evidence Based Nursing Blog

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Added Value of Medical Added Value of Medical LibrarianLibrarian

12. 12. If your facility or institution has a medical librarian or access If your facility or institution has a medical librarian or access to one, do you perceive that this provides added value for the to one, do you perceive that this provides added value for the institution and employees?institution and employees?

– 96.396.3% of (184 of 191 hospitals) said yes.% of (184 of 191 hospitals) said yes.– Comments added by 89 hospitals for yes responses, and 2 Comments added by 89 hospitals for yes responses, and 2

No/no response (see separate comments list)No/no response (see separate comments list)– Librarians sometimes unaware of what was valued by those in Librarians sometimes unaware of what was valued by those in

Magnet coordinator roleMagnet coordinator role

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MagnetMagnet Coordinator Coordinator CommentsComments• ““Our librarians are easily accessible and very willing to assist students, Our librarians are easily accessible and very willing to assist students,

staff, and visitors with any questions or concerns. They have really done staff, and visitors with any questions or concerns. They have really done a nice job of welcoming research issues and expanding resources to meet a nice job of welcoming research issues and expanding resources to meet our needs.”our needs.”

• ““We partnered with the librarians to help us set up a file management We partnered with the librarians to help us set up a file management system for cataloging evidence.”system for cataloging evidence.”

• ““As employees are focusing on more evidenced-based practice and As employees are focusing on more evidenced-based practice and hospital-based research, medical librarian became a valuable resource to hospital-based research, medical librarian became a valuable resource to staff.”staff.”

From one without:From one without:• ““We don't have access, but are recognizing the value; I have consulted a We don't have access, but are recognizing the value; I have consulted a

university librarian and have brought this information to my CNO – that university librarian and have brought this information to my CNO – that is why we will have this service available in 2008.” is why we will have this service available in 2008.”

More comments available with report on NAHRS website, More comments available with report on NAHRS website,

http://nahrs.mlanet.org/activity/mapping/research/index.html http://nahrs.mlanet.org/activity/mapping/research/index.html 8282

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Librarian comments – value & Librarian comments – value & rolerole• Value of resources and servicesValue of resources and services

• Involvement of a health sciences librarian on Magnet teamInvolvement of a health sciences librarian on Magnet team• Librarian involvement on committeesLibrarian involvement on committees

– Education: Staff; Nursing; Patient/Family Education: Staff; Nursing; Patient/Family – IRB (Institutional Review Board)IRB (Institutional Review Board)– Nursing ResearchNursing Research– Patient Safety Patient Safety

ExampleExample: : “Librarian is a member of multidisciplinary teams, provides in-“Librarian is a member of multidisciplinary teams, provides in-services, is closely aligned with Medical Education, Human Resource services, is closely aligned with Medical Education, Human Resource development, CME, and clinical research activities; supports information needs development, CME, and clinical research activities; supports information needs for patient care; manages centralized knowledge-based resource and media for patient care; manages centralized knowledge-based resource and media services for entire system of 6 hospitals and 10,000+ employees.” services for entire system of 6 hospitals and 10,000+ employees.”

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““The Magnet Journey: The Magnet Journey: Opportunities for Librarians to Opportunities for Librarians to

Partner with Nurses.”Partner with Nurses.”• Title of article for JMLA Vital Pathways

symposium issue October,2009 • Vital Pathways for Hospital Librarians (VP)

task force: official MLA response to threats faced by hospital librarians

• Like Magnet, Vital Pathways focus was on outcomes

• Efforts continuing by HLS & NAHRS sections now that VP taskforce ended

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After the Class is Over: Magnet After the Class is Over: Magnet Challenge Action PlansChallenge Action Plans

• Analyze your organization, your nurses and nursing leadership

• Think about the concepts we’ve discussed• Read some of the literature we’ve provided – search

for more addressing your idea• Analyze your library’s resources and viable

alternatives• Convey your willingness and eagerness to be part of

the Magnet process—and your enthusiasm• Be aware that additional resources for library may

not be forthcoming85

How to Fund: Business plan or How to Fund: Business plan or Grant proposal?Grant proposal?

