Christine Higbie 31 Jan 07 7:49 PM MST Week 5 Discussion Post (Actual): Interdisciplinary relationships The thirteenth force of magnetism is interdisciplinary relationships. McClure and Hinshaw (2007) describe this it as the respectful relationship between physicians, nurses, pharmacists, therapists, and all other members of the health care team. Dr. Kerfoot in this week’s video, called this force the collaborative working relationship within and among the valued disciplines (Laureate Education, 2004). I feel that the interdisciplinary collaboration within my organization is very strong. Currently, each month there is an interdisciplinary department head meeting. Every admitted patient receives an interdisciplinary teaching sheet, the admitting RN must also address if the patient needs a consult from one of the disciplines. During the monthly department head meetings, issues brought forth from staff and unit managers are discussed. If there is an issue that requires a hospital wide change it will be discussed there then often an interdisciplinary committee will be established to develop and implement the change. When a patient is in need of services from another health care discipline there are established protocols that can be started or the nurse can contact the physician for further orders if needed. One example is if a patient has developed or has the potential to develop a wound, we can consult or wound care specialists first and get their evaluation then we notify the physician to update them. As nurses, we know the value of team work. If one discipline is not working with the others, it can cause a strain or rift within the organization. I understand why the Magnet Recognition Program requires the organization seeking recognition excel in all of the 14 forces. Schlag (2005) states “Each of the fourteen elements helps to define what an organization should do to differentiate itself as a healthcare setting that supports professional nursing practice and quality patient care.” Effective interdisciplinary relationships are critical to the success of any organization. References: Laureate Education, Inc. (Executive Producer). (2004). The Nurse Leader: New Perspectives on the profession. [Video Recording]. (Available from Laureate Education, Inc. 12975 Coral Tree Place Los Angeles, CA 90066-7020). Schlag, M.K. (Jan/Feb 2005). Education: key to the Magnet Culture. The Journal of Continuing Education in Nursing. Vol. 36(1) pg. 12. Retrieved January 31, 2007 from ProQuest Database. McClure, M. & Hinshaw, A. (2007). The 14 Forces of Magnetism. Nurse Week. Retrieved January 31, 2007 from http://www.nurseweek.com/news/features . Amy Fanning 1 Feb 07 4:33 PM MST Christine, I agree that this is a very important force and wonderful that your facility, (is it a Magnet facility?), participates in this monthly meeting. How do they schedule the meeting so that all disciplines involved can attend? My organization has a meeting every other week to discuss our hospice patients and one every thirty days to discuss home health patients. These meetings are crucial to the communication between the nurses, home health aides, physician, and social worker. The hospice meeting is required by Medicare however, I think it would be done regardless. As you stated, if we do not work together it causes strain in the group and does not benefit the patients which is our ultimate goal. Amy Fanning Christine Higbie 1 Feb 07 7:50 PM MST Amy, No, I do not work in a magnet facility. My hospital is in rural Northwest Ohio and is only about a 100 bed facility with two small satellite campuses. As to the meetings since it is a small facility scheduling the meeting is somewhat easier. The are set-up for the 2nd tues of the month, so everyone can plan their schedule. I was surprised at the responses I received from the VP of nursing when I interviewed her for our paper. The CEO doesn't believe becoming a Magnet facility will mean anything in our community, so they chose not to look at it. It is hard to change the culture, so I don't see it coming. Chris Margaret Imbrock 2 Feb 07 10:34 PM MST Chris, Hang in there. I had a discussion with my manager today about magnet also. One thing she reminded me about was that the magnet forces provide a framework for improving quality and staff satisfaction. It is forcing us to do something that we, as professionals, should already be doing, ensuring a quality service within a safe environment. The multidisciplinary conferences are a great way to keep on track with patients and a great way to demonstrate the collaboration between disciplines. When one looks at the amount of $$$ expended for this honor, I wonder is it really worth it. Think about not only what you pay ANCC but also the labor and material resources that you use. As Dr. Yensen pointed out how magnet has now evolved into a cash cow for ANCC. The appraisal fee alone 4 years ago was $100-$50 / bed according to Mary Crotty (2005) plus then you had to pay 2 appraisers for a small facilities at minimum $4000 each. If they stay more than 2 days or if you need more appraisers the price goes up. This does not take into account if your organization pays or hires a consultant to guide you. We hired a doctoral prepared nurse for 2 years, I would estimate her salary at about $60,000 annually (that is a very conservative guess). Plus now you have to attend seminars, for which you are paying $400+/person to attend and of course one cannot go alone and you won't find those programs locally. Plus you have to buy all those notebooks and the paper to fill them. As leaders in nursing, can we not be persuasive to negotiate greater collaboration and safer practice environment to improve patient outcomes? Rural hospitals struggle financially due to low medicare and medicaid reimbursements and decreased insurance payments. They do not have the finances for a plaque or statue that could most likely hire at least 2 nurses to provide care if not more or buy a badly needed piece of equipment. Reference: Crotty, Mary, (2005, March-April). Forces of Magnetism. Revolution. Retrieved February 2, 2007 from Ebsco database. Date Modified: 2 Feb 07 10:42 PM MST Christine Higbie 3 Feb 07 6:40 AM MST Margaret, The cost issue is astounding. I'm sure if I asked my CEO that's what he would say, it is too expensive to acheive and what are the benefits for a small rural hospital? Currently, our hospital does a great job on many of the 14 forces without being Magnet, I would say the only one we do not do we at is staff education or encouraging staff to go back to school. I will keep planting the seeds of thought, maybe they will grow. Chris Carla Kimmons 3 Feb 07 12:23 PM MST Hi Everyone, Our organization engaged the Magnet process and obtained recognition in 2004. We're now preparing for recertification. I will say that the process forced changes that nurses wanted, but administration had resisted due to the "good ole boy" mentality. It took a new Chief Nurse Officer to initiate and drive the changes. I agree the framework can, and should, be used in all healthcare settings. It is unfortunate that it takes a marketing device to get our healthcare organizations on board. Now, during a time of budget restrictions and layoffs, I am notified that we have retained a Magnet consultant to guide us through our recertification application process. We are cutting our workforce, yet paying consultant fees for a process we have been through before. Our entire healthcare team was involved in the original process and this is prompting dialogue and interdisciplinary support as we challenge this decision. Perhaps the economic status of our healthcare environment will force ANCC to reformat this program to be accessible to all. We want this standard to be the rule, not the exception. Faith Vaughn 2 Feb 07 9:38 PM MST Christine, I remember those interdisciplinary meetings at the last hospital that I worked at. Every Thursday all of the disciplines had to meet including nurses working on the floor. That was more stressful for me than anything, because we were instructed to go to the meetings at a certain time, and sometimes it was almost impossible, especially to choose between eating lunch and going to a meeting. I think that it was ridiculous. I think that once a month meetings would have been more manageable. Faith Vaughn, RN, BSN NC Kristin Fowler 3 Feb 07 1:04 AM MST When I worked in med-surg nursing, the hospital where I was at did not have any interdisciplinary meetings. The different roles were required to write progress notes which were supposed to be then reviewed by the other members of the team. That did not work so well and I remember one time that the Attending physician discharged a patient with a new home oxygen requirement at 8:30 pm on a Friday evening with no prior communication with social services to arrange the oxygen. I agree with Faith that scheduling meetings can be hard to do, especially since most staff works daylight hours when the nurses can be the busiest. However, communication is key when trying to coordinate complete thorough care. Kristin