Every May, National Nurses Week gives us an opportunity to recognize and celebrate the immeasurable impact that nursing professionals have at the bedside and beyond, supporting and caring for patients and their families at every stage of life. Learn about some of the new and exciting opportunities for nurses and aspiring nurses in Vermont in this interview with Kate FitzPatrick, Chief Nursing Officer at the UVM Medical Center.
Listen to the interview at the link below, or read the transcript that follows.
What is your vision for nursing at the UVM Medical Center?
I would start by saying that I don’t really see it as my vision. I see it more as our vision. So I see it as an opportunity to include the voices of our nurses at the front lines and our nurse leaders in helping shape a shared vision for nursing. I would say there’s a couple of key components that are a part of that vision.
Some of those include first and foremost this idea that we value our nurses as professionals with a practice, versus staff or labor. We value and invest in lifelong learning for our nurses as part of the vision. So, we are creating an environment where there are opportunities for growth and development of all of our nurses. We really value nurses voices in making decisions about their practice and their practice environments. So those are some core things when I think about what’s shaping our shared vision for nursing here at UVM Medical Center.
What does it look like to have nurses involved in decision making?
That’s a great question. So, one of the focus areas for us over the last year and a half has been developing what we call nursing professional governance, or NPG. And NPG is a structure that brings together nurses from various care settings, to really drive decision-making about things that are part of their clinical practice or their practice environment.
From the inception of NGP here, we involved clinical nurses in how that was designed, so we had a specific group of clinical nurses that were part of a design team with a couple of leaders involved. And they really crafted what is now our NPG structure. And I think it’s one of the most unique and revolutionary models in the country, because it uses a service line approach. So, we have nurses again who practice in different areas, but care for common patient populations, serving together on counsels and really looking at care and care delivery together. And then we also have incorporated patient and family advisors on every aspect of the structure.
So it’s those two things make it very unique and really powerful.
What are we doing to expand the role of our nurses? What might somebody look forward to if they’re thinking about going into nursing in 2018?
Yeah, that’s a great question. So, a couple of things around expanding the roles, really looking at the roles of our nurses. One thing that we’ve done over the last year is some work called accountability mapping. Where we’ve really engaged our front-line nurses from different roles, brought them together to really talk about what are the key things that this role really drives and is accountable for. So we’ve done that for our staff nurses. We’ve done that for all of our leadership roles. We’ve just recently done it for our care coordinators, our nurse educators. And so what that’s done is really allow us to be very clear and specific about what is this contribution of each individual role in nursing. It helps nurses also understand what each other brings to the care delivery for patients. So that’s been really powerful.
But some of the other things we’ve done to really advance or expand nurses is, we have a new clinical advancement and recognition program called CARP. And we’ve added an RN 4 to that structure. So in this new model, which was designed by clinical nurses, we have the ability for nurses to promote. And that involves them taking on projects or leading specific work, helping support other nurses’ development at the bedside, being involved in quality and safety initiatives. And it also requires certain educational preparation and professional certification as part of the criteria for different levels. So we’re really very excited about this new clinical advancement structure.
And I’m happy to say, we’ve promoted our first four RN4s, which has been really great for them to start to take on these expanded roles.
What are some of the quality improvement or research projects like?
They’re working on a variety of different things. But just to give you a sense. So one of our clinical nurse 4s is in the emergency department. And he is doing some work to really look at how we prepare nurses in the emergency room setting to care for trauma patients. And he’s envisioning the development of what he’s calling a trauma nurse fellowship, which is an innovative way to really build the competence of nurses around injured patient care. So that’s just one example of many.
Is that a new development in the profession?
I think it’s always been an expectation that as part of our practice, nurses have domains of areas that they focus on. Clearly clinical practice is part of that, that’s a central part of it. But there’s also a leadership element to it. And then there’s also this idea that nurses work within a framework of evidence-based practice or help lead research, so that we’re always really studying the practices that we’re doing and how we’re delivering care, making sure it’s the right thing, and having some way that we can substantiate that the things we’re doing in practice really are driving towards the outcomes we want for our patients.
So I think it’s been part of the fabric of what a nurse is. What we’re trying to do here at UVM Medical Center is really design a culture where nurses have more opportunities to work in all those domains beyond just clinical practice.
What are some more accomplishments so far?
One of the ones I’m really proud of, beyond the nursing professional governance structure and the clinical advancement program, which have both, I think, been super enhancements to our professional environment here. The other is work that nurses have led in the past year to standardize patient-centered reports, which is really how nurses hand off to one another at change of their shift. And involving patients and families in that process, but also having some standard work, in terms of how they communicate with one another, how they communicate and engage the patient and family and what’s important to them for the next period of time, but also how they do a dual safety check together of the environment to really make sure that we’re doing some proactive risk assessment together.
So I think it’s a really wonderful initiative to really help minimize risk to patients and improve safety.
What does that look like?
One of the most important elements of this is we move the actual RN to RN shift hand-off into the patient’s room. They are at the bedside together. They’re capturing the most important things that happened in the previous shift and then beginning to talk about what’s going to be happening in the upcoming shift and sharing important events that happen, then really bring the patient and families voicss in, in terms of what’s most important for you in the next 4 to 8 to 12 hours and how can we make sure that we’re aware of that and can help facilitate that. That includes some very specific things around areas that we know can be risky, like medication administration.
There’s been a lot of talk about Magnet Recognition® from the American Nurses Credentialing Center. What does that mean to the nursing profession and to the organization?
One of the things I always like to say first when I talk about Magnet designation is it’s really not about the destination or the finish line to get the official Magnet recognition. It’s more about the process of how we transform a culture to really focus on practice excellence. And how Magnet came to be in the country is that back in the 1980s, there was a nursing shortage. There were a group of nurse researchers who were part of the Academy of Nursing who started to observe that there were some hospitals in the country who, despite a nursing shortage, were able to attract and retain high quality nurses and they were continuing to demonstrate high levels of quality and had very strong metrics around their outcomes.
They identified these organizations who have this secret sauce of sorts, and so why I’m excited about it is we have amazing things happening here at UVM Medical Center. We have wonderful nurses and they’re doing amazing work and we get wonderful feedback from our patients. What we haven’t focused on as much that we need to is, how do we really engage nurses differently in quality improvement work? How do we have them really engage in evidence-based practice work and have structures that support them to do that? And it’s not just about the nurse, it’s about the nurse and the interprofessional team.
So that’s just a little bit about what Magnet is about. So it’s really more about the journey to start to embed the standards that Magnet represents, which we know as we’ve studied hospitals in the country, there’s about eight percent of the hospitals in the country have attained Magnet designation. As they have been studied over the many decades that Magnet’s been in place, we’ve seen that they continue to be the organizations that have the highest level of outcomes for quality and safety for our patients and that have the most satisfied fulfilled nurses.
What is a nurse scientist? And what makes it unique from other nursing roles?
Yes, we are very excited about the nurse scientist role that actually right now is a pilot program, or a pilot role. And it’s been a wonderful collaboration between the UVM Medical Center and the UVM College of Nursing. So, my colleague who’s the chair of the nursing program at UVM and I talked about the mutual benefit of having a PhD prepared nurse who has focused their career and their work in nursing on advancing the science of nursing. So really, how do we study the practices that we’re engaged in now and are they the right practices for patient care outcomes?
Partnering with the nurses at UVM Medical Center over the last five months to really think about, how is it that we can create a structure where nurses can ask a research question and then be shepherded or mentored through the process of actually putting together a full on research project. And look at how they would conduct a research study. So that will then help in the future, this role of a nurse scientist target some real specific interventions to help develop the skill set and the knowledge around nursing research.
You’ve seen a lot of change in nursing as a profession. What might surprise you? What might not?
I think one of the things is just the different ways that I’ve seen roles for nurses expand. So, as we’ve thought about more care happening in the ambulatory setting, nurses that also work out in community settings. There has been more of a shift of care being delivered out of the care hospital and into those types of settings. And so the roles that have emerged for nurses, like nurse navigators. I think there’s also been great opportunities for advanced practice nurses like nurse practitioners, to really think about practicing in different settings that’s helping with work around population health and managing patients across a care continuum in a different way.