Chapter 15: Projects as Chief Nursing Officer: MD Anderson’s Magnet Designation; the Nursing Practice Congress; Primary Team Nursing
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Description
Dr. Summers talks about accepting the challenging position of Chief Nursing Officer. She notes that MD Anderson was in the process of preparing for its re-designation as a Magnet Institution (by the American Nurses’ Credentialing Center).
Dr. Summers explains why the Magnet designation is important to MD Anderson and describes how this designation supports the practice of transformational leadership. She explains that it connects to her role as Chief Nursing Officer and her goal of creating an environment in which nurses are in charge of decisions about practice.
Dr. Summers next talks about the Nursing Practice Congress and the model of Primary Team Nursing model she developed at MD Anderson. She explains how this involves scheduling nursing activities for an entire team and lists the benefits of this model for patients, the institution, and for team members.
Identifier
SummersB_02_20140401_C15
Publication Date
4-1-2014
Publisher
The Making Cancer History® Voices Oral History Collection, The University of Texas MD Anderson Cancer Center
City
Houston, Texas
Interview Session
Barbara Summers, PhD, Oral History Interview, April 01, 2014
Topics Covered
The University of Texas MD Anderson Cancer Center - Building the InstitutionThe Administrator The Leader Professional Path Contributions to MD Anderson MD Anderson Snapshot MD Anderson Impact Understanding the Institution The Professional at Work Discovery, Creativity and Innovation Professional Practice On Leadership
Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License.
Disciplines
History of Science, Technology, and Medicine | Oncology | Oral History
Transcript
Barbara Summers, PhD:
Then there was the day, three years after I had been in this associate vice president position, the day when David came to me and offered me the position of the Chief Nursing Officer. And I was surprised, to say the least. The previous chief nursing officer, Dr. Crosley, had left fairly quickly, and David had offered me this opportunity. Initially I thought, “I don’t know if I could do this, because I didn’t have this on my radar and I don’t know if I could be a Chief Nursing Officer.” Then I stepped back and I thought, “But wait a minute. Who would he possibly bring in here who could do it better than me?” So I again took the position of, “I believe I have some fundamental skills that can be useful. I believe I have a passion for nurses and nursing practice that can promote advancements in the practice of nursing and that can benefit the nurses and patients in the institution. And, you know, nothing ventured, nothing gained.” So I said yes, and moved into the position, and it was definitely drinking from a fire hydrant, not even a hose. It was directly from the fire hydrant. There were multiple opportunities for us to look at nursing practice and how we could improve it and how we could strengthen it. We were in the cycle of preparing for our second Magnet nursing designation, and there were some areas that we really needed to work on and focus on to be able to authentically meet the standards for Magnet designation.
Tacey Ann Rosolowski, PhD:
Can you tell me about that? Since you brought up the Magnet, that was one of the things I wanted more information about that. What is that Magnet designation, and why is it so important to the institution to have that?
Barbara Summers, PhD:
The Magnet designation is important from an external perspective as well as an internal perspective. External to the institution, it is a designation of excellence in nursing practice. It’s a designation of the value with which nursing is held by the organization. It’s an indication to nurses that this is a true magnet, in that you will be attracted to practice here because the practice environment is very supportive of nurses. It’s an indication to patients and their families that the level of nursing care here is of the highest quality. So that’s externally why it’s beneficial. Internally it’s beneficial because to meet the standards for Magnet designation requires that the organization have in place all of these supports and structures to ensure that nursing is practiced at the highest level. So it requires that there be evidence of transformational leadership on the part of the chief nurse, but also the other nursing leaders in the organization.
Tacey Ann Rosolowski, PhD:
What does that mean exactly?
