>> Hey everybody, thanks for having me today.
So this presentation, first off,
is a paired-down version of a presentation that
I did in Indianapolis in March, at the Sigma Theta Tau
International Healthy Work Environment Conference,
so the longer full presentation focused on
skilled communication as one of the six pillars
of a healthy work environment, and more specifically,
how we use transparent two-way communication
in the evaluation and revision
of our professional practice model.
So, after we got the feedback from the conference,
which was from, you know, international audience,
they were really impressed with the work
that our nurses had done,
so we decided it would make sense to kind of tailor
this down to be more specific to us in a short version,
and take it on the road, so this was presented
at the Nurse Leadership Forum at the end of April,
and then Mary asked me to come and present here.
So, that's how this evolved.
So as you know, we are a magnet hospital,
and magnet hospitals are required to have
a professional practice model,
and regularly evaluate nurses' knowledge
and engagement with the model.
So, evaluating the professional practice model,
or PPM, is nothing new,
however we wanted to take a new approach this time,
so, what we did in the beginning of the process was to ask
our nurses, we took a random sample of nurse managers,
and the newest nurse on the unit,
and I went around as part of my project
for completing my graduate degree,
that's how I came on board with this project,
and so, I began working with this team.
And we asked, what do you know about
the professional practice model,
how does it relate to your practice,
just some general questions
to get a baseline level of knowledge,
and what we found was that nurses didn't really know much
about the professional practice model in its form,
but what we heard was perfectly aligned with
all nurses from all levels in all departments,
as well as aligned with previous work
we had done in focus groups and surveys.
So, the original plan was to baseline that small sample,
test the questions, and see if it gave us the information
we wanted, and then baseline everybody,
but when we reached saturation at that point,
we realized we don't need to baseline everybody,
we're hearing the same thing, our nurses are
perfectly aligned in what they think
about what it means to be a nurse.
So, we kind of changed course, and thought,
when we researched the literature, the traditional approach
is you create the model, you revise the model, then you
create an educational and marketing campaign and teach it
to everyone, but we wanted to do something different.
So, the nursing leadership supported the use
of having our nurses put the model in their own words.
So, this was kind of an ah-ha moment where we realized that
if the nurses crafted the language and it was
in their words, we wouldn't have to teach them anything,
it would be just the way they practiced.
It would be nothing new to learn, it would just
be a way to kind of package what they're already doing.
So, we have a group of nurses called Magnet Ambassadors,
and they meet regularly, quarterly, to work on
magnet initiatives and act as a good liaison
between leadership and front-line nurses
back and forth, helping with communication of different
quality improvement and magnet-related initiatives.
So, our goal was to not have this be because of magnet.
We wanted people to have a professional practice model
that was relevant and meaningful
and just part of what you do here,
not something that you have to relearn
every couple years for magnet.
So, we thought, what a perfect group
to get feedback from as the Magnet Ambassadors.
So, we put together a proposal and went
to one of their meetings and said basically,
how would you like to help us work on this project?
What we want you to do is meet with the nurses on your
units whenever you can, informally, just as time allows,
if you have five minutes in the hallway,
during lunch break, during shift breaks,
huddles, wherever the case may be,
and ask them what it mean to be a Hopkins nurse.
Our probing question was,
if you were talking to someone that didn't work here,
in one sentence, how would you explain what makes being
a nurse here different from anywhere else?
'Cause there is a difference.
So, 27 Magnet Ambassadors volunteered for the project
and 21 out of the 27 completed it.
So, we had a 78% completion rate, which was pretty good
If you've ever worked on any projects.
And they recorded 132 hours of conversations
for 6.6 hours of recordings.
We gave them each a digital recorder
to just use at their convenience.
We had an outside company transcribe it,
and make sure it was anonymous, and then each of our
work group read each conversation two times.
At least two members read every conversation.
So, then we performed a thematic analysis
on that qualitative data and then took that
to the Magnet Ambassadors and said, did we get it right,
is this what you heard, is this what nurses said?
And then we took it up through the communities.
One member of of our work group went to all
of the various committees in central nursing,
and then we took it to the directors meeting and said,
does this make sense to you?
Does this sound like what you're hearing as well?
And then, we took all their feedback from all the committees
and directors back down to the Magnet Ambassadors and said,
what do you think, is this language still right,
does this still make sense,
does this still represent what you heard your nurses say?
So, the Magnet Ambassadors were the final say
on approving all the language and all the terminology
and really the heart of the PPM.
It took several rounds back and forth
to get that information.
So, these are some quotes after the launch
from our Magnet Ambassadors, who were a part
of the launch in a panel participation method.
So, they talked about what it was like to work
on the project, how their role changed them,
and how they wanted to work moving forward on the model.
So, as you'll see, one of the unifying things
that came through was the Hopkins pride.
That was evident from the start that nurses are really proud
to work here, and there may be pluses and minuses
along the way, but the pride is always there.
