Transformational Leadership: Advocacy and Influence TL6 ...€¦ · On April 22, 2016, Joseph’s...

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Transformational Leadership: Advocacy and Influence TL6: The CNO advocates for organizational support of ongoing leadership development for all nurses, with a focus on mentoring and succession planning. TL6b: Provide one example, with supporting evidence, of mentoring OR succession planning activities for nurse managers. Introduction and Background The Organization of Nurse Leaders (ONL) is a not-for-profit professional association committed to the advancement of professional nursing, promoting the delivery of quality patient care, and influencing the development of health policy in Massachusetts, Rhode Island, New Hampshire, and Connecticut. A key component of advancing the nursing profession is the mentoring of future nurse leaders. In support of this effort, the ONL created the ONL Leadership Academy. A component of the Leadership Academy was a mentoring program, whereby an experienced nurse leader is matched with a nurse who aspires to grow in his/her career. In 2012, Melissa Joseph, RN, MSN, NE-BC, a Nursing Director at the Brigham and Women’s Faulkner Hospital (BWFH) in Boston, met Gaurdia Banister, RN, PhD, NEA-BC, FAAN, Executive Director, Institute for Patient Care at Massachusetts General Hospital (MGH), an experienced nurse leader who would influence Joseph’s professional career. Through her mentoring relationship with Joseph, Banister has exposed Joseph to opportunities inside and outside of MGH, coached and guided her through her academic pursuits, and been her most enthusiastic supporter. Banister had been assigned by the ONL Leadership Academy steering committee to be Joseph’s mentor. Five years after that initial meeting, Joseph, now a successful Nursing Director (ND) of General Medicine Unit (Ellison 12) at MGH, is the recipient of multiple awards and scholarships and is pursuing her doctoral studies in nursing. Mentoring is a long term relationship where the focus is on supporting the growth and development of the mentee. The mentor is a source of wisdom, a teacher, and a facilitator who offers support and encouragement as their mentee demonstrates their potential and achieves their goals. The mentoring experience is planned by both the mentor and the mentee and may include formal activities such as in-person meetings, email/telephone communications, attending conferences or other educational programs, as well as more informal social activities. As a mentor, Banister recognized that Joseph had the qualities and enthusiasm to grow as a nurse leader and the story of their mentorship experience follows. Example: Mentoring the Next Generation of Nurse Executive Leaders After leaving BWFH, Joseph became a Nurse Practice Administrator at Cambridge Health Alliance, a community healthcare provider in Cambridge, Massachusetts. In June 2013 Banister spoke to her about a Nursing Director position on a new general

Transcript of Transformational Leadership: Advocacy and Influence TL6 ...€¦ · On April 22, 2016, Joseph’s...

Transformational Leadership: Advocacy and Influence TL6: The CNO advocates for organizational support of ongoing leadership development for all nurses, with a focus on mentoring and succession planning. TL6b: Provide one example, with supporting evidence, of mentoring OR succession planning activities for nurse managers. Introduction and Background The Organization of Nurse Leaders (ONL) is a not-for-profit professional association committed to the advancement of professional nursing, promoting the delivery of quality patient care, and influencing the development of health policy in Massachusetts, Rhode Island, New Hampshire, and Connecticut. A key component of advancing the nursing profession is the mentoring of future nurse leaders. In support of this effort, the ONL created the ONL Leadership Academy. A component of the Leadership Academy was a mentoring program, whereby an experienced nurse leader is matched with a nurse who aspires to grow in his/her career. In 2012, Melissa Joseph, RN, MSN, NE-BC, a Nursing Director at the Brigham and Women’s Faulkner Hospital (BWFH) in Boston, met Gaurdia Banister, RN, PhD, NEA-BC, FAAN, Executive Director, Institute for Patient Care at Massachusetts General Hospital (MGH), an experienced nurse leader who would influence Joseph’s professional career. Through her mentoring relationship with Joseph, Banister has exposed Joseph to opportunities inside and outside of MGH, coached and guided her through her academic pursuits, and been her most enthusiastic supporter. Banister had been assigned by the ONL Leadership Academy steering committee to be Joseph’s mentor. Five years after that initial meeting, Joseph, now a successful Nursing Director (ND) of General Medicine Unit (Ellison 12) at MGH, is the recipient of multiple awards and scholarships and is pursuing her doctoral studies in nursing. Mentoring is a long term relationship where the focus is on supporting the growth and development of the mentee. The mentor is a source of wisdom, a teacher, and a facilitator who offers support and encouragement as their mentee demonstrates their potential and achieves their goals. The mentoring experience is planned by both the mentor and the mentee and may include formal activities such as in-person meetings, email/telephone communications, attending conferences or other educational programs, as well as more informal social activities. As a mentor, Banister recognized that Joseph had the qualities and enthusiasm to grow as a nurse leader and the story of their mentorship experience follows. Example: Mentoring the Next Generation of Nurse Executive Leaders After leaving BWFH, Joseph became a Nurse Practice Administrator at Cambridge Health Alliance, a community healthcare provider in Cambridge, Massachusetts. In June 2013 Banister spoke to her about a Nursing Director position on a new general