Barbara Summers, PhD:
It means that the—and I’ll focus on the role of the Chief Nursing Officer. It means that as CNO, being a transformational leader, that I am involved in decision-making at the highest levels of the organization as they relate to clinical operations and patient-care delivery and will have an impact on nursing care and nursing practice. It means that as a transformational leader, I initiate change in the organization, both within and outside of nursing. It means that as a transformational leader that I engage the hearts and minds of the entire nursing community in pursuit of a goal or a vision. So that’s what that’s about. And then another aspect of Magnet designation is around the concept of structural empowerment, and that really talks about how do we create the environments whereby nurses, clinical nurses are actually in charge of practice decision-making. And the way that we have done that here is through the development of our Shared Governance Model, which is our practice congress, our Nursing Practice Congress, which has actually evolved into an interprofessional practice congress.
Tacey Ann Rosolowski, PhD:
I’ve not heard anything about this Nursing Practice Congress. Can you tell me more about that?
Barbara Summers, PhD:
Yes. The Nursing Practice Congress is comprised of nurses as well as other healthcare professionals now—respiratory therapists, pharmacists, social workers, case managers, patient transportation, etc.—who are elected by their peer group to serve as Nursing Practice Congress representatives or delegates, and their responsibility is to come to Nursing Practice Congress and to make decisions about clinical practice on behalf of their constituent group. So, you know, I like to say it’s what the United States Congress would look like if it were functional. And the beauty of the Nursing Practice Congress, or the Practice Congress, is that any clinician can bring an issue forward to the Practice Congress. An issue, idea, or a concern can be brought to the Congress. The Congress then listens to the individual presenting the issue and makes the decision whether or not it’s an issue appropriate for the Practice Congress. And if it is, then the Practice Congress authorizes the creation of a team that will be focused on this particular issue.
Tacey Ann Rosolowski, PhD:
Can you give me an example of something that would come up in the Congress?
Barbara Summers, PhD:
Sure. One example was an issue that was brought forward that resulted in developing an algorithm to manage patients who were complaining of chest pain in the hospital that would allow nurses to initiative specific interventions while they were waiting for a physician to come and evaluate the patient. So, I mean, that was lovely because the end product was a nurse-initiated chest-pain protocol that would allow nurses to order an EKG and order specific laboratory tests to be done and to make sure there was an IV started if the patient didn’t have an IV, while they were simultaneously calling for a physician to come and evaluate the patient. So that involved nurses working with cardiologists and the EKG technicians and Laboratory Medicine. Another example, which I think was just lovely, is an issue that was brought forward to support patients who became physically ill while they were here as an outpatient and soiled their clothing because they had an accident of elimination, couldn’t make it to the bathroom in time, or they had vomiting or whatever. This group came together—it was a very lovely interprofessional group—and created a process so that if that happened to a patient, that we would then have a team, small team, that would include a nurse that would come down and be with the patient, evaluate them, make sure they were stable, and then give them a pair of scrubs so that they could change their clothing, and also some toiletries so that they could get cleaned up so that they would be able to be comfortable and not have to be embarrassed and be in soiled clothing for the rest of the day.
Tacey Ann Rosolowski, PhD:
Now, you talked about both of these examples as being lovely, and that’s an interesting word that you’ve used to identify. What do you mean by that? What does that word mean when you say that’s a lovely example of something happening?
Barbara Summers, PhD:
It’s lovely because the clinicians identified the issue, owned the issue, and resolved the issue, and that’s what you want to see happen. You know, they don’t want and they don’t need and it’s not good for me sitting in my chief nurse office to come down with decisions, because I am not at the front lines practicing. I am not the expert. So the thing that’s most lovely is that these professionals are owning their practice and they’re making their own decisions about their practice. So the Nursing Practice Congress has been just tremendously successful and effective and has a very high rate of issue resolution. They have a database where they track all the issues that have been brought forward and what the resolution and outcomes have been. It’s been really very good to see that, and it just continues to build that sense of professionalism among the nurses.
Tacey Ann Rosolowski, PhD:
Now, just to clarify, is this congress unique to MD Anderson, or is it something that’s happening in other institutions?