• A grant proposal is like proposing a new service, except that you are going to an external funding source

• In business plan, think of administrators as an “external” source with little or no knowledge of what we do – write so that they understand your request

• No library jargon!• KISS principle: Keep it simple, stupid

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Peg’s thoughts on grants: Peg’s thoughts on grants: http://www.healthknowledgeconsultants/grhttp://www.healthknowledgeconsultants/gr

ants.htm ants.htm • Strategic Planning Model

– Strengths – why you can be trusted with their money

– Weaknesses – why you need funding– Opportunities – funding organization priorities

(Magnet expectations)– Threats – what will happen without funding

• Find funding organizations interested in supporting your needs

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Strategic Planning: SWOT ModelStrategic Planning: SWOT Model

Strengths Weaknesses

Opportunities Threats

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Effective Programs

Analysis of each component is foundation for success

Program Planning ModelProgram Planning Model

Information portals Lack of librarian time

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Effective Programs

Opportunities or Threats?

Strengths or Weaknesses? Knowledge sources Nurses’ needsCan you turn weaknesses into opportunities for improvement?

Thoughts continued…Thoughts continued…Needs assessment is vital for either grant or new

service plan• Proposal Development Bibliography – a beginning

DeSilets, L. (2007, May). Needs assessments: an array of possibilities. Journal of Continuing Education in Nursing, 38(3), 107-114. Retrieved June 22, 2009, from CINAHL with Full Text database. Overview of different methods – use not limited to continuing education.

Dickerson, P. (2008, October). Addressing barriers to enhance outcomes. Journal of Continuing Education in Nursing, 39(10), 437-438. Retrieved June 22, 2009, from CINAHL with Full Text database.

Barriers in context of continuing education – need to get input from the learners.

 Caldwell, L., Luke, G., & Tenofsky, L. (2007, Jan-Feb). Creating value-added linkages through creative programming: a partnership for nursing education. Journal of Continuing Education in Nursing, 38(1), 31-36. Retrieved June 22, 2009, from CINAHL with Full Text database.

Focus on collaboration and partnerships. Hospital library is mentioned as part of what the hospital supplied to on-site BSN program. Notes value of champions from each organization.

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More thoughts on More thoughts on proposals…proposals…

• Realistic plan & budget – but double time you think you need – Keep objectives simple – don't tie to specific

methods

• Follow their writing instructions!!!• Meet deadlines

– Build in enough time in proposal development process for last minute snafus

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Summing up: Summing up: • Collaborate with nursing

to choose resources and strategies!

• Map projects to Magnet model components!

• Evaluate efforts, gather& analyze data – translate to outcomes!

• Publish your data and share your ideas with librarians & with nurses elsewhere!

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Summary: From ideas to Summary: From ideas to actionaction

Librarians & the Magnet Program

By Joy Kennedy & Peg Allen

Librarian roles in Librarian roles in the Magnet journeythe Magnet journey

Magnet components

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Transformational LeadershipTransformational LeadershipSuggested IdeasSuggested Ideas from our Classesfrom our Classes

• Table of Contents Service, especially electronic TOC & RSS feeds

• Collection of Nursing Certification Books

• Business databases such as EBSCO’s Health Business Fulltext & databases available from local public libraries

• SDIs to Administration of articles on topics such as Leadership

• Library as “Learning Center” or “Continuing Ed. Center”

• Special collections developed on Innovation & Leadership, Shared Governance, Evidence-based Practice, Mentoring, Teambuilding, Budgeting

• “Hot Topic” searches on Library website

• Using SharePoint to share ideas, searches among leaders

• Providing databases of all kinds & training

• Bibliography of resources in packets for mandatory management/leadership classes 95

Transformational LeadershipTransformational LeadershipMore ideasMore ideas

• Start by meetings with nursing leaders to discuss how library can help them, especially time saving services

• Searches for nursing leaders on magnet components & other topics as they lead the Magnet journey

• Workshops and 1-to-1 teaching for leaders on searching for management topics

• Statistics on searches by department and unit, showing that nurses at all levels use services

• Work with nurse administrator to support budget or share costs for new resources for nursing

• Nursing Research: Show Me the Evidence Blog from the library at St. Joseph Hospital (Orange, California)

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Comments on TransformationLeadership

• “The library is away from their unit and provides them a quiet place to contemplate and explore new ideas. “

• “Since I am included in many Manager meetings - I do get a chance to hear some of the concerns in the organization - and many times I come back, run a search - and email the person who would most likely be interested in what the literature has to offer them. This has really impressed several individuals.”