care medical unit at MGH. Banister had shared Joseph’s resume, as well as her own impressions of Joseph with Theresa Gallivan, RN, MS, NEA-BC, Associate Chief Nurse, Cardiac, Medicine, and Emergency Nursing Services. Gallivan was impressed by Joseph, as were other Nursing Directors, physicians, and clinical nurses who participated in the screening process, and hired her for the position in July 2013. Banister worked closely with Joseph as she transitioned into her position at MGH. As an African American woman herself, Banister recognized that Joseph would be the only African American ND at MGH and wanted to lend her wisdom, guidance, and support as Joseph transitioned into her new role. Organizational Influence In her first year at MGH, Joseph focused on opening her new unit and all that entailed including hiring and onboarding of staff. Together they collaborated with other members of the healthcare team to create an effective and collaborative interdisciplinary team. As the unit stabilized into a cohesive team which delivered excellent care, Joseph began to look for opportunities to engage in larger organizational initiatives. In October 2014 Gallivan knew that the Chief Nurse of Nantucket Hospital, a small hospital affiliated with MGH, had reached out to Jeanette Ives Erickson, RN, DNP, FAAN, NEA-BC, Senior Vice President for Patient Care and Chief Nurse (CNO), to conduct an assessment of their professional practice environment. As a result of Joseph’s success on Ellison 12, Gallivan recommended to Ives Erickson that Joseph be considered to take the MGH Nursing lead in conducting the assessment. Ives Erickson notified Bonnie Kester, RN, Chief Nurse at Nantucket Hospital that Joseph would be working with her on the practice environment assessment. Joseph shared this news with Banister and asked for her input on how to make this a successful consultation (attachment TL6b.a). As her mentor, Banister recognized the importance of validating and celebrating Joseph, by stating “This is very exciting and a reflection of your leadership.” During their conversation, Banister discussed the need to use reliable tools to accurately assess the nursing practice environment. She and Joseph discussed the work of their colleague, Elizabeth Brown, RN, MSN, MBA, Director, Partners Health International, in assessing professional practice environments of organizations across the world. Banister had previously received permission from Brown to use those tools and forwarded them to Joseph on October 14, 2014. Using those tools, as well as her experience as an ND, Joseph and her MGH colleagues led a successful assessment of the nursing practice environment. They also submitted recommendations to the Nantucket Hospital leadership team about strategies to enhance the professional practice environment and promote interprofessional practice. Attainment of Personal Goals On August 13, 2014, Joseph shared her desire to pursue doctoral studies with Banister (attachment TL6b.b). Returning to school can be a daunting endeavor as one considers balancing school and work, determining a course of study, and the often staggering costs of education. Mentorship during this decision-making period is very important and

Joseph was fortunate to have Banister as a mentor who welcomed the opportunity to discuss and guide her. Banister assisted Joseph with identifying scholarship opportunities and encouraged her to apply for the many MGH awards and recognition programs, described in OOD 7, which provide financial support for educational pursuits. Joseph applied for, and received, several awards and scholarships (attachment TL6b.c).

Joseph was accepted into the Doctor of Philosophy program at Walden University. On May 6, 2016, she emailed Banister (attachment TL6b.d) and asked her to meet with her to discuss her research ideas, the process for engaging the MGH Yvonne L. Munn Research Center, and to discuss the dissertation process. This email exchange illustrates that Joseph sees Banister as a wise mentor who can guide her not only within MGH, but also for the long-term trajectory of her career.

On April 22, 2016, Joseph’s received the E. Lorraine Baugh Scholarship for Leadership (attachment TL6b.e). The award is given to an individual who demonstrates scholastic achievement, leadership, and commitment to the African American community. With the pride of a mentor reflecting on the success of her mentee, Banister wrote that Joseph “is first and foremost grounded in nursing practice. She has a spirit of inquiry, is a proven leader, and has excellent interpersonal skills. There is a buzz about Melissa at MGH. As a nursing director of the busy Ellison 12 medical Unit, she has set a new standard.”

Ongoing Support

Banister’s mentoring relationship of Joseph continues in her course work for her PhD and plans for her dissertation topic. Joseph reaches out to Banister as she continues her engagement with organizational activities as well her ongoing involvement in the New England Regional Black Nurses Association. Banister’s mentoring has only heightened Joseph’s deep commitment to the community and volunteerism through such activities as a volunteer resource for the Black College Fair and as a pen pal for the Promising Pals program at the James Timilty Middle School.

Banister and Joseph’s relationship reflects mentoring at its best. Banister has been an enthusiastic cheerleader for Joseph. She has celebrated her successes, offered counsel and guidance in challenging and confusing times, and worked to clear the path for Joseph to achieve her goals.

On May 6, 2016, at 8:00 AM, Joseph, Melissa,R.N. <[email protected]> wrote:

Good Morning Gaurdia,

Happy Friday!!!! I am currently taking Qualitative Reasoning and Analysis and will be done the end of this month with this class. This summer and fall, I'll be taking Quantitative Reasoning and Analysis, Preparing for Dissertation, and will have a choice to take Advanced Qualitative or Quantitative or Mixed Methods Analysis. I am looking to start dissertation work next year. I wanted to know if I could schedule some time with you to discuss

1) research ideas - phenomenon of interest2) process for engaging with the Yvonne Munn's Research Center3) Dissertation process

> I am open to a face to face to meeting, Skype, email. It could be inincrements of 30 minutes on different dates for each topic. Whatever I can do toaccommodate this meeting as I know your time and schedule is packed :-).

> Thank you in advance,> Melissa

-----Original Message----- From: Banister, Gaurdia E.,R.N.,Ph.D. Sent: Friday, May 06, 2016 9:24 AM To: Joseph, Melissa,R.N. Cc: Harris, Tara D. Subject: Re: Request

Hi Melissa, I'll have Tara set us up for an hour face to face, and then we'll see how much more time we need. Take care, Gaurdia

-----Original Message----- From: Harris, Tara D. Sent: Thursday, May 12, 2016 4:05 PM To: Joseph, Melissa,R.N. Subject: FW: Request

Hi Melissa,

Gaurdia has some availability on Tuesday, May 24th. Please let me know if you are available anytime in the afternoon that day. Tara

-----Original Message----- From: Joseph, Melissa,R.N. Sent: Tuesday, May 17, 2016 4:18 PM To: Harris, Tara D. Subject: RE: Request