Barbara Summers, PhD:
There may be some other institutions that have a congressional model. The first congressional model that I’m aware of was at the Inova Fairfax Hospital, and that’s decades ago. And actually, when we developed our congress model, it was somewhat modeled after the Inova Fairfax Hospital model. Subsequently, other institutions have taken up this congress model that we developed, and they have implemented a variation of it in the organizations. It’s not the norm. And most other hospitals have a councilor model where they have a council that looks at clinical practice, a council that looks at education, etc. The thing that’s unique about this model is that the delegates are elected by their constituent group to represent their constituent group, so the responsibility of the delegates is actually to communicate with their constituents to say, “This is the issue that’s come up. This is the team that’s been formed. Please get involved if you have an interest in this. These are upcoming decisions. If you have thoughts or input, please let me know.”
Tacey Ann Rosolowski, PhD:
And I see how what’s unique about this model is precisely what you’ve described in those examples, that it comes from the front lines, it comes from the people who are hands-on. They’re solving it. They’re taking ownership and resolving the problems.
Barbara Summers, PhD:
Exactly.
Tacey Ann Rosolowski, PhD:
Very interesting.
Barbara Summers, PhD:
So, structural empowerment, transformational leadership. Probably the most important standard for hospitals that are being redesignated, who’ve met the Magnet standards and are now in redesignation is the demonstration of our creation of new knowledge, improvements in practice and innovation. And over the years, the Magnet designation process has shifted from organizations reporting processes, like, “Oh, we have the Nursing Practice Congress and it meets once a month and we make sure we have 75 percent attendance to reporting outcomes.” And so because you can’t have outcomes if you don’t have the processes in place, so now the focus is really on what are your outcomes, and the outcomes are of utmost importance when we’re looking at new knowledge, improvements, and innovations. So as an example, in innovations, we have through our nursing Professional Practice Model, which is grounded in relationship-based caring and is based upon the Theory of Quality Caring developed by Dr. JoAnn Duffy, we have now built a new nursing care delivery framework in the hospital called Primary Team Nursing that involves creating a dedicated team of nurses and nursing assistant staff who provide care consistently to the same group of twelve or sixteen patients. And they are all scheduled together as a team, and they work under the guidance of a bedside clinical nurse leader, who is a master’s-prepared nurse, but who is practicing at the bedside. This is not a manager. And they focus on continually improving the outcomes of their care. So because they are practicing in a team with a clinical nurse leader, they are able to evaluate the outcomes for this small group of patients, and they’re able to visualize in real time the impact of their practice and make adjustments to their practice so that they can improve the outcomes. It also significantly improves the continuity of care for patients and families, which results in greater satisfaction for the patients and families. They have a higher degree of confidence that their information is being communicated effectively and handed off from one nurse to the next nurse because they actually are seeing fewer nurses. They have the same care providers over and over. It’s greater satisfaction for the multidisciplinary team because they are interacting with fewer numbers of nurses, and so they are getting more consistent information about the patients. We are much improved in our continuity of planning and delivery of care because there are fewer people involved, and so we can maintain that consistency. And then there’s tremendous benefit in satisfaction for the team, the nursing team, because they, number one, are a much tighter group, and so they come to know one another at a deeper personal level and they can celebrate their successes as a team. They also can see the fruits of their labor. They can actually observe from beginning to end what happens with a specific patient family who comes in to receive care in the hospital. So that’s an example of an innovation.
Tacey Ann Rosolowski, PhD:
Can you tell me more? The primary care teams was on my list to explore further. There was a lot of reporting on this in the MD Anderson internal media. Is now the time to delve into that a little more, or would you like to kind of talk about other issues that you were confronting in this first—
Barbara Summers, PhD:
Well, I want to make sure that just we get a number of the issues out, and then we can come back.
Tacey Ann Rosolowski, PhD:
Sure, okay, we’ll come back to it.
Recommended Citation
Summers, Barbara PhD and Rosolowski, Tacey A. PhD, "Chapter 15: Projects as Chief Nursing Officer: MD Anderson’s Magnet Designation; the Nursing Practice Congress; Primary Team Nursing" (2014). Interview Chapters. 1252.
https://openworks.mdanderson.org/mchv_interviewchapters/1252
Conditions Governing Access
Open
