Magnet Status Matters: What Magnet Recognition Means for Hospitals and the Nurses Working There

Magnet Status Matters: What Magnet Recognition Means for Hospitals and the Nurses Working There

Hospital administrators across the nation advocate the merits of Magnet designation. The American Nurses Credentialing Center (ANCC), an affiliate of the American Nurses Association, awards Magnet status to hospitals that satisfy designated criteria that measure the strength and quality of the institution’s nursing care.

What Are Magnet Hospitals?

Magnet-designated hospitals are regarded as the pinnacle of nursing practice, leadership, and innovation. A Magnet designation stands on five pillars: transformational leadership, structural empowerment, professional practice, innovation, and empirical outcomes.

More than ever, hospitals seek to attract the best nurses, physicians, and ancillary medical staff. Magnet hospitals appear to fare better with these recruiting metrics, but do the benefits outweigh the costs? The return on investment requires measurable patient care metrics, a superior nursing environment involved in hospital decision-making, and higher net patient revenue than non-Magnet hospitals. With consumers looking to hospitals for quality, hospitals seek to raise the bar with a Magnet designation as a roadmap for excellence.

Finding a Hospital with Magnet Status

With nurses becoming more valuable amid the growing shortage, nurses can leverage their demand by exploring open nursing jobs and finding a Magnet hospital that meets their needs. How do you apply to a Magnet hospital? As with any hospital, search the institution’s website and locate the nursing employment link. Use our Magnet Showcase to review Magnet-designated hospitals to research your next employment opportunity.

Safety Across the Board

Hospitals are constantly striving to improve patient safety. However, a safer work environment extends beyond patient safety through lower nurse-to-patient ratios. A Magnet appointment is an investment into a safer physical work environment for the nurses. Reduced physical injuries and decreased blood and body fluid exposure rates translate into healthier nurses and reduced costs.

Improved Outcomes

When nurses have an elevated level of job satisfaction, patient outcomes improve. Low staff nurse turnover, a path to grievance resolution, decentralized decision-making, participation in data collection, and involvement in patient care delivery encourage and reward nurses through advancement in nursing practice. A Magnet designation validates the hospital’s mission.

Reducing Burnout

The COVID-19 pandemic left the nursing landscape littered with shortages and premature departures. Nurses seek engagement and empowerment; competition is fierce for high-quality, professional nurses. As health care grows, patients are becoming more complex. Shift work is demanding, with long pressure-filled hours. If you include the mental, physical, and emotional factors that fuel attrition in nursing, obtaining a Magnet designation can lead an institution toward an increase in the quality of the work environment.

Professional Improvement

Within health care, quality improvement is a sustained culture of practice improvement. The professional development of nurses is a tenet of Magnet: having employers support nursing autonomy and empowerment can lead to cooperation in leadership and vision. To succeed in health care, interdisciplinary communication and a collaborative mission of nursing practice can result in better partnerships with hospital leadership.

The Costs

Obtaining Magnet status can be expensive for smaller institutions. It takes over four years to complete the process, with an average of over two million dollars invested by the hospital. Proponents will argue that Magnet designation will offset the associated cost with higher net patient revenue and improved outcomes. A Magnet-designated hospital receives an adjusted net increase in inpatient income of $104.22–$127.05 per discharge. This translates into an added $1,229,770–$1,263,926 in income per year. Hospitals achieve payback from Magnet Status in two to three years using this data.

Critics argue little evidence exists that Magnet hospitals’ nurses are better off compared to their non-award-bearing competition. More than an impression of nursing excellence is needed to justify the added time and cost for what some professionals consider a marketing gimmick. For nurses weighing the claimed benefits of a supportive work environment, autonomy, less risk of burnout, opportunities for education and research, and the real-world practice environment of a Magnet hospital is imperative. So, nurses, do your research.

We’ll be at the 2022 ANCC National Magnet Conference® October 13-15 at the Philadelphia Convention Center in Philadelphia, PA. Stop by booth 2018. We look forward to seeing you there!

Three Trailblazing Hawaiian Nurses: Part 2 – First Hawaiian Registered Nurse

Three Trailblazing Hawaiian Nurses: Part 2 – First Hawaiian Registered Nurse

Welcome to part two of Three Trailblazing Hawaiian Nurses blog series – Mabel Leilani Smyth, First Hawaiian Registered Nurse with Hawaiian ancestry, often referred to as “Hawaiʻi’s Florence Nightingale.”