8am works. Thanks, Melissa

Melissa Joseph, RN, MSN, NE-BC Nursing Director Ellison 12, General Medicine Massachusetts General Hospital 55 Fruit Street, Ellison 1201A Boston, MA 02114 phone 617.726.9490 e-mail: [email protected] Excellence Every Day through knowledge and compassionwww.mghpcs.org/EED

-----Original Appointment----- From: Harris, Tara D. On Behalf Of Banister, Gaurdia E.,R.N.,Ph.D. Sent: Tuesday, May 17, 2016 2:37 PM To: Joseph, Melissa,R.N. Subject: Melissa Joseph/Gaurdia Mtg When: Tuesday, May 24, 2016 8:00 AM-9:00 AM (UTC-05:00) Eastern Time (US & Canada). Where: FND 314

Hi Melissa,

Your meeting with Gaurdia is confirmed for Tuesday, May 24th at 8am. Tara

-----Original Message----- From: Joseph, Melissa,R.N. Sent: Wednesday, August 13, 2014 7:27 AM To: Banister, Gaurdia E.,R.N.,Ph.D. Subject: PhD

Good Morning Gaurdia,

Hope you are doing well on this rainy day. I've really been thinking lately about pursuing my PhD. I would love to meet with you to discuss a strategy in pursuing this goal, navigating the system to accomplish this while at MGH, and any funding knowledge you may have in meeting the financial constraints to obtaining the PhD.

Do you have any availability for next week or even this week?

Thanks, Melissa

Sent from my iPhone

-----Original Message----- From: Banister, Gaurdia E.,R.N.,Ph.D. Sent: Wednesday, August 13, 2014 7:31 AM To: Joseph, Melissa,R.N. Subject: RE: PhD

Hi Melissa, It is such a small community. I was speaking with Dr. Deb D'Avolio last night and she mentioned that she had met with you and your mother. There are no coincidences. I'd love to talk to you about your educational goals. I'm booked solid this week and the next 2 weeks I'm away. I'm happy to chat by phone when I'm away. I'll be working on a couple of projects or we could meet in person the first week in September. Let me know what works best for you. Take Care, Gaurdia

From: Ives Erickson, Jeanette, R.N.,D.N.P. Sent: Monday, October 06, 2014 8:15 AM To: Kester, Bonnie, RN, CNO; Joseph, Melissa,R.N.; Gallivan, Theresa M., R.N. Subject:

Bonnie,

Melissa Joseph, nursing director in medicine is looking forward to working with you and your nursing director. I have copied Melissa on this message so that you can connect.

Best

Jeanette Ives Erickson, RN, DNP, FAAN

Chief Nurse and Senior Vice President for Patient Care

Massachusetts General Hospital

Boston, MA 02114

On Oct 8, 2014, at 5:10 PM, Joseph, Melissa,R.N. <[email protected]> wrote:

Hello,

First, thank you for this amazing opportunity! Bonnie Kester, Kimberlee Patten, and I connected today. We are looking forward to the experience. I will be visiting the hospital and spending some time there on November 5th, 6th, and 7th. We will schedule future visits for Kimberlee here at MGH for mentorship in addition to providing onsite mentorship at Nantucket Cottage Hospital. I will keep you posted.

Thank you again,

Melissa

From: Ives Erickson, Jeanette, R.N.,D.N.P. Sent: Wednesday, October 08, 2014 5:12 PM To: Joseph, Melissa,R.N. Cc: Gallivan, Theresa M., R.N. Subject: Re: FW:

Wonderful. Please let me know if I can do anything to support you.

From: Joseph, Melissa,R.N. Sent: Wednesday, October 08, 2014 5:36 PM To: Banister, Gaurdia E.,R.N.,Ph.D. Subject: FW: FW:

Hi Gaurdia,

I hope this email finds you well. Please see attached emails about being invited to conduct an assessment of the practice environment at Nantucket Hospital. I am so excited. I’m looking to have your input on this opportunity. Would you happen to have any time to meet or have a phone conversation about this opportunity?

Thanks, Melissa

On Oct 9, 2014, at 9:23 AM, "Banister, Gaurdia E.,R.N.,Ph.D." <[email protected]> wrote:

Sure, this morning is good to connect or we can talk next Tuesday. What works best for you? This is very exciting and a reflection of your leadership! In the mean time, I’m forwarding an email from my colleague, Betsy Brown at Partners HealthCare International that contains the assessment tools she uses when conducting professional practice environment assessments. Potential tools to consider and discuss when we meet.

From: Brown, Elizabeth J. Sent: Thursday, July 31, 2014 4:28 PM To: Banister, Gaurdia E.,R.N.,Ph.D. Subject: RE: Practice Environment Assessment tools It was great to see you today. I look forward to our ongoing work.

In follow-up, attached are the set of assessment grids that I typically put into one binder when going onsite to use as a guide for conversation and data collection. I support this with document reviews, interviews, focus groups. I’m happy to share them. It took a lot of work and research to compile these tools so I ask that Partners HealthCare International be referenced. Thanks for reaching out. I think the more we can leverage what is in the system to support nurses and our work, locally and globally, the better.

Thanks and warm regards,

Betsy

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Partners Healthcare International, Nursing Assessment Client: Observation period:

III. Clinical Practice and Expertise: An assessment of the care delivery model, role of nurses, and nurse workload

Component Factors to Assess Observations Clinical Practice

What would you consider are the biggest strengths of your nursing clinical practice? Are there opportunities to scale these such that best practice gets shared and spreads? Where are the biggest challenges?