• “I partnered with our Practice & Education Councils to visit EACH unit on day shift to promote remote access to resources and Nursing Consult in particular. We dropped off snacks to each unit's break room and did on-the-spot "speedy reviews" of what this product has to offer. We also left behind vendor-provided promotional items, reference cards, my business cards, and remote access applications with each unit's manager. Since that time, I have seen an upswing in Nursing Consult usage, and we received over 100 new Athens access applications.”

• Time saving for Administrators: “Whenever I work with a nursing administration employee on a CINAHL search, I always show them how to create an account in EBSCO; they love the fact that they can save their searches, including articles stored in their folder. “

Structural EmpowermentStructural Empowerment --Suggested Ideas from our Classes --Suggested Ideas from our Classes• Open houses, trivia contests

and raffles promoting library – let them know that library is for all staff

• Promote Nurses Week as well as National Medical Librarians month

• Serve as a mentor in learning the research process

• Support and attend research day poster sessions – see what happened with those searches!

• Workshop on creating posters for research days and conferences

• Become part of new nurse orientation – last stop on tour (with treats?) so they can browse and see what’s available

• “Extra” services – notary, test proctoring

• Post/share articles written by nurses and other staff; maintain bibliography

• Demonstrate that “knowledge is power”

• Support for journal clubs – try online, as Moodle forum

• Column in nursing newsletter98

Structural EmpowermentStructural EmpowermentMore ideasMore ideas

• Support for updates of nursing policies & procedures through searches, ILL, etc.

• Development of intranet site of Library resources; availability of Library resources inside electronic medical record

• Forums, wikis & SharePoint on hospital Intranet for nurses to collaborate & share

• Building relationships with local nursing students & act as resource for public library & junior college

• Work with Nursing Staff Development to jointly create professional development courses for nurses

• Act as consultant/searcher to nurses with new ideas for change

• Supporting nurses continuing education with the collection, instruction, encouragement

• Teaching nurses to search, about evidence-based practice principles, how to use databases

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Comments on Structural Empowerment• “Employees are empowered where they have access to

information, support, resources and opportunities to learn & grow in their work setting.”

• “just getting the word out to the nurses that we are here to support their journey and what we have to offer.”

• “Of course, there is more to structural empowerment than internet connectivity, but we all know information is power, right? If they are empowered to make clinical decisions based on evidence, they need access to the evidence, even beyond a packaged resource on the intranet.”

• “The library will search for funding opportunities for specific research projects, specifically community nursing projects that support the hospital's community involvement.”

• “Librarians who have some familiarity with public health information resources can be valuable members of a team tasked with developing a hospital's community engagement program - identifying the major health challenges in a given community, mapping strengths and weaknesses... “

Exemplary Professional PracticeExemplary Professional Practice --Suggested ideas --Suggested ideas from our Classesfrom our Classes

• Support community outreach – help with health fairs and health career events

• Teach health literacy classes at public library, working with nurses from various specialties

• Provide handouts and resources for community events, including Medline Plus bookmarks and pens

• Resources and workshops on finding patient education resources, including those for diverse populations

• Library services for patients as TV menu choice – hand delivering packets

• Support “information prescription” program

• Proactive sharing of articles on “hot topics” – example of article on bullying that addresses horizontal violence issues

• Support for nurses returning to school

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Exemplary Professional PracticeExemplary Professional PracticeMore ideas--More ideas--

• Books, bibliographies or Internet Portals on nursing theory and/or conceptual framework of nursing

• Teach nurses about searching for info on EBP, how to use quality measures

• Keep ANA guidelines in collection• Nursing ethics resources• Serve on Interdisciplinary Research committee• Provide citation management software & support it to effect

collaboration• Find out about Professional Practice Models, how to search for

information about them in support of organization’s choice• Be internal expert and resource for planning

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Comments on Exemplary Professional Practice

• “I approached our Nursing Director this morning who is also the person handling Magnet.  She was extremely pleased that I am taking the initiative to find out what I can do as a librarian to support the Magnet process. She advised me that both the PPM and the Nursing Care Model are being developed.  She suggested we meet this week and discuss.  I am excited about developing better ties with the Nurses.”