That was a unifying theme.
So, they noted that they were gratified,
that they weren't really aware how much pride was there
until they worked on this and started hearing it from all
the different areas and all the different nurses,
and that the graphic really represented
what it was like to be a nurse.
And then just a few more quotes about how
an unanticipated benefit was the fact that it generated
positivity and unity on their units.
Working on this project really made the nurses think
and work together about, kind of their core values.
Why are you here in the first place, why are you a nurse?
So, as I said, there was a noticeable improvement
in positivity and as you know, nurses here at a large
academic medical institution are surveyed a lot.
We're asked for our opinion a lot,
which is great, it's very important to be involved,
but we may not always see the results of our feedback
or hear what happens from our input,
so, we really intentionally built this process in
that we would go to their quarterly meetings
and give them feedback and updates, and let them know,
here's where we are, here's what's remaining,
this is where we need your help,
and they were really key in this process all along the way.
Every little step was run through the Magnet Ambassadors,
and they, in turn, would take it to their units and get
feedback from their nurses about the work they were doing.
So, it really built a high level of trust, and the nurses
really saw the changes in the model as the work progressed.
So, they were engaged and really excited to be a part of it.
So, here is a little slide and this is
actually available on the Intranet
If you go on the Internet and Intranet, we have some videos.
If you have not seen them, I encourage you to watch them
and a resource tab on the Intranet
where we have several resources for your use.
We have the videos, a downloadable version of the poster,
we have just the graphics for you to use
in meeting minutes or agendas, or however,
a newsletter, any use that you have on the unit.
We have this slide, we have a PDF of the slide,
the presentation I'm giving now,
a little bit longer than this one
and we will be putting a guide with that,
like a talking guide, we have a talking points guide,
so there's many resources and there will be
additional ones added as we develop them.
So, I just wanted to kind of give you an example
of the subtle but diligent work the nurses did.
So, the design on the top was the original PPM
in it's latest version when we started this project.
It had been revised over the years.
It was in place since 1981 so it's been around for a while,
and what our nurses said was, their goal as being
a nurse here is to achieve safe,
compassionate family and patient-centered care.
That's their goal and to do that,
achieving that goal involves all these components.
We care, we influence, we excel, we empower,
and each of them had categories and behaviors
that are associated with each.
So, they moved, I don't know if you can see,
the top one is a little hard to read.
The inner circle used to say we achieve,
but the nurses said, that doesn't really make sense,
that's not how we practice,
so we're going to move that to the outer circle,
and that's going to be the continuous goal is achieving
this safe, compassionate, patient family-centered care.
So, that was the first change.
Then they reorganized the components to be an inner circle
and align the words with each component.
They added a baby to represent the full lifespan,
and then they linked we achieve
with our patients and families because they
are the center of everything that nurses do by color.
It's the Johns Hopkins blue.
So, that was a subtle but unifying note there.
They also said that caring is the standard.
Caring is where it all starts for nurses.
It's the gold standard so it's Johns Hopkins gold,
and it's where the arrow starts
because it all starts with caring.
So, that's another, like subtle thing
that you may not realize but a lot
of thought and conversation went into that.
They even took the time to align the two warm colors
opposite each other and the two cool colors opposite
each other because it would be more visually pleasing.
So, a lot of the things that they did
were in service of their three goals,
which were to have a graphic that was easy to read,
easy to recognize, and visually appealing.
And I think they really achieved their goal.
It looks so much crisper and clearer
and the feedback that we got from the various presentations
we've done are that you can really
read a lot into it, but it's not overwhelming.
Sometimes if you see professional practice models,
they're very busy and they wanted to make sure
that it was just clean and easy to read.
So, hopefully you've seen these, and this is the end results
so far of the Magnet Ambassadors' work.
So, every unit has a professional practice model poster,
which is the educational piece.
This is the entire model.
I know it's hard to read on screen,
but this is available on the web,
and you all have them on your unit.
And this is a succinct way to put the model.
Instead of a long paragraph form that it used to be in,
they put bullet points with specific behaviors
that we would expect to see when nurses
are practicing in a professional manner,
and we want to tie these into ways that we operate daily.
So, we want to make it easy for you to say, you know,
Mary, you did such a great job with Mr. and Mrs. Jones,
they were having such a hard time,
what a great example of we care,
to make it really relevant and easy so that
if someone says, tell me about your
professional practice model, it's not anything new,
it's just talking about the way you practice.
Think of it as kind of a way to visually
highlight and package what you already do.
That's the goal.
so, it's nothing new to learn, nothing new to memorize,
it's just kind of a way to label
and describe what you already do.
And then, of course, the PPM tumblers.
They were given to all nurses
and its members of the nursing team,
and that's, I guess, another point I should highlight.
The Magnet Ambassadors wanted to make sure that
our nursing teams were included, not just nurses.
So, we left it up to the units
to define what your team is to you.