Care Delivery Model – Structure and processes by which responsibilities for patient care are assigned and work is coordinated among members of the nursing staff (Hoffart)

Is a single care delivery model used on all the inpatient units? o How was the model developed? o Was it developed (and is it modified as needed) with the input

of direct care nurses? o Which approach to care best describes the model: primary

nursing, functional nursing, team nursing, modified team nursing, other

Does the care delivery model… o Define and promote the professional role of the nurse and

assume that each nurse is accountable for his/her own practice

o Assure support for patients and their families, including physical, emotional, and spiritual support

o Assure continuity across shifts o Promote interdisciplinary collaboration o Differentiate nursing functions and roles from non-nursing

and support functions → Are support staff assigned to nurses (rather than to

patients) who oversee and supervise their work? Does the model allow care to be customized to reflect a patient’s

values, preferences, and expressed needs?

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Does the model promote continuity across hospital settings and discharge locations (i.e., home and other facilities)?

Is the model realistic/practicable given the number of available

RNs and the mix of RN and support staff? Is nursing practice guided by written clinical care protocols,

standards of care, and policies and procedures? o Are the protocols, standards, and policies and procedures

based on research findings or other evidence? o Are they readily available to direct care nurses at all times?

Role of direct care nurses Is there a job description for the direct care (staff) nurse? If yes,

obtain a copy. Are nurses at this institution expected and empowered to… o Assume responsibility and accountability for their own

nursing practice o Exercise independent judgment to resolve patient care issues o Develop and execute nursing care orders and actions and to

control their practice o Collaborate with nurses, physicians, and other health care

professionals to plan and delivery care o Oversee and supervise unlicensed members of the nursing

care team Does the institution have documented competencies for nursing

staff (including temporary, per diem, and other supplemental nurses)?

Do nurses with less experience have access to clinical support

from experienced nurses? Are mechanisms in place to allow/encourage staff nurse input

into decision making affecting nursing practice, clinical quality, and patient safety?

How does the institution assure that all nurses practicing in the

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organization have appropriate and up-to-date credentials/license?

Support staff Is there a job description(s) for clinical support staff (e.g., nurses aides)? If yes, obtain a copy. o Are the roles of support staff clearly defined (in the job

description or through another formal mechanism)? Are support staff supervised and overseen by professional nurses? If not, who oversees/supervises them?

Does the institution have documented competencies for support

staff? Is there a competency-based orientation/training program for support staff?

Are the tasks that can be delegated to support staff clearly and

formally defined (i.e., in a policy or standard)? Do staff nurses receive training in how to supervise and delegate

responsibilities to support staff?

Are there adequate support systems (laundry, housekeeping) on all shifts?

Nurses in specialized settings and roles

Nurses in specialized settings o Do nurses in specialized settings complete a competency-

based orientation/training program? o Do the clinical competencies reflect the unique needs of the

patient population? o Is nursing practice in specialized settings guided by written,

evidence-based clinical care protocols, standards of care, and/or policies and procedures

o Do nurses with less experience have access to clinical support from experienced nurses?

Does the institution employ any advanced practice nurses? If

yes… o Do the nurses report to the chief nurse? o Do they have job descriptions? o Do the nurses have the appropriate education, training, and

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licensure? Does the institution have a mechanism to monitor the nurses’ credentials (does it have a credentialing and privileging process)?

o Who oversees the clinical practice of advanced practice nurses?

o Are the advanced practice nurses available to nursing colleagues for consultation on patient care issues?

Nursing workload, staffing How many patients do nurses on general medical/surgical floors

typically care for on a shift? What type of skill mix is encountered on most general units?

How does the organization evaluate whether nurse staffing

patterns are adequate to meet patients’ needs? What have recent evaluations found?

Is scheduling tailored to…

o The unit’s patient population and patient complexity o Staff member skill sets and staff mix? o Are UAP’s factored in the staffing scheduling/ratios?

Are there particular units or shifts that routinely experience

staffing difficulties? What happens when there are not enough nurses to staff a

unit/shift? Is there a level

Recommendations/Next Steps:

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Partners Healthcare International, Nursing Assessment Client: Observation period:

II. Leadership and Leadership Development: An assessment of leadership roles and of programs and systems to support leadership development

Component Factors to Assess Observations/examples provided Leadership

What would you consider are the biggest strengths of your nursing leadership and structure? Are there opportunities to scale these such that best practice gets shared and spreads? Where are the biggest challenges?

Leadership roles: Chief Nurse

Does the chief nurse have a job description? If yes, obtain a

copy. Are role expectations and accountabilities clearly defined through the job description or other formal mechanisms?

Organizational influence o Does the chief nurse provide input into the

organization’s direction and strategy? If yes, through what mechanisms?

o On which organizational committees is the chief nurse a member? Which committees does the chief nurse lead?

o Collaborative relationships with the CEO and senior management team

o Does the chief nurse see themselves as an agent of change? How?

Authority and accountability o Does the chief nurse have authority over and

accountability for all nursing care? Does s/he view him/herself as an advocate for nursing practice?

o Does the chief nurse represent all nurses at the highest governing body?

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o Are decisions about nursing and nursing care made by senior leaders in the organization without the chief nurse’s input?

Management style o Is the chief nurse available and visible to nurse

managers? To staff nurses? o Does the chief nurse encourage the participation of

nurse managers and nursing staff in decision making? How?

o Does the chief nurse set aside time to coach, develop, and provide feedback to members of his/her management team?

Vision o Does the chief nurse have a vision for the nursing

department, for nursing staff, and for the care they provide? Is it evident in his/her decisions, priorities? Is it evident on the nursing units?

o Are resources/support available to the CNO to accomplish the nursing vision/goals?

Communication o How does the chief nurse communicate with managers

and staff? o Do nurse managers and staff share the chief nurse’s

vision for the nursing department? o Does s/he promote 2-way communication with staff

(e.g., via open forums, committee structure, unit rounds)

o How does the chief nurse influence/establish standards of practice within the organization?