• “I've talked to the nurse in charge of our "Journey to Magnet" and she says we don't have a Professional Practice Model yet, but that would be part of the strategic plan developed at the all-day Magnet retreat that I will be attending on Nov 23rd.  She asked if I would talk for 5-10 minutes about this online Magnet course and how the library can help in the pursuit of Magnet.  With all the information I've learned so far, that won't be a problem.” 

• “through a literature search, [library can] provide reviews and updates, standards, trends, and changes as they relate to nursing practice issues”

Typical comment:Typical comment:• “We often say that it seems as though all the nurses

here at the hospital are going to school! We do support them in every sense since we feel that we are their "home" library and that they are here more than they are at school, especially for those who are taking online courses. One of the most recent things we did was to create a Resources for Local Nursing Programs link (http://www4.umdnj.edu/camlbweb/nursingschools.html) from the Academic Resources -- Nursing Education section of our library page. We tell the nurses that we will even try to help them troubleshoot using the resources from their nursing schools. Also, since we have these links from the library page, the sites are not arbitrarily blocked by our firewall as has happened in the past. “

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New Knowledge, Innovations, New Knowledge, Innovations, and Improvement and Improvement

--Suggested Ideas from our--Suggested Ideas from our ClassesClasses• Add CINAHL (or another

nursing database)• Add more full text – Joanna

Briggs, Cochrane Library, nursing research and specialty journals

• Involve nurses in decisions on new library resources

• Diversity collection – links • Facilitate new product

demonstrations

• Support for new technologies, including handheld devices

• Rounding with nurses on different units

• Use nursing staff to help with training

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New Knowledge, Innovations, New Knowledge, Innovations, and Improvement and Improvement —More ideas—More ideas

• Provide information on how to find EBP articles, several EB nursing pages including PICO samples, and a link to the EB pyramid

• Provide literature searches, provide Linkout from PubMed, additional electronic resources

• Teach evaluating the literature• Help them really understand

EBP• Put policies in APA format

• Collaborating with nurses to provide online EBP course, training classes on PICO clinical questions

• Provide point-of-care information products

• RSS feed to AHRQ Healthcare Innovations Exchange & OJIN

• Overhaul the nursing journal collection

• Provide “tips” under email signature re new web resource, search tip, etc.

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Comments on New Knowledge, Innovations, Improvement

• “help the nurses ensure their practices are evidence-based by participating in the Nursing Policy & Procedure Committee; I encourage them to find updated references when reviewing/revising p&ps, and I conduct literature searches, ideally with them but often on my own, to find the highest level evidence possible”

• “providing a sample research problem and giving nurses a PICO worksheet or something to work through to really "get" how PICOs are developed.”

• “I prepared over 40 clinical disease PowerPoint presentations along with EB/full-text articles for academic medicine. It is now the goal of the library to provide these clinical modules to the nurses as supplemental resources for self-directed learning. The bibliographies will be expanded to include nursing literature and, where necessary, the PowerPoint Presentations will be edited to reflect nursing's unique approach to disease treatment and management.”

Empirical OutcomesEmpirical Outcomes --Suggested Ideas from our C --Suggested Ideas from our Classeslasses

• “We keep track of the nursing searches and one on ones that we do and what type of nurse the patron is (admin, staff, educator, etc) and provide those numbers to the leadership. …This is a concrete way the library can show that nurses are learning more about searching and using the literature in clinical practice.”

• Using Google docs for quizzes, evaluations & feedback on searches – shorter surveys are best

• Capture stories of how services, especially searches, made a difference in patient care

• Capture statistics on use of electronic resources, including title specific data for nursing journals

• Publications list kept by library is part of the evidence for Magnet 108

Empirical OutcomesEmpirical Outcomes--More ideas--More ideas

• Tying library services to outcomes both quantitative and qualitative

• Provide evidence that library education & efforts are effective as well as use statistics by type of user

• Provide searches and information in support of National Patient Safety Goals

• Benchmarking data for QI department• Provide guidelines (guidelines.gov) and

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Questions? Questions?

Evaluation--Complete MLA form• Certificates returned for forms

Thank you!

Joy Kennedy, MLS

joykenn@gmail.com

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