Hawai’i’ is one of the most multicultural and ethnically diverse places on Earth. This rich blend is reflective of its nursing history. Pioneer Registered Nurses in Hawaii include nurses of Native Hawaiian, English, Chinese, Japanese, and Filipino heritage. Their lives and work create a beautiful kaleidoscope of service that has improved the lives of residents in this tropical paradise for over 100 years. The life stories of three groundbreaking Hawaiian RNs can inspire us all.

Mabel Leilani Smyth 1892 – 1936 First Hawaiian Registered Nurse with Hawaiian Ancestry “Hawaiʻi’s Florence Nightingale

Mabel Leilani Smyth was born in Honolulu on September 1. 1892, to Julia Goo and Halford Hamill Smyth. Like many Hawai’ians, she had an ethnically mixed lineage. Smyth’s ancestors included people from Hawai’i, England, China, and Ireland. Smyth’s older sister Eva was born visually impaired, and from a young age, Mabel was Eva’s companion and guide while her mother tended to the three younger children and her father was at sea. Caring for her sister foreshadowed a lifetime of caring for others.

Smyth spent her childhood on her mother’s Kona coffee farm in Hawaii. All the Smyth children worked hard picking and cleaning coffee beans and cultivating and pounding taro root to make poi, a national dish of Hawai’i. Julia Smyth earned additional money weaving and selling lauhala hats. The family was trilingual, speaking Hawaiian, English, and Pidgin in the home. Being fluent in three languages helped her cross racial and ethnic boundaries and gain acceptance in multiple communities. After Smyth’s father died around 1907, the family moved to the Palama neighborhood, a suburb of Honolulu on the island of Oahu. In 1910, Smyth graduated from President William McKinley High School and began working as a nanny for the Rath family.

Mabel Smyth Begins Career as a Nurse 

James and Ragna Rath, Caucasian social workers, moved from Massachusetts to Hawaii in 1905 for James to direct the Palama Settlement, a multifaceted community service agency. In 1900 at least five cases of bubonic plague were reported in the Chinatown section of Honolulu. To eradicate the threat, city officials decided to burn the homes of the plague victims. Unfortunately, the fire burned out of control, destroying at least four blocks of Chinatown. As a result, thousands of recent impoverished immigrants were homeless, and many lost their jobs and businesses. The Central Union Church created the Palama Settlement (PS) in response to these dire conditions. Church officials founded and supported many programs, including visiting nurses, a pure milk station, a day camp for children with tuberculosis, an adult night school where English lessons were taught, a day care center for working mothers, and a swimming pool with hot showers. James Rath was busy overseeing these efforts, and Regna Rath worked by his side. The Raths had five children and needed at-home childcare, so they hired Mabel Smyth.

In 1912 the Raths took their five children and Smyth to Massachusetts for a sabbatical. Before the Raths returned to Honolulu, they encouraged and arranged for payment for Smyth to attend the Springfield Hospital Training School for Nurses. Upon her graduation in 1915, Smyth returned to her family in Honolulu. She spent two years as the “agent” of the Hawaiian Humane Society. The Society had a mission to relieve suffering wherever it was found – among children, animals, and even battered wives. Smyth left the Society to become the first nursing supervisor at the PS. Organizationally, the PS divided the city of Honolulu into seven districts, with a nurse assigned to each. Each nurse was responsible for providing their district school nursing, home visiting, and clinic hours. At age 26, Smyth oversaw the entire nursing program.

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Mabel Leilani Smyth was the first Hawaiian Registered Nurse with Hawaiian ancestry, often referred to as “Hawaiʻi’s Florence Nightingale”

Smyth is First Hawaiian Nurse to Earn Advanced Certificate in Nursing

Smyth took a year off from the PS, from August 1921 to August 1922, to pursue graduate work in public health nursing at Simmons College in Boston. She was the first Hawaiian nurse to earn an advanced certificate in nursing. After her year of graduate studies, she continued her supervisory work at PS until 1927, when she accepted a position with the Territorial Board of Health as the first Director of the Public Nursing Service for the Territory of Hawaii. Up to that time, the Board of Health had hired nurses in either tuberculosis work or maternal child health work. Under her leadership, these programs merged and expanded to create a generalized public health nursing program covering all the islands in the Territory. Two years later, the nurses at the PS came under the auspices of the Department of Public Health Nursing to better coordinate care and reduced duplication of services.

