Stepping Up: Ensuring the Future of the Bucks/Mont ONS Chapter through Professional Accountability 15 th Anniversary Keynote Address Anne Jadwin, RN, MSN,

Stepping Up: Ensuring the Future of the Bucks/Mont ONS Chapter through Professional Accountability

15th Anniversary Keynote Address

Anne Jadwin, RN, MSN, AOCN, NE-BC(2nd Bucks/Mont ONS Chapter President -1998)

Purpose: The purpose of this session will be to discuss principles of

professional RN accountability as related to the profession of nursing, the health care team, the employing agency, and clients/patients. The early history of the Bucks/Mont ONS chapter will be described, highlighting key achievements during our 15 year history, and the relationship between professional accountability and the future success of the chapter. The phenomenon of Complexity Compression will be described, in conjunction with strategies to regain control over nursing practice, such as involvement in professional organizations.

Session objectives: Identify the key principles of professional RN

accountability, and how they impact the profession of nursing.

Demonstrate an understanding of the history and achievements of the Bucks/Mont ONS Chapter.

Describe the phenomenon of complexity compression, and strategies to regain control over professional nursing practice.

Identify ways to become more involved in your local chapter of the Oncology Nursing Society.

Professional Accountability 101

Key Definitions

Accountability – ability and willingness to assume responsibility for ones’ actions and accepting the consequences of one’s behavior

Autonomy – independence of thinking, functioning Authority – power to do something Responsibility – acting in a reliable, trustworthy,

credible manner

To Whom are Nurses Accountable?

To the profession To patients/clients/families To other members of the health care team To the employing agency To self

Accountability to the Profession

ANA code for Nurses ANA Standards for Nursing Practice and Education Nursing Quality Assurance and Improvement

programs –increasing emphasis on RN impact on patient outcomes

Participation in a professional organization – your involvement in ONS!

Accountability to Clients/Patients/Families Clinical competence – knowing why and how things

are done Safe nursing care Allowing clients/patients/families to participate in

care planning and care activities Respecting individual differences Altruistic intentions – serving others without self-

interest Serving as advocates

ANA Official Position on Competence

Public has a right to expect registered nurses to demonstrate professional competence throughout career

The RN is individually responsible and accountable for maintaining professional competence

Your local ONS chapter can help!

Accountability to the Health Care Team

Bring specialized nursing knowledge and skills to the health care delivery situation

Share information with team members Confront if potential errors may occur Perform nursing tasks with competence Treat team with dignity and respect

Accountability to the Employing Agency

Quality of work Following agency established standards, procedures,

policies Protect against unsafe practice situations Attitude conveyed about the work place Use of outside agency personnel

Accountability to Self Practice nursing to personal standards using

professional standards of care as basis for practice Be true to oneself Take care of personal, physical, mental, and spiritual

health needs (professional self care) Protect self from harm Life-long learning – again, your local ONS chapter

can help!

Oncology Nurses. . . Exceptional People – Extraordinary Care

Official theme selected for 2011 Oncology Nursing Month is Oncology Nurses: Exceptional People, Extraordinary Care.

How do we know this is so?

The “Dream” of a Bucks/Mont ONS Chapter It started with a phone call…… Group of oncology nurses were networking to

form an ONS chapter convenient for Bucks and Montgomery County residents

The future belongs to those who believe in the beauty of their dreams

- Eleanor Roosevelt

And so a “CHIP” forms Chapter Interest Group (CHIP) formed, and had to

show sustained membership/funding support, educational program development, member involvement

Application to ONS in to be recognized as an official chapter came in November 1996

Submitted by Dr. Donna Molyneaux, our first chapter President

Chapter charter formally presented during Opening Ceremonies at 1997 ONS Congress, New Orleans, LA

The Early Years Struggled with consistent membership and meeting

attendance Board members had “multiple jobs” –needed to

show broader involvement in chapter Fiscal constraints due to low membership, lack of

program support to fund dinner meetings Lack of experience in new chapter development Much support/reliance on national ONS, and

networking with local/regional chapters (joint program collaboration)

Were there none who were discontented with what they have, the world would never reach anything better

- Florence Nightingale

Steady Growth in Membership!