Does that include CCSR, Tech?
Does that include, some people included some of their EVS.
It's all kind of based on what
you consider your nursing team.
We wanted to be inclusive while being fiscally responsible,
and for new hires hired from the launch on,
you can call central stores, the tumblers are now with them,
so you can just request a nursing PPM tumbler
and there's an SAP number and it'll be sent to your unit
and just billed for how many you order.
So, that's kind of a permanent procedure in place
so that new hires can come onboard,
and you can develop a process on your unit,
whoever typically kind of does the conversation with hey,
congratulations, you've done your orientation,
now you're a nurse on our floor.
Here's part of what we value on this, you know,
maybe a little talk about the professional practice model.
If they haven't already seen the videos,
you can incorporate that.
And then the lower left-hand corner are their
professional practice model post-it gratitude pads.
So, these were an idea that
the Magnet Ambassadors came up with.
They initially, and this is kind of an example
of the organic work they did.
One of them suggested having little postcards
so that they could kind of write little notes to each other
like what a great job, what a great example of we influence.
You know, you led that multidisciplinary rounds today
and you made a change in the care plan
that's going to really be beneficial.
And then they had talked about,
well then, what would the nurse do with that afterwards?
It would probably just get tossed because
there's nowhere to keep that kind of stuff.
So, then someone suggested, how about a token?
And so we had a sample of that made and they realized,
hm, it looks kind of like a bar coaster.
So, same problem, what would we do with that afterwards?
So then, just through conversation in one of the meetings,
one of them said, what about a post-it note?
We could stick it on each other,
we could stick it on the computer,
we could stick it on our locker.
It's smaller, you know, not as thick, not as unwieldy.
They could keep it or not, and it's just more portable.
So, they completely thought of that idea
on their own, so now we have them.
They're available in sets of 40 pads through Smartworks.
It's about $73 for a set of 40 pads.
At the NLF, we had a panel discussion from nurse managers
and nurses who had done kind of a little above and beyond
on the rollout of the revised PPM since the launch,
and one of their suggestions was two-fold,
to use these however they work for you.
That's how the Magnet Ambassadors envisioned
the PPM cards to work, the gratitude cards,
but if that didn't work for your unit,
feel free to change it up.
For example, this unit in endoscopy realized that
no one was really using them in that way.
They were just kind of using them as a regular post-it note,
so she decided she was going to give them to two people
who were going to be the keepers of the PPM.
So, these people had them in their pocket at all times,
and were kind of like the bright-spot notifiers.
So, whenever they saw something happening,
they would have a conversation and use the post-it note,
and that's how it worked for their unit,
so feel free to tweak these however it works for you.
She also had an idea about the poster.
Most people have hung it kind of in their nurses' station
or their break room where nurses see it a lot,
but she realized, through group input from her unit staff,
that they wanted to hang it where everyone could see it,
so they have a main thoroughfare where they
take patients for NNR procedures, and they hung it there,
and it sparks conversations with patients and families too,
oh, what's this, what's it mean, what's it about?
So, that was kind of an intentional
but unanticipated design,
and as far as the tumblers,
they recommend using something that's already in place,
so, if you have a regular meeting,
do you have a regular lunch and learn,
do you have, perhaps, some forum like this?
They had, in that outpatient area,
a regular session, I guess it's kind of a lunch and learn
where vendors come in and show them how to use new products.
So, she set up a station there and her station was PPM.
So, she had people choose a video to watch.
They talked about the PPM and its influence
and impact on practice, and then she handed out the tumbler,
and then they would come back
in the next month and talk about the poster,
and then the next month and do another activity,
so little drips and drabs of information
rather than kind of a big bang all at once.
So, whatever works for you and your staff,
but, you know, nursing is hard, it's 24/7.
You can't call everybody together,
hire a temp worker to answer the phone,
and you know, do a meeting all at once.
It's not like a regular business like that.
So, you have to do what works for you.
Our feedback also suggests that when available,
one-on-one opportunities are better than
kind of a big launch and presentation because
it's a little more meaningful,
and they also recommended to use your people that
are enthusiastic and engaged about the process
no matter what their role.
Don't be constrained because they're not an NC3
or they're not an NT2MRE.
If you have an NC1 or NC1M who is excited
about this, let them run for it,
and that's what they have found to be most successful.
They'll get a group of people, have some early adopters,
get excited, and really spread the word,
and it takes it, not only off of your shoulders,
but it gets the staff more involved
so it's more meaningful and they're more engaged.
So, that was all I wanted to share, and I wanted to see
if you had any questions or any feedback.
If you guys have Magnet Ambassadors in Psychiatry,
if you don't, I really, really recommend
taking the time to seek a volunteer.
They really are involved in a lot of projects,
not just magnet projects, and like I said,
we're trying to get away from working just for magnet.
We want to just work to the fullest extent of our practice
just because that's what it is to be a Hopkins nurse.