Smyth gave many lectures to community and professional groups on the islands to increase public understanding and support for public health nursing. She successfully strove to upgrade lay midwives’ skills and standards, instituted immunization drives against diphtheria, coordinated chest x-ray screenings for TB, organized well-baby clinics across the islands, and represented Hawaii at several national public health meetings on the mainland.

In addition to her work, Smyth was a leader in professional nursing organizations. She was a charter member of the Nurse Association of the Territory of Hawaii when it was formed in 1920 and then elected president of the organization in 1925 and 1932. Smyth was also president of the City and County of Honolulu Nurses Association, a leader of the Honolulu Chapter of the American Red Cross, and a member of the Board of Registration of Nurses from 1925 to 1935. In 1926, Smyth was a small group of nurses who created a public health nursing course at the University of Hawaii to prepare nurses who wanted to practice public health nursing.

Hawaiian Florence Nightingale

Sadly, Smyth’s life was cut short at the young age of 43 after spending half her life serving others. A sewing needle had been lodged in her chest since she was a child. On March 24, 1936, she underwent an operation to remove the needle and tragically died of a post-surgical embolism that same day.

Smyth was widely mourned both in Hawaii and in the nursing community. Her obituary in the American Journal of Nursing read in part:

Endowed with charm and a dynamic personality, she had attained a high position in the ranks of Hawaiian women of achievement. Through her devotion, sympathy, keen sense of community responsibility, spirit of cooperation, and intelligently directed energy, Miss Smyth was, at the time of her untimely death, at the very height of her powers, the outstanding leader in nursing in the Territory of Hawaii.

After her death, a committee was formed to establish a memorial to the “Hawaiian Florence Nightingale.”  It raised over $110,000 for the Mabel Smyth Memorial Building, with over 4,000 people contributing. The building was dedicated on January 4, 1941, with Hawaiian chants and music. It housed offices of the medical and nursing professional organization on the island, classrooms, a library, and an auditorium. The building was a fitting memorial to a nurse who did so much for her family, neighbors, and all Hawaiians.

Check back next week for part 3 of the Three Trailblazing Hawaiian Nurses blog series – Alice Ting Hong Young, Hawaii’s First Nurse Midwife.

Reducing Mistakes: What Every Nurse Can Do

Reducing Mistakes: What Every Nurse Can Do

RaDonda Vaught, RN, was not the first nurse to be prosecuted for making a mistake, but the circumstances and her trial were the most public.

Nurses from around the country watched and spoke out, supported her, and shared similar issues about the environment of care that she worked in, the failure of organizations to support nurses after self-disclosure, and the lack of trust in non-punitive response to error.

We learned that organizational system issues were present and acknowledged, yet RaDonda was held individually accountable, prosecuted, and convicted. (Department of Health and Human Services, 2018)  This punitive response to the error is the biggest reason for the lack of trust in just culture. It can cause nurses to suppress patient safety information as they attempt to protect themselves, their licenses, and their livelihood.

Healthcare Environment Can be a Chaotic Place for a Nurse

The healthcare environment is an ever-changing, distraction-ridden, and often chaotic place nurses work. Nurses have learned to develop workarounds of procedures to care for patients within systems riddled with roadblocks and a lack of staff. They drift from ideal practice interventions and are forced to multi-task most of their day. These behaviors are often mistaken for autonomy rather than the root cause until that mistake is grave or deadly. This environment of care is ripe for error and unsafe patient care outcomes.

When direct care nurses and nurse leaders fully understand how the environment impacts patient safety, they can develop a better awareness of the behavioral choices nurses make when providing care and build ways to decrease the likelihood of error. The first and most crucial part of arming yourself with knowledge about why mistakes happen is understanding the difference in behaviors.