Bucks/Mont ONS Chapter Membership Trends

020406080

100120140160

# of Members

Plenty to Celebrate!

2003 ONS Chapter Excellence Award 11 chapters competed for this award Based on alignment of ONS national strategic plan

with chapter goals/outcomes Detailed application submitted by Cathy Belt, 2003

chapter president Receipt of $4000 cash award to chapter Plaque hanging in the national office in Pittsburgh Recognition at Chapter Presidents’ reception in

Anaheim, CA in 2004

2004 ONS/SuperGen Inc Chapter Newsletter Award Bucks/Mont ONS chapter recognized for award-

winning newsletter, The Bridge Criteria – reflects chapter activities, dynamic

involvement of chapter members, creativity, strategic placement of content

Application submitted by Ann McCullough, our newsletter editor

Nineteen submissions Recognized at ONS Congress 2004, Anaheim, CA Cash award of $500

2007 ONS Recruitment and Retention Award Bucks/Mont chapter receives 2007

recognition from national for ONS Chapter Recruitment and Retention

Honored at the Chapter/SIG Awards reception at national Congress in Las Vegas, NV

$500 cash award

2007 Recognition by National Received one of two awards for Chapter

Voting Participation in ONS national election Bucks/Mont ballot return rate was 47.7% in

ONS national election

2009 Special Project Recognition by ONS Special Project award received from national for

Best of ONS Congress 2009 Offered since 2005 – the “brainchild” of Nancy

Barton (who also developed the PERKS program) Highlights from national ONS Congress sessions

presented Enhanced educational opportunities for oncology nurses in region at reasonable cost

Live your beliefs and you can turn the world around- Henry David Thoreau

Stepping Up Ask not, what can my chapter do for me? But rather, what can I do for my chapter?

I’d like to be more involved, but who has the time?

Coping with Complexity Compression 40% of RN work day is taken up by increasing demands of the healthcare delivery system

Increased documentation New procedures – care, equipment Process changes, new initiatives Technology New staff Shorter patient lengths of stay More complex patients Financial constraints Manager turnover

“Complexity Compression” – a new term used to describe this phenomenon – University of Minnesota/Minnesota Nurses’ Association study in 2003; inductive methodology - phenomenon described to groups of nurses, their responses documented, key factors ranked; themes emerged

Current expressions of complexity went beyond what nurses “expect” to happen

(Krichbaum, K. et al. Complexity Compression: Nurses Under Fire, Nursing Forum, 42 (2), April-June 2007).

Evidence Base Supports Existence of this Phenomena for Past Two Decades Many studies have evaluated the nursing practice

environment and complex work environments Aiken et al. 2001. Nurses’ report on hospital care in five countries.

Health Affairs, 20(3), 43-53. Aiken, Sean, Sloane, Sochalski, & Silber. 2002. Hospital nurse

staffing and patient mortality, nurse burnout, and job dissatisfaction. Journal of American Medical Association, 288(16), 1987-1993.

Blegen, M.A. (1993). Nurses’ job satisfaction: A meta analysis of related variables. Nursing Research, 42(1), 36-41.

Lashinger & Havens. 1996. Staff nurse work empowerment and perceived control over nursing practice; conditions for work effectiveness. JONA, 26(2), 27-35.

Woods, D.D. 1988 Coping with Complexity: The psychology of human behavior in complex systems. In Tasks, errors, and mental models, pgs 128-148.

The result? Nurses are expected to assume additional

responsibilities, often unplanned, while conducting their other multiple responsibilities, all within a condensed time frame, with expended energy.

Leads to job stress, anxiety, frustration, anger, feelings of helplessness, loss of control.

(Krichbaum, K. et al. Complexity Compression: Nurses Under Fire, Nursing Forum, 42 (2), April-June 2007).

Simultaneity Complexity “In contrast to medicine, law, and other professions in which

the client-practitioner relationship is based on sequential care to one client at a time, clinical nurses are expected to care for 2 to 5 patients simultaneously. Unlike some professions (teachers in classrooms, lawyers in class-action suits, or pastors with their parishioners) in which the client-practitioner relationship is based on groups of similar clients with similar needs, nurses must care for multiple, diverse clients with different and rapidly changing conditions and needs.”