Leadership roles: nurse manager Are the clinical units overseen by nurse managers? If not,

skip to the next row. Do nurse managers have a job description? If yes, obtain a

copy. Are role expectations and accountabilities clearly defined through the job description or other formal

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mechanisms? Influence, collaboration o Do nurse managers provide input into organizational

decisions? If yes, how? o Do nurse managers collaborate with colleagues in

nursing and other disciplines formally (e.g., by participating on interdisciplinary committees) and informally (e.g., by partnering with other departments and disciplines to address practice issues)?

Vision o Do nurse managers have a vision for nursing practice

on their units? Is it consistent with the vision for nursing practice cited by the chief nurse? Is their vision reflected in their decisions and is it evident on the nursing units?

Authority and accountability o Do nurse managers have authority over, and

accountability for, nursing practice on their units? Do they view themselves as advocates for nursing practice?

o Are decisions about nursing practice on the manager’s unit made without the input of nurse manager? If so, under what circumstances? (who/why) – determine how much autonomy staff nurses have to make decisions that affect patient care

o Nurse manager span of control (# of staff in charge of/units)

Management style o Do nurse managers seek input from staff and involve

them in decision making? o Are managers available and visible to nursing staff? o Do nurse managers provide regular feedback to nurses

and support staff? How?

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Unit based leadership (non-nurse managers)

Who manages the clinical units and to whom do they report?

Do nurses play a role in overseeing unit-level patient care

activities on each shift? How? (e.g., Is there a designated nurse leader/charge nurse for each shift?)

Do the unit managers seek input from nursing staff and

involve them in decision making? Are the unit managers available and visible to nursing staff?

Do the unit manages provide regular feedback to nurses

and support staff? How?

Leadership roles: Other members of the nursing leadership group (e.g., clinical specialists, program managers, directors)

Are there other levels of nursing leadership (in addition to the chief nurse and nurse manager)? If yes, describe each role and obtain a copy of the job descriptions.

For each role, assess: o Influence on the organization, nursing department, and

nursing practice o Authority and accountability o Evidence of interdisciplinary collaboration o Management/consulting style (hierarchical vs.

participatory)

Leadership Development: Selecting nurse managers and introducing them to their roles

How are nurse managers selected? o Who is involved in the interview and selection process? o Who makes the final decision regarding nurse manager

hires? o What is the background of most nurse managers? Do

they have management experience? What is their educational preparation?

How are new nurse managers prepared and introduced to

their roles? o Is there a formal orientation process? What does it

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involve? (Obtain a copy of the curriculum if available.) o Have nurse manager competencies been formally

defined? Are they incorporated into the orientation program?

o Does the nurse manager orientation include a preceptorship? If yes, who fills the preceptor role?

Leadership Development: Ongoing professional development opportunities

Do nurse leaders have access to regular input and guidance about their performance? From whom? Through what mechanisms? (e.g., through regular one-on-one meetings, informal interactions, mentoring program, annual performance review, peer reviews/eval)

Does the organization/nursing department offer nurse

managers formal professional development opportunities (e.g., classes, retreats, access to consultation)?

During the past 1-2 years, which of the following leadership

competencies have been addressed through professional development programs?

o Foundational leadership skills (includes analyzing

organizational issues, decision making, reflective leadership, problem solving, change management, Managing unit performance, quality and patient safety)

o Communication and relationship building skills (includes

shared decision-making, conflict resolution, team dynamics, influencing behaviors, develop collaborative skills)

o Interdisciplinary practice, collaboration, teamwork

o Professionalism (includes ethics, evidence-based clinical

and management practice, advocating for nursing practice, personal and professional accountability, creating an environment to promote professional practice)

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o Human resources management and development (includes

workforce planning; interviewing and hiring; rewarding and recognizing performance; interpreting legal and regulatory guidelines; identifying and eliminating harassment and abuse; coaching; mentoring, and staff development; identifying clinical and leadership skills, culture and diversity, Operational planning)

o Knowledge of healthcare environment/priority initiatives

(includes patient care standards defined by external organizations/regulatory bodies, patient care delivery models and work design, outcome measurement, case management, quality improvement, risk management, patient safety)

o Business skills (includes budgeting/financial

management, strategic thinking, Information technology)

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Recommendations/Next Steps:

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Partners Healthcare International, Nursing Assessment Client: Observation period:

I. Organizational Structure: An assessment of the structure, governance, and management systems of the organization and the nursing department

Component Factors to Assess Observations Organizational Structure

What would you consider are the biggest strengths of your nursing organizational structure? Are there opportunities to scale these such that best practice gets shared and spreads? Where are the biggest challenges?

Mission, vision, & values that drive the organization

Written documents: Does the organization have a written mission, vision, and/or values statements? Does nursing have separate statements and, if

yes, are they congruent with the organizations’?

Management structure, organization

Does the organization have an organizational chart? If yes, request a copy.

Is the organization vertically or horizontally

structured?

Who oversees the department of nursing? Is there a chief nurse, i.e., one senior nurse leader who oversees nurses and nursing practice in the organization?

To whom does the chief nurse report?

How many levels exist between the CEO and

chief nurse? Between the COO (or equivalent) and chief nurse?

How many levels exist between the CEO and

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direct care providers (i.e., staff nurses)? Is there a senior executive “team”? Who is in it,

what is the team’s role, and does it include the chief nurse?

Are systems in place to facilitate communication

between hospital executives and staff? To facilitate communication across non nursing and/or nursing departments?

Decision making, organization Which individuals/groups play a role in

determining the organization’s priorities and strategy? Are the organizational decisions facilitated and

supported by data? Are organizational decisions analyzed with

respect to the effect of patient outcomes and nursing work life? Is there a committee structure? Do the

committees help oversee and provide input into clinical operations and policies? For each committee, answer the following… o What is the committee’s charge and to

whom does it report? o Who is on the committee and is the

membership interdisciplinary? o Is nursing represented on the committee?

Who are the nursing members? o How does the committee obtain input

from front-line staff?

Management structure, Nursing Department of nursing - o Does it include all nurses in the

organization? Which nurses are not in the department?