Human error is unintentional and not considered a behavior at all. It is an outcome of the fallibility of being human. Risky behaviors occur when we drift away from policy and procedure and develop habits that we think are safe because we don’t appreciate the risk of injury. Reckless behavior is a conscious disregard for a known risk, understood by the person, and the action is taken anyway. It is intentional. (Institute for Safe Medical Practices, 2022)

Healthcare is not perfect, and mistakes will be made no matter how careful a person’s actions and behaviors are. It is a mistake to expect no mistakes! Organizations should strive to be reliable, not perfect, and provide an atmosphere that includes and promotes systems that catch mistakes before they reach the patient. (Rodziewicz, Houseman, and Hipskind, 2022)

What Every Nurse Can Do 

Direct care nurses can improve the environment of care and decrease the possibility of making mistakes by:

  • Speaking out and sharing concerns about the culture of safety with your leaders. Nurses are the most vital source of error identification in all organizations and all circumstances.
  • Insist on duplication and validation processes for high-risk injury interventions. Embrace teamwork by helping each other to ensure that clinical practice is correct.
  • Become active members of shared governance committees and assist in developing policies driven by real practice, not ideal environments. The best policies have multiple decision trees to the desired outcome, for example, “if this occurs, then do that .”Policies can then incorporate the known workarounds so that leaders understand the multiple avenues nurses may need to take to provide efficient and effective care.
  • Learn about the incident management and investigation processes in your organization. Volunteer as “subject matter experts” so investigators understand how nursing care is provided, and the incident analysis is fair.

Nurse leaders ensure that the care environment is safe. Actions they take can include:

  • Create real fixes when systemic or other issues are raised and praise those nurses who are brave enough to raise their voices.
  • Avoid quick responses and decisions to occurrences and let the investigation take its course.
  • Stand by staff when human errors or risky behaviors happen. Console nurses who make mistakes and avoid causing them more harm from the punitive response.
  • Promote transparency of the investigative process and promote legal support for nurses who may be held individually accountable.
  • Promote teamwork and consider alternative nursing delivery methods that can be flexed as acuity increases and decreases
  • Develop on-site resources for self-care and staffing schedules that enable nurses to take advantage of them. Stress, lack of sleep, poor nutrition, and lack of exercise can create cognitive changes that cause a lack of appreciation of risky decisions that direct care nurses can make. (Okpala, 2020)

Finally, all nurses need to become politically active. By participating in local and state governments, nurses can educate elected officials who may need help understanding the healthcare environment and expect perfection in care. In addition, nurses must help to create or support legislation that protects healthcare workers from legal prosecution. A culture of safety in healthcare takes a village!

References

  1. Department of Health and Human Services, Centers for Medicare and Medicaid. Statement of Deficiencies and Plan of Correction: Vanderbilt University Medical Center. Published December 10, 2018. Accessed July 29, 2022 https://hospitalwatchdog.org/wp-content/uploads/VUMC-PLAN-OF-CORRECTION.pdf
  2. Institute for Safe Medical Practices. Criminalization of human error and a guilty verdict: A travesty of justice that threatens patient safety. ISMP Medication Safety Alert 27(7). Published April 7, 2022. Accessed September 25, 2022 https://www.ismp.org/sites/default/files/attachments/2022-04/20220407_0.pdf
  3. Okpala P. Nurses’ perspectives on the impact of management approaches on the blame culture in health-care organizations. Int J Healthcare Manage. 2020; 13(S1): 199–205. doi: 10.1080/20479700.2018.1492771
  4. Rodziewicz TL, Houseman B, and Hipskind JE. Medical Error Reduction and Prevention. Updated May 1, 2022. StatPearls. Treasure Island, FL: StatPearls Publishing; 2022: 42-44. Accessed August 2, 2022 https://www.ncbi.nlm.nih.gov/books/NBK499956/#_NBK499956_pubdet_
Three Trailblazing Hawaiian Nurses: Part 1 – First Registered Nurse in Hawaii

Three Trailblazing Hawaiian Nurses: Part 1 – First Registered Nurse in Hawaii

Welcome to part one of Three Trailblazing Hawaiian Nurses blog series – Mabel Isabel Wilcox, First Registered Nurse in Hawaii. 

Hawai’i’ is one of the most multicultural and ethnically diverse places on Earth. This rich blend is reflective of its nursing history. Pioneer Registered Nurses in Hawaii include nurses of Native Hawaiian, English, Chinese, Japanese, and Filipino heritage. Their lives and work create a beautiful kaleidoscope of service that has improved the lives of residents in this tropical paradise for over 100 years. The life stories of three groundbreaking Hawaiian RNs can inspire us all.