Schmalenberg, C. and Kramer M. (2008). Clinical units with the healthiest work environments. Critical Care Nurse, 28: 65-77 .

6 Complexity Compression Themes# 1 Personal – physical/mental exhaustion, family/individual

concerns

#2 Environmental physical (tight spaces, lack of storage, many distractions), psychosocial (interpersonal conflicts with other staff, non-

collegial atmosphere, workplace incivility) cultural (lack of trust/respect, lack of unit cohesiveness)

(Krichbaum, K. et al. Complexity Compression: Nurses Under Fire, Nursing Forum, 42 (2), April-June 2007).

Compression Complexity Theme #3#3 Practice

Delegation – oversight of other personnel, assignment coordination Conflicting priorities (many equally important tasks) Floating/cross-training – multiple roles/functions Time – difficulty prioritizing No safety net – lack of back-up or support for unplanned events Patient/family issues – conflicts related to emotional, physical,

spiritual concerns of patient and family members Culture: patients and staff – additional time/attention to address

cultural issues, diverse co-workers Mentoring/precepting – additional responsibilities to mentor/precept

students, new staff

(Krichbaum, K. et al. Complexity Compression: Nurses Under Fire, Nursing Forum, 42 (2), April-June 2007).

Compression Complexity Theme #4

#4 Systems System failures – breakdown or failure Multi-changes – multiple, concurrent changes within the

department/organization Lack of safety net – lack of back up for system failure Documentation – new, excessive, changing forms/methods Regulatory/legal – state, federal regs that impact practice changes Budget – fiscal constraints that affect patient care Staffing – inadequacy of staffing system, lack of flexibility Technology – new, changes in work flow, training needs

(Krichbaum, K. et al. Complexity Compression: Nurses Under Fire, Nursing Forum, 42 (2), April-June 2007

Compression Complexity Theme #5#5 Administration/management

Ineffective – unskilled, inexperienced Lack of understanding – insufficient knowledge of

administrators and managers about the work done by nurses

Change in upper management – numerous, unpredictable changes in leadership with impact on new initiatives, policy/procedure

(Krichbaum, K. et al. Complexity Compression: Nurses Under Fire, Nursing Forum, 42 (2), April-June 2007

Compression Complexity Theme #6#6 Autonomy/Control

No input into decision-making –nursing perspective is not solicited related to decisions impacting nursing practice at unit or system level

Input not valued – perspectives are solicited, but not valued

Change in upper management – changes in personnel, managerial style and philosophy, impact on policy and procedures that guide practice

(Krichbaum, K. et al. Complexity Compression: Nurses Under Fire, Nursing Forum, 42 (2), April-June 2007

Strategies to Address the Big “CC”

Gaining control over practice – shared decision-making, staying competent in field of practice, promoting more positive work environment, conflict management, assertive communication

Professional development – gaining new skills/knowledge, cross-training, informal/formal education, specialty certification, always staying one step ahead

Staying involved/engaged – workplace committees, community groups, professional organizations (my 4th plug for getting involved in ONS!)

Prepare for the “unexpected” – develop contingency plans, teamwork (divide & conquer)

Professional self care – nutrition, exercise, sleep, preventative medical care, meditation, leisure activities, spiritual reflection, relationships, resolve conflicts, have FUN.

How can your local chapter help you cope with complexity compression?

Group discussion period

Do what you can, with what you have, where you are.

-Theodore Roosevelt

How Can I Get More Involved?I’m barely hanging on now! Check out our chapter virtual community on the ONS web site Join a SIG at national level Join a chapter committee – many hands make “light work” Attend Leadership Development Institute, attend National ONS Congress Participate in a community outreach event, help plan an educational

program, write a virtual article Bring an oncology nurse friend to a chapter event Network with other colleagues – meet someone new each time Consider running for office – talk to current officers about skills needed, time commitment (its not as “bad” as you may think!)

Wherever you go, go with all your heart.- Confucius