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o Is there an organizational chart for Nursing?

If yes, request a copy. o Is the department leader a nurse? (This role

is called the “chief nurse” in this document.) o Do departments/disciplines other than

Nursing report to the chief nurse? If yes, list. o Is the Nursing Department structured

vertically or horizontally? How many management levels exist between the chief nurse and staff nurses? What are they?

o Is there a formal nursing leadership group?

Who is in the group? How often does it meet? What is the group’s role?

o How do the chief nurse and the nursing

department obtain access to administrative, clerical, and IT support?

If there is not a Department of Nursing…

o To what department(s) do the inpatient staff nurses belong?

o Is the leader of the department a nurse?

o Are there mechanisms to assure nursing

input into departmental planning and decisions affecting nursing practice? What are they?

o Is there a formal nursing leadership group?

Who is in the group? How often does it meet? What is the group’s role?

Management structure, Are the inpatient units managed by nurse

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Inpatient units managers? o If not, who manages the units? o On average, how many units does one

manager oversee?

Decision making, nursing How are department-level decisions affecting nursing and nursing practice made? Who is involved in decision making?

Is there a nursing committee structure? If yes,

note the following for each committee… o What is the committee’s charge? o Who leads the committee and who are its

members? o Are direct care nurses on the committee?

If not, is there a way for direct care nurses to provide input to decisions the committee makes?

How are decisions related to nursing practice

made at the unit level? o Are staff involved in making these

decisions? How is their input obtained?

Recommendations/Next Steps

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Partners Healthcare International, Nursing Assessment Client: Observation period:

V. Recognition, professional development, and recruitment and advancement of nurses: An assessment of activities and programs that promote the development of nurses and a professional nursing service

Component Factors to Assess Observations Professional development

What would you consider are the biggest strengths of your professional development program? Are there opportunities to scale these such that best practice gets shared and spreads? Where are the biggest challenges?

Compensation, rewards, and recognition

Compensation system How are nurses paid? Are they salaried or are they paid for

hours worked? Are they paid extra for overtime, off-shifts, week-ends, and holidays? Are the wages competitive in comparison to similar organizations/area hospitals?

Are nurses financially compensated for… o Years of experience? o Education or specialty certification? o Clinical expertise or professional achievement (e.g.,

through a clinical ladder)? Does the compensation system recognize role distinctions

among staff nurses -- are advanced practice nurses compensated at a higher level?

Rewards and recognition Are opportunities for promotion and advancement linked

to indicators of professional excellence (e.g., the attainment of more education, greater clinical expertise, specialty certification, demonstrated leadership and innovation)?

Has the nursing department developed mechanisms to

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recognize the accomplishments of individual nurses (e.g., through an awards system, newsletters, etc)?

Are nursing and nurses recognized at the organizational

level? Are they featured in the organization’s promotional materials, newsletters, bulletin boards, internet sites, etc?

Professional development Is there a process to assess, plan, organize, and evaluate the educational needs of nurses at all levels? o How are staff education needs assessed and

programming determined? o Are financial resources budgeted for the ongoing

development of nurses? (Is there a tuition reimbursement program, budgetary support for onsite continuing education, and support for attendance at conferences?)

o Are there career development opportunities for non nursing employees interesting in nursing as a career?

o Does the organization support and encourage nurses at all levels to seek additional formal nursing education?

o What are the methodologies for delivering educational programs?

o Are many educational programs on line? How successful are these?

Is there an orientation program for nurses new to the

organization? o Does it include classroom and clinical components? o Does it include a preceptorship? If yes, who serves as

preceptors to newly hired nurses? o Is the orientation program competency-based? If not,

how is a nurse’s readiness for independence assessed? o Can the orientation program be customized to meet the

needs of individual nurses? o Is the program extended or otherwise modified for new

graduates? What types of professional development opportunities are

available for experienced nurses?

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o Are formal mentoring and coaching opportunities available for experienced nurses?

o How are nurses educated about new treatments, technology, and care practices?

o During the past 2 years, what educational programs have been offered to nurses onsite? How many nurses attended each program on average?

o Are advanced nursing roles used to support and enhance nursing care and promote nurses’ professional development?

o Has the nursing department created incentives (e.g., financial compensation, recognition/rewards) that encourage nurses to participate in professional development activities?

• Are competencies outlined for staff educators? Are

there opportunities for their own professional development?

• Is there a formal professional development department/infrastructure? How many people work there? what is it’s responsibility? how does it relate to unit based education?

• Is there a practice or education committee or council for nursing?

• Does the hospital have clinical educators for students? Are they employees of the hospital or the nursing school?

• What is the relationship between the hospital and nursing schools?

• What clinical affiliation agreements do you have? Do the professional opportunities meet standards

established by the government, licensing board (if applicable)?

Does the organization track attendance at professional

development activities for individual nurses?

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Is there a formal performance evaluation process? How

often is each nurse evaluated and who conducts the evaluation? o Does the evaluation include an assessment of clinical

competencies and professional contributions? o Are performance goals for the next year identified and

a plan for achieving them developed? o Who provides input into the evaluation (nurse

manager, nurse being evaluated, peers, other colleagues and supervisors)?

o Are the results of the performance evaluation linked to a pay increase?

Recruitment Does the nursing department have a recruitment strategy? What does it include? o Is the strategy supported by Human Resources? o Does the strategy reflect the input, ideas, and

involvement of direct care nurses? How are nurses from outside the organization interviewed

and hired? o Who selects applicants for interviewing? o Who is involved in the interview process? (Is the chief

nurse, nurse manager, and/or staff nurses involved? Who makes the final hiring decision?

o Are those involved in the interview process trained/coached in interviewing techniques?

o How are interviewers made aware of key skills and attributes required for each role?

How are promotions within the organization handled? o How are nurses encouraged to seek career

advancement within the organization? o Is there an interview process? How is involved and

who makes the final hiring decision?

The following materials are useful to this assessment and

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should be requested if available: o Hiring and reduction in workforce policies and policies

that safeguard employee rights o Nurse vacancy and turnover rates; statistics on average

tenure of nursing staff and education of nursing staff o Percentage of temporary nurses used (includes per

diem and registry/traveling nurses) o Patient satisfaction scores o Employee/nurse satisfaction scores

Documents reflecting recruitment, retention, and professional development practices

Request a copy of the following documents, if available: o Policies/procedures related to hiring, safeguarding

employee rights, and involuntary termination and layoffs

o Nurse vacancy and turnover rates; statistics reflecting average tenure of nursing staff and education of nursing staff

o Percentage of temporary nurses used (includes per diem and registry/traveling nurses)

o Patient satisfaction scores o Employee/nurse satisfaction scores

Recommendations/Next steps:

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Partners Healthcare International, Nursing Assessment Client: Observation period:

IV. Quality and Patient Safety: An assessment of structures, processes, and practices to assure patient safety and improve the quality of care

Component Factors to Assess Observations Quality and Patient Safety

What would you consider are the biggest strengths of your nursing quality and patient safety? Are there opportunities to scale these such that best practice gets shared and spreads? Where are the biggest challenges?

Mission and values Is a commitment to high quality care and patient safety evident in the organization’s mission statement and/or strategic priorities?

Quality and safety program: Structures and processes to assure patient safety and to measure and improve the quality of care and services

Does the organization have a comprehensive plan to assess, analyze, and evaluate clinical and operational processes and outcomes? o Are any clinical and operational quality indicators

routinely monitored? If yes, which indicators are tracked? (e.g., adverse drug events, falls, unanticipated deaths, unplanned returns to the ICU, pressure ulcer prevalence, restraint prevalence, urinary catheter-associated UTIs, central line catheter-associated bloodstream infections, hospital-acquired pneumonia prevalence)

o Are nurse sensitive indicators r/t patient outcomes and nurse work-related injuries measured? Are there systems in place to monitor and analyze these measures?

o How are errors and near errors tracked? Are there

policies that encourage self-disclosure of errors and near errors without fear of punishment?

o Are there systems in place that deal with error prevention?

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o Are interdisciplinary teams involved in evaluating and improving performance at the organization level? At the unit level? Do the teams include nurses?

Is there a quality department? If yes, what is its charge?

o Is there a quality committee? If yes, what is its charge? Who are the members?

o Is the chief nurse involved in the quality program and quality improvement efforts? How?

o Is data regarding quality and safety shared and discussed at all levels, including with the board and senior management team? With staff, including nursing staff? Dashboards?

Practices to promote patient safety Is interdisciplinary care promoted and practiced?

o Do the different disciplines involved in patient care participate in joint decision making?

o Are mechanisms to promote effective interdisciplinary communication in place?

Are there mechanisms to promote 2-way communication

between managers and staff? (e.g., via open forums, open door management policies, committee structure, safety rounds) o Do managers involve staff and seek staff input into

decision making and planning? Have high risk systems (e.g., medication systems, patient

transfers and hand-offs) been evaluated and safe practices introduced and their effectiveness monitored? Patient handoff communication mechanisms (SBAR)

Are evidence-based policies and procedures used to guide

practice? Are they readily available to clinical staff at all times?

o Are there appropriate equipment, supplies, and

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technology to support the efficient delivery of quality nursing care? Are nurses involved in organizational decisions related to assessing and selecting supplies, equipment and information systems and technology (goal is to improve workflow through participation and end user buy-in which is r/t patient safety)

Are resources budgeted to support ongoing staff

training/learning and assure competency? o Is there a competency-based nursing orientation? o Does the nursing orientation include a preceptorship? o Do nurses receive education and training before new

technology/equipment is introduced? o Are resources (reference materials, clinical experts)

available to support bedside learning and decision making?

Are nurses’ work hours within safe limits (i.e., no more

than 12 hours of work in 24 hours, no more than 60 hours in 7 days)?

Is the number of nurses on each unit and shift sufficient,

given the number and complexity of patients? (See assessment of Clinical Practice and Expertise, Nursing Workload and Staffing)

Are there support systems in place that help reduce “failure

to rescue” eg. Rapid response teams, in house physicians 24/7 (hospitalists) etc

Do patients have means to discuss and address options in

care through the support of an ethics committee/team?

Avenues to address issues on unsafe work environments (staffing, skill mix)

Recommendations/Next Steps

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From: Banister, Gaurdia E.,R.N.,Ph.D. Sent: Wednesday, April 08, 2015 7:39 AM To: Joseph, Melissa,R.N. Subject: FW: The National Black Nurses Association is now Accepting Scholarship Applications -Deadline: April 15, 2015 by 5pm EST

Please see below, Gaurdia

From: National Black Nurses Association [mailto:[email protected]]

Sent: Tuesday, April 07, 2015 5:04 PM

To: Banister, Gaurdia E.,R.N.,Ph.D.

Subject: The National Black Nurses Association is now Accepting Scholarship Applications - Deadline:

April 15, 2015 by 5pm EST

National

Black

Nurses

Association

Deadline: April 15, 2015

Dear NBNA Membership:

It is that time of the year again, the National Black Nurses Association is now accepting scholarships.

Scholarships provide students with funding for continuing education. This funding enables nurses to grow and better contribute their talents to the health and healthcare of our communities. Please review the Scholarship Application form carefully, remember, to submit ALL required documents with your application.

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Deadline: April 15, 2015 5pm EST

2015 Scholarship Application Checklist

• National Black Nurses Association ScholarshipsDefinitions

• 2015 Scholarship Application

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• Written Essay Guidelines• 2015 Membership Application• 2015 NBNA Scholarship Membership Honor Pledge

Thank you!

Page 8 — Caring Headlines — October 15, 2015

Education/Support

Presentation of the 2015 PCS Scholarships

— by Julie Goldman, RN, professional development manager

n September 22, 2015, Jeanette Ives Erickson, RN, senior vice president for Patient Care, wel- comed friends, family, and col- leagues to this year’s PCS schol- arship presentations. Scholar- ships support MGH staff inter- ested in earning a degree in Nursing or one of the health professions. Providing fi-nancial assistance to those wishing to further their edu-cation, and increasing the diversity of our workforce are basic tenets of our MGH philosophy and an important part of our mission and values.

Said Ives Erickson, “We’re thankful to all our donors: Mr. Norman Knight; Mr. and Mrs. Gil Minor; the staff of Lunder 10 and Cox 1; and the Dowling family for funding these programs that help advance higher learning and increase the number of diverse nurses and healthcare profes-sionals practicing at MGH.”

The following scholarships were presented:• The Norman Knight Doctoral Nursing

Scholarship (Photo 1, l-r)• Debra Burke, RN; Carol Casey, RN; Jennifer

Clair, RN; and Julie Cronin, RN

Ocontinued on next page

1

Below: senior vice president for Patient

Care Jeanette Ives Erickson, RN, presides over PCS scholarship

presentation ceremony.

October 15, 2015 — Caring Headlines — Page 9

Education/Support (continued)

• The Charlotte and Gil Minor Nursing andHealth Professions Scholarship to AdvanceWorkforce Diversity in Patient Care (Photo 2)• Melissa Joseph, RN; Michael Grasso, RN;

Rai Singh, RRT; and Jane Martell, RN

• The Cathy Gouzoule Oncology Scholarship(Photo 3)Michele Golden, RN

• The Norman Knight Nursing Scholarship(Photo 4)• Alicia Shulman, RN; Jessica Robertson, RN;

Charlene Badolato, RN; Jessie MacKinnon, RN;

Linda Caruso, RN; Alexa O’Toole, RN; Tara Belisle; Scott Farren, RN; Amira Hamzic, RN; and Karin Rallo, RN

• The Pat Olson, RN, Memorial Scholarship(Photo 5)• Michele Alvarez

Through the generosity of supporters, a re-cord 25 scholarships were presented this year. For more information about the Patient Care Services Scholarships contact Julie Goldman, RN, professional development manager, at 617-724-2295.

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CaringMay 5, 2016

Headlines

Joseph receives prestigious E. Lorraine Baugh Scholarship

for Leadership

Nursing and Patient Care ServicesM a s s a c h u s e t t s G e n e r a l H o s p i t a l

Nursing director, Melissa Joseph, RN (right), with distinguished nursing leader, E. Lorraine Baugh, RN, at recent spring conference of the New England Regional Black Nurses Association.

May 5, 2016 — Caring Headlines — Page 5

n Friday, April 22, 2016, at the annual spring conference of the New England Regional Black Nurses Association (NERBNA), nursing director, Melissa Joseph, RN, received the prestigious E. Lorraine Baugh Scholarship for Leader- ship. The award is given to a candidate who demonstrates scholastic achieve-ment, leadership, and commitment to the African American community. Joseph, a researcher, author, and chief operating of-ficer for Visual Vitality Con sulting, a disability consulting com-pany that addresses barriers to accessibility and promotes diver-sity and inclusion for site-challenged individuals, is a well re-spected nursing leader throughout the MGH community.

Gaurdia Banister, RN, executive director of The Institute for Patient Care, says of Joseph, “Melissa is first and foremost grounded in nursing practice. She has a spirit of inquiry, is a proven leader, and has excellent interpersonal skills. There is a buzz about Melissa at MGH. As nursing director of the busy Elliso n 12 Medical Unit, she has set a new standard. She has established collaborative partnerships with her physician col-leagues, she is a role model for staff and a strong patient advo-cate who embraces inter-disciplinary teamwork.”

Significantly, the Ellison 12 inter-disciplinary team crafted a letter of recommendation for Joseph in which they wrote, “Melissa has created a warm and welcoming environment that supports the contributions of all members of the inter-disci-plinary team from direct-care providers to support staff. No voice is too small to be heard, no problem too insignificant to be addressed... Melissa partnered with the Chaplaincy to im-plement Tea for the Soul, a monthly get-together that encour-ages staff to decompress and reflect while sharing a bit of nour-ishment. She enlisted the help of the Benson-Henry Institute for Mind Body Medicine to educate staff about techniques for self-care with great success.

Says associate chief nurse, Theresa Gallivan, RN, “Melissa successfully navigates organizational cultures, builds key rela-

tionships, and leverages her significant lead-ership and management capabilities to im-prove the patient and family experience. She has a participatory leadership style that emphasizes accountability, staff-engagement, and excellence, which has enabled her to lead teams to impressive quality, satisfaction, and efficiency outcomes.”

E. Lorraine Baugh is co-founder of the National Black Nurses Association and founder and president emerita of NERBNA. She’s an accomplished, highly respected, in-ternational nurse leader, and receiving a scholarship in her name is an honor in its own right. Patient Care Services and the MGH community congratulate Joseph on this well deserved recognition.

For more information about NERBNA or the E. Lorraine Baugh Scholarship, contact Gaurdia Banister at 724-1266.

Joseph receives prestigious E. Lorraine Baugh Scholarship

for Leadership

Recognition

OMelissa Joseph, RN

nursing director, Ellison 12 Medical Unit

“There is a buzz

about Melissa at

MGH. As nursing

director of the

busy Ellison 12

Medical Unit, she

has established

collaborative

partnerships

with physician

colleagues, she is

a role model for

staff and a strong

patient advocate

who embraces

inter-disciplinary

teamwork.”