Mabel Isabel Wilcox 1882-1978 First Registered Nurse in Hawaii

The first Registered Nurse in Hawaii was Mabel Isabel Wilcox. Her maternal (David and Sarah Lyman) and paternal (Abner and Lucy Wilcox) grandparents were Caucasian Christian missionaries who traveled from New England to the Kingdom of Hawaii in the 1830s to establish schools and preach the Gospel.

Mabel was born on the island of Kauai on November 4, 1882, to the Wilcox’s son Samuel and the Lyman’s daughter Emma. She remembered a carefree childhood in a family that valued religion, philanthropy, education, and public service. When Wilcox was in her teens, there were no college preparatory high schools in Hawaii, so her parents sent her to California to complete her high school education. However, she stayed on the mainland, and in 1911 she graduated from the Johns Hopkins School of Nursing in Baltimore and passed her Registered Nurse examinations. Soon after graduation, Wilcox returned to Hawaii and began her career as the resident school nurse at the Kawaiahao Seminary, a Congregational Church-sponsored girls’ school in Honolulu, becoming the first Registered Nurse in Hawaii.

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An early photo of Mabel Wilcox Hawaii’s first Registered Nurse

Earned the Moniker “Kauku Wilikoki”

Wilcox missed her extended family on Kauai, so in 1913 she accepted an assignment to begin and head the Territorial Board of Health’s anti-tuberculosis (TB) campaign on the island. She was the only Board of Health nurse on the island and served approximately 5,000 people. Often on foot or horseback, she did case investigations, collected sputum samples, educated the community about the disease, and provided follow-up care to those diagnosed with TB. Wilcox quickly saw the need for a TB Hospital on Kauai. She convinced service clubs and business organizations on the island to support her idea and solicited most of the funds needed from her aunt and uncle, Emma and Albert Wilcox. After a year of construction, the Samuel Mahelona Memorial Hospital opened in 1917.

Although Wilcox was hired to reduce the number of tuberculosis cases on Kauai, in 1920, Hawaii reported a 25% infant mortality rate, double that of the mainland. In addition, there were no maternal/infant health nursing programs on Kauai, so Wilcox added education on nutrition, sanitation, and healthy birthing practices to her rounds when she encountered pregnant women and young children. As a result, she earned the moniker “Kauku Wilikoki” or Doctor Wilcox for her work.

As soon as the U.S entered WWI in April 1917, Wilcox was anxious to do her part. She wrote the American Red Cross nursing service requesting an overseas assignment. Her work with maternal/child health in Hawaii gave her knowledge and experiences she would draw on during her war years.

Nurse Behind the Lines During WWI

Beginning in the winter of 1918, Wilcox was the Head Nurse of a hospital and outpatient clinic for women and children in Le Havre, France. The facility was relatively safe miles from the battlefront lines when Wilcox arrived. After that, however, the fighting grew closer. In September of 1918, Wilcox was sent into nearby Belgium, directly behind the advancing Allied troops, to inspect maternal and child health conditions and conduct clinics. While there during the final Allied campaign, she wrote to her family: “One night we were bombed, crawled under the bed, two of us trying to get into one helmet. Scared.” After the war ended, Wilcox spent another year in France helping mothers and children, many of whom were orphaned or refugees. Once the French government was stable enough to take over her work, she returned to Hawaii. She was awarded medals from the Queen of Belgium and the mayor of Le Havre for her service.

Kauai’s First Territorial Maternity and Child Health Hygiene Nurse

In 1921 Congress passed the Sheppard-Towner Act providing funds for maternal-child health programs. With these new monies, Wilcox was hired as Kauai’s first Territorial Maternity and Child Health Hygiene Nurse to focus full-time on improving the health of women and children. As they began hiring more nurses, she became the Supervising Nurse, a position she held until her retirement in 1935. In the first year, public health nurses made nearly 1,000 home visits, and newly organized “demonstration clinics” recorded an attendance of 4,403 mothers. Infant mortality dropped by 14% in the first year of the program. The program successfully provided care to 8,398 mothers and infants in 1927.

