The relationship fostered be-

tween nurse, patient and pa-

tient family is one of the main

subjects of the Magnet document

and is of the utmost importance for

care providers at Children’s Hospital

Boston. Creating an environment in

which patients can flourish takes the

entire team, and it’s often the admin-

istrative tasks that take place behind

the scenes that ensure the highest

quality of patient care.

Along with illustrating the hos-

pital’s patient care philosophy, the

Magnet document required details

about the processes Children’s has

established to ensure that our goals

are met. The hospital’s blueprint for

meeting patient needs is the Plan

for Provision of Care, which consid-

ers the many components of care,

including the:

n unique needs of each patient

and family

n improvement of quality and

safety of care in patient areas

n structure and process in

each area to identify patient

care needs

n provision of a uniform level of

care throughout the organization

“Each unit has a scope of ser-

vices statement that outlines the

patient populations served and

how their needs are met, and is

reviewed annually,” says

Herminia Shermont, MS, RN,

CNA, director of Surgical Pro-

grams. Data on unit activity,

including admissions, discharges,

transfers and lengths of stay; unit

technology; turnover and vacancy

Methods to meet patient needs

� continued�on�page�2

Volume 1 • Issue 6 • October 2007

NURSESDedicated to Excellence

It’s an excItIng tIme for children’s

Hospital Boston, as we’ve just heard

from the american nurses creden-

tialing center that our documentation

has been found to “fall within the

range of excellence” required by

the magnet recognition program. I’d

like to thank every one of you who

worked tirelessly to compile this

evidence of the exceptional quality of nursing provided here

at children’s.

One of the components of our submission was called

Journey nurses. One nurse representing each Force

of magnetism was asked to write a reflective essay on

how his or her nursing practice related to a given Force.

Fourteen nurses’ essays were featured and represent the

journeys we each embarked on as we started our nurs-

ing careers and those pivotal moments we all experience

throughout our careers.

my own journey began on a 34-bed pediatric wing at

a new Jersey hospital. there, I faced many challenges,

including competition for resources and a lack of clear

leadership. Looking back, I realize that those obstacles

shaped the nurse I am today. But to a greater extent,

it’s the interactions with my children’s colleagues that

have influenced me. When I’m asked what my greatest

contribution has been during my 18 years at children’s,

my response is simple: I’ve never done anything on my

own; it’s always taken a team. I believe we are all on this

journey together.

this issue of Dedicated�to�Excellence provides insight

into the contents of the magnet document. We look

forward to the november site visit, when we can demon-

strate our exceptional patient care to the appraisers.

Sincerely,�

Eileen�Sporing,�MSN,�RN,�CNAA,�BC

Senior�Vice�President,�Patient��Care�Operations,��

Chief�Nursing�Officer

From Eileen Sporing, MSN, RN, CNAA, BC

Magnet site visit confirmed

Herminia Shermont, MS, RN, CNA

�www.childrenshospital.org/nursing

Theoretical/practice frameworks

Children’s Hospital Boston’s

family-centered approach

to care is evident in every-

day clinical practice. the magnet

document illustrated our family-

centered approach by emphasizing

children’s firm belief that the needs

of individual patients and families

should direct the nursing care they

receive. “the goal of all nurses is

not only to promote the optimal

health and development of each

patient, but also that of the family,”

reads the document’s summary of

our nursing theoretical and practice

framework.

central to this framework is the

synergy model, which was devel-

oped by the american association

of critical care nurses in 1998.

Martha Curley, PhD, RN, FAAN,

nurse researcher, was one of the

architects of the model and helped

implement it at children’s.

In the synergy model, patients and families are active participants in their nursing

care. the nurse comes to know each patient and family and they, in turn, come to know

the nurse. When this relationship is synergistic, optimal patient outcomes are more

likely to occur. the synergy model incorporates eight competencies to help nurses reach

and maintain the skills and knowledge needed in order to offer this type of care. these

competencies are clinical judgment, clinical inquiry, caring practices, response to diversity,

advocacy, facilitation of learning, collaboration and system thinking. the magnet docu-

ment further states that these values are central to nursing’s Professional advancement

Program. Performance evaluations reflect adherence to the synergy model and stress the

importance of the eight competencies.

the combination of this practice framework and the dedication of children’s nursing

staff has helped create an environment of compassionate, family-centered care that is

one of the hallmarks of children’s nursing practice.

Methods to meet patients needs continued�from�page�1

rates and the overall experience of the staff,

are analyzed to develop staffing plans. These

formalized staffing plans are reviewed on a

continual basis in conjunction with quality

improvement activities, utilization review,

risk management activities, changes in

patient needs and expectations and multiple

screening indicators that relate to patient

outcomes that may also impact staffing

effectiveness.

“Children’s is committed to determin-

ing and delivering the appropriate number

of nursing staff for each patient care unit

since these numbers have a direct impact

on the care delivered,” says Shermont. For

example, Children’s uses ANSOS One-Staff,

a computerized information system that

uses rules-based scheduling, incorporating

employee preferences and skill–level to

assist with staffing and scheduling.

The staffing policy is further outlined

in the Assigning Nursing Care of Patients

policy. As noted in the policy, clinical leaders

making assignments must consider multiple

variables, including the:

n frequency and intensity of nursing care

associated with each patient

n changing nature of each patient’s

condition

n nurse’s knowledge, skills and expertise

n degree of supervision required

“Safe and accurate staffing is monitored by

the charge nurse and the unit’s nursing man-

agement to ensure that every patient’s needs

are met effectively by the nurses we have on

staff,” says Shermont.

Thank you to everyone who helped us with the Magnet process:n Magnet Core Team: eileen Laband,

Lynne Hancock, Diane Hanley,

Linda connor, Jