Northwest Organization of Nurse Leaders News

NWONL Leaders in Action August 2020 (8 min read)

It’s our 4th magnet designation, I thought we would be, at least, nearly ready.


When I became then CNO at Providence Portland Medical Center (PPMC) in December of 2017 I had not led an organization through a Magnet designation as a CNO. Joining an organization seeking their fourth designation was likely a good place to gain experience. My rationale was that since there has been multiple successes already, the infrastructure for success would be readily present and I personally would learn a great deal from the people and systems already in place.


Shared governance, ownership and partnership


It was immediately apparent that we had some work to do on the nursing infrastructure at PPMC.  Our hospital wide shared governance councils were not meeting and only a handful of our unit-based councils were meeting consistently.  Nurse sensitive indicators were not widely shared and most nurses I directly interviewed could not tell me how nursing was performing as a whole or at the unit level. Additionally, there were no strong nursing venues to share data and best practice.  Though this was concerning, we had plenty of time to get this back on track, we were on our Magnet journey, so I brought the team together we made a plan and got busy. 


We rebuilt our shared governance structure and we got the nurses their data.  Together we started to see the culture shift around nurse sensitive indicators.  It was no longer another task to be done for quality, rather the product of our work that was for us to own.  We partnered with medical staff early and saw an immediate improvement in our outcomes.  We started to assemble our required Magnet “document” and it initially seemed we were right on track to be ready on time if not early for submission. A little over 90 days before our document was due it became clear that our document was not on track.


Not as “on-track” as we believed…


There were signs along the way that things may not be going as well as they seem. Due to several contributing factors, I came to understand that our ¾ complete document could not be used and we had a major problem. We had to start over and do it fast. I reached out peers both inside and outside the organization who had experience in Magnet for their input.  We again found ourselves at the table making revisions to our initial plan. The great thing was that in fact, all of the work was there.  The problem lay in the document itself, ninety days from submission and we didn’t have a document to submit. Ninety days to a complete document of this level seems at first glance an impossible task.  I had to make some changes to the writing team, we made one addition and we empowered others with the autonomy to do the work.  The team knew what needed to be done and made it happen. 


At the same time, it was becoming clear that we no longer had a relevant professional practice model (PPM).  The Magnet champions requested support to revise the PPM and were empowered to research and develop a new model.  The team decided that a relationship-based professional practice model better aligned with our high reliability culture and inter professional care delivery model.  


We re-visited our “why”


In parallel to the work of the Magnet champions and revising the PPM, I was transparent and candid with all our nurses and leaders. I made sure that everyone from leadership to the bedside understood our current state.  I also took the time to help everyone understand the obstacles.  I reassured that we had a plan, built by a trusted team and I explained what I needed from everyone, both technically and personally.  I believe that it was through this transparency and visibility that our nurses rallied. The stories flowed in and everyone began to see Magnet a little differently, they better understood what it stood for and took tremendous pride in sharing their part. It also should be added that the support of leadership across the system was instrumental, if not critical, to our success.


Support from all levels


Fortunately, we have some smart and dedicated people and leadership at PPMC was dedicated to achieving magnet. It became an all hands-on deck process and there was not a single person in the organization that did not try to contribute where they could to support our journey. This comprehensive support is quite a cultural accomplishment and one that I commend PPMC Leadership for fostering and maintaining. It’s also a fantastic foundation to work from. Leadership also understood that they didn’t have all the answers or best practices, those would have to come from the people doing the work.


Empowerment in action 


It’s easy to talk about empowerment or even gloss over it but what does it really mean? For us, it meant that our direct care nurses and their leaders, even though they did not have the infrastructure necessary to ease their way, were empowered to drive their practice and advocate for changes that improved outcomes, improved patient and nursing experience and ease the way of those providing care.  The culture was there regardless of the challenges.   This culture of empowerment was again evident is the work the Magnet Champions (direct care nurses) did on the PPM. They did the research and created a model that would guide the professional practice of nursing at PPMC.


The culture of empowerment was so strong that we found every story we needed and more. To me this is the true testament of the culture of a Magnet organization.  Our nurses were empowered to own their practice, make improvements to areas of opportunity and improve outcomes. Fast forward ninety days and our document was done and submitted.  Shortly thereafter we learned that our document was accepted, and we moved directly to site visit and were scheduled for March 2020. We quickly moved to site visit preparation.  


Unexpected constraints


It was at this time that our work on COVID 19 really ramped up alongside Magnet prep. Not surprisingly so did the stress level of across the organization.  It was not uncommon in the beginning to hear our nurses discuss the pandemic and the changes associated that disassociated them from the decisions made to adjust practice to respond to the pandemic.  In response to this sentiment, I took the new PPM and created a video outlining how we were using our PPM to respond to COVID 19. This fundamentally changed the engagement of our direct care nurses in our COVID response.  There was no longer a feeling of something being done to them, rather the result of the profession collaborating with the other members of the care delivery team to adapt to the current challenges facing healthcare.  Our nurses now understood that this was their own work and engaged at a deeper level. This engagement translated to anticipation for the site visit: our direct care nurses were actually excited to share the work they were doing in response to COVID.


Fast forward, more constraints…


Fast forward to late February, a few weeks prior to the site visit we received a call from the Magnet Program office asking us to move to a virtual visit (Covid-19 impact).  We repositioned again to prepare for a virtual visit. One week prior to the site visit, the volume of PUI’s and Covid patients increased dramatically, and we needed our nurses and care delivery team to focus on the immediate safety and care expectations for this patient population.  The Magnet commission was a great partner in this and understood the dynamic.  They quickly agreed to move our virtual visit to June.  


Everyone focused on our response to the pandemic during March and April then in May we ramped up again for our virtual site visit.  We checked in with our staff and leaders. They responded that they were ready even though everyone was distracted with COVID 19.  In our  mock virtual department visits it seemed that everyone was ready to go.  Our appraisers requested that we use Microsoft Teams for our visit, a platform known to us, so we agreed.  This would be the Magnet Programs 5th virtual site visit in the United States.


Who says it can’t be fun?


Our first order of business was to create an event that was as exciting and interactive as an in-person visit.  We put each appraiser on an iPad on a rolling stand.  We then dressed the stand in scrubs and gave them a name badge.  We took the stands around and checked for connectivity throughout the house looking for any dead zones.  We used a duel escort model.  We chose one Magnet champion to be the “escort” with a second working behind the scenes to do any trouble shooting that may be necessary.  This allowed the escort to fully engage with the appraiser they were assigned to.  Between our Magnet team and the appraisers, the experience was very real, interactive and engaging.  It truly felt like the appraisers were on site.  Lots of lessons learned and tips and tricks for a site visit but from our experience it truly is possible to have a virtual experience that is as meaningful as an in-person visit.  


Dream Job?


After having this experience, I am invigorated by the nursing team at PPMC at all levels and look forward to what the future holds.  I have shared with a few peers how excited I am to be a CNO in an organization that values the professional practice of nursing. Sure, we will always have some more work to do to continue to grow and improve the infrastructure in place to help further empower our direct care nurses in their pursuit of excellent patient care, but this is the good stuff!  Now it is time for innovation.  We have been recognized for the good work that has been done and we are not stopping here. 


Yes, I can state confidently that I truly am in my dream job. -JG