Congress discontinued funding the Sheppard-Towner programs in 1929. Then in 1930,  Wilcox became the supervisor of the new generalized public health nursing program on Kauai. She oversaw tuberculosis, maternal-child health, and school and home health nursing programs on the island. During this time, Wilcox was a leader in many professional associations. She launched the Kauai Nurses Association, served as its first president from 1932-1946, served as the first executive director of the Kauai TB Association, and was on the Board of the Mahelona Hospital.

G.N. Wilcox Memorial Hospital

On Kauai, many sugar plantations maintained small, often inadequate, hospitals for their workers and families. After Wilcox’s father and mother died (1929 and 1934, respectively), she and her siblings decided to build a new, modern general hospital in their memory. She retired in 1935 and spent her time and energy making the G.N. Wilcox Memorial Hospital a reality for the next few years. It was dedicated on November 1, 1938, with 96 beds in wards and semi-private private rooms, 17 physicians and 50 employees, and 14 graduate nurses. The hospital provided more than 10,000 days of care in the first year of operation.

Upon Wilcox’s retirement, Mabel Smyth, RN, the Head Nurse of the Territorial Board of Health, wrote a tribute to her in The Pacific Coast Journal of Nursing.

It read in part: “With clarity of purpose and wisdom in leadership Miss Wilcox has developed an unusual spirit of loyalty and devotion among her corps of nurses and superiors … every nurse … on the island turns to her for inspiration and leadership in matters pertaining to individual and community well-being.” (Smyth, M, “Public Health Nursing in Hawaii: A Tribute to Mabel I. Wilcox,” (1935) The Pacific Coast Journal of Nursing,  297-98).

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Mabel Wilcox circa 1911 and 1951

Influence of Wilcox Lives On

In her late 50s and 60s, Wilcox stayed active with the Wilcox Hospital in an unpaid capacity. She served on the hospital board, raised money for expansions, and recruited nurses. During this time, Wilcox also became very interested in historic preservation. Because both sides of her family tree had been missionaries and plantation owners in Hawaii for over 125 years, she and her living siblings began restoration efforts to preserve their ancestral homes and papers. Today the Waiolo Mission House, the Lyman House Memorial, and Grove Farm all stand as testimonies to their efforts, as do many manuscripts, records, and correspondence housed at the Grove Farm library.

After years of declining health, Wilcox died on December 27, 1978, at age 96. Before her death, the Kauai Tuberculosis Society honored her with these words: Through the years, there has been little in the health and welfare fields on this island that does not owe its beginnings to Miss Wilcox’s vision and active support. Her scope has been not only island-wide but territorial and even national.

Wilcox is is buried on her beloved Kauai Island.

Check back next week for part 2 of the Three Trailblazing Hawaiian Nurses blog series – Mabel Leilani Smyth, First Hawaiian Registered Nurse with Hawaiian Ancestry.

The Nursing Beat is Changing How Healthcare Information is Absorbed

The Nursing Beat is Changing How Healthcare Information is Absorbed

The Nursing Beat, a new healthcare media startup, officially launched this week. It’s the creation of a consortium of nurses sharing a strong desire to foster community with the goal to make  the ever-evolving world of healthcare easy to digest by arming healthcare professionals with the most up-to-date information. 

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Nurses Supporting Community Initiatives 

 As an organization, it stands by its words and acts within its community to support initiatives imperative to nurse retention and workforce sustainability.

According to Hannah Berns, MHCI, BSN, RN, and COO of The Nursing Beat, they attended the Nurses March on Washington in May 2022 to advocate for safe staffing and anti-violence measures. They also recently launched Pulse Check, a professional consulting program offering various career development services, from panel interview preparation to entrepreneurial consultations, to help nurses establish their professional identity and maximize their career potential.

With thousands of subscribers and a growing following on TikTok, The Nursing Beat is changing how healthcare information is absorbed.

Magic Behind The Startup

The startup’s leadership team is almost entirely composed of nurses. From their Advisory Board which was established in conjunction with The Nurses on Board Coalition, to their executive team. They speak to their audience authentically in a language familiar to their community. #ByNursesForNurses.

As The Nursing Beat says, healthcare starts with you. This is your beat.

Peering into the Post-COVID Nursing Curriculum

Peering into the Post-COVID Nursing Curriculum

Nursing education after COVID will rely more on technology and digital tools than ever. Simulation and online learning will be part and parcel of the curriculum for nursing students. It will also be more competency-based as the new AACN Essentials further integrate into nursing curriculums.

