Department: Leadership Q&A
Senior Vice President of Patient Care Services and Chief Nursing Officer, Lutheran Medical Center, Brooklyn, N.Y.
Q The amount of clinical documentation for my staff members is killing them. Any suggestions on how to minimize the time nurses spend documenting?
I have articles going back over 20 years on this topic and agree on the burdensome nature of nursing documentation. Requirements increase every year, no different from the detailed expectations of physician documentation. Whether it's for billing, coding, regulation, quality, or legal purposes, our documentation serves as the proof-of-care rendered. Without it, even the most excellent care isn't reflected as excellent at all. Documentation is also important in the coordination of care and, often, for safety reasons such as checklists and timeouts.
As I mentioned in this column last year, the use of health information technology may be the transformative push we need for documentation reform as we convert to standardized, reportable, timely, and accurate data collection through an electronic medical record. Systems can be designed to support the work of the nurse, decrease documentation time, and increase documentation compliance.
There are principles of documentation design in either paper or electronic formats to save nurses time and increase the quality of documentation. Guidelines such as no duplication and keep it simple seem obvious, yet are often overlooked. Look for duplication not only within nursing documentation, but also across disciplines. For example, listing home medications only has to be done once; it may have to be reviewed by all disciplines during the initial assessment, but this data can be brought over and reviewed or revised without redocumenting. If possible, combine elements to eliminate additional forms, such as vaccination screening with administration. Using reminders and cues also helps. It's important to avoid adding policies and details that are beyond what's required or don't match with nursing workflow; you'll only get noncompliance and demoralization in return. Finally, involve your staff members in documentation revisions. Their engagement and ideas are always extremely valuable.
Q What's more important for the Magnet®commission, culture or clinical outcomes?
Both! Without a culture of excellence built on the Magnet Model components, you'll most likely be unable to achieve sustainable outcomes—clinical or nonclinical. Without evidence of outcomes, you won't achieve Magnet recognition, so it's all connected.
It's true that before 2008, the Magnet focus was on structure and processes; now, it's more on outcomes. However, it's still imperative to have a functional infrastructure and strategic plan for nursing culture development at your organization. The business literature has discussed the importance of culture vs. strategy in company success for years and, in my opinion, the conclusion is still that both are relevant with an edge toward culture. Remember the old adage: Culture eats strategy for lunch!
The components of a Magnet culture include transformational leadership, exemplary professional practice, new knowledge/innovation/improvements, and structural empowerment. The final component that brings it all together is your outcomes, which may include patient-centered Hospital Consumer Assessment of Healthcare Providers and Systems scores; clinical results, such as skin breakdown and hospital-acquired infections; nurse-centered measures, such as job satisfaction and percent of BSN-prepared nurses; organizational improvements led by your CNO; and population measures, such as impact of community health programs. You must show evidence of all the components, both process and outcomes, to achieve Magnet recognition.
A Magnet culture of excellence means that all staff members are intrinsically and deeply invested in the Model components—they're empowered, looking for innovation, and practicing in an exemplary manner. When this exists, the outcomes are plentiful. Good luck to you on your quest for Magnet recognition.