But what about the content of the curriculum?

Nursing education, according to Mary Dolansky, Ph.D., RN, FAAN, Sarah C. Hirsh Professor, Frances Payne Bolton School of Nursing and Director, QSEN Institute at the school, may include instruction on telehealth, an emphasis on systems thinking, stress on leadership, and a focus on innovation and design thinking.

Nursing education after COVID

Mary Dolansky, Ph.D., RN, FAAN, is a Sarah C. Hirsh Professor at the Frances Payne Bolton School of Nursing and Director, QSEN Institute at the school

A Look at Nursing Education After COVID

Telehealth

Understanding how to use telehealth in nursing is key, according to Dolansky. The Frances Payne Bolton School of Nursing at Case Western Reserve University, Cleveland, developed a series of four modules on telehealth so that all students received a basic foundation in telehealth nursing, including telehealth presence. It included teaching on using Zoom or the phone to assess and evaluate patients. She notes that interactive products that give students a feel for how such interactions occur and practice them can provide an excellent education.

Systems Thinking

Another aspect of post-COVID nursing education involves systems thinking, says Dolansky. This involves “really getting students to think beyond one-to-one patient care delivery and about populations. We need to create more curricula for nurses out in primary care sites and nurses out in the community, and that has not been a strong emphasis in schools of nursing. Instead, we focus mainly on acute care.”

More specifically, students should learn, for instance, how to use data registries to look at areas of patient need. One COVID example, notes Dolansky, would be to use registries to identify long-term COVID patients. Another could be to use a registry or database to discover what patients have followed up on their chronic disease since, during COVID, many patients stopped visiting healthcare providers.

Emphasizing Leadership

In the post-COVID curriculum, developing leadership skills may become more critical. “What we observed in the COVID crisis,” says Dolansky, “was an opportunity for nurses to stand up and speak out more. We were the ones at the frontline and had the potential to be more innovative and responsive. Many great nurses did step up and speak up, but we need to ensure that every nurse can speak up for patients in future crises or even advocate for our patients now. Nurses can be the biggest advocates for patients.”

Every school of nursing probably has a leadership course, Dolansky notes. But ensuring that there are case studies from COVID as to how nurses did stand up and speak out and how that made a difference would be a fundamental curriculum change.

“We want to prepare our students that you will be a leader and you will be on TV talking about how you are innovating and adapting to the changing needs of the health of our population. And COVID was a great example for that.”

Innovation

Post-COVID, nursing education needs to help students with innovation and design thinking, notes Dolansky. Over the past 10 years with QSEN, “what we’re trying to advocate is shifting the lens of a nurse from direct patient care delivery, which has been the focus of nursing, to shifting a little bit to systems thinking.”

Critical thinking, notes Dolansky, focuses on making decisions for an individual patient. Design thinking and innovation are more about “looking at the system in which we work and empowering the nurses to fix the systems. This is key to quality and safety, but it’s also key to the need for our nurses to contribute strongly to the health of the future population. They have to be at the table to respond to these crises. We need them to have the skill set of being a leader, standing up, being at the table and when they’re at the table, having ideas, being creative, and knowing how to test them. And having the technical skills to use the technology is probably where most of the solutions will be for the future.”

QSEN and Competencies

With the latest AACN Essentials, there is a drive for competencies in nursing education, notes Dolansky. The Essentials: Core Competencies for Professional Nursing Education, approved by the AACN in April 2021, calls for a transition to competency-based education focusing on entry-level and advanced nursing practice.

While revising the Essentials began before the pandemic, the experiences and learnings from the pandemic greatly impacted the work, notes a recent article in Academic Medicine. As a result, the Essentials includes population health competencies that specifically address disaster and pandemic response and will better prepare the next generation of nurses to respond safely in future events, the article says.

Now, a crosswalk has developed between QSEN competency statements and the 2021 AACN Essential Statements, notes Dolansky. However, she notes that the AACN is taking the QSEN foundation and moving it forward, stating to the public that “the nursing profession has these competencies that are providing safe quality care to the public.” Since 2012, the QSEN effort has been based on the Frances Payne Bolton School of Nursing.

“Own Their Competency”

In the culture of nursing education, students now need to be educated to “own their competency,” says Dolansky. “Students will see that competency development is part of their lifelong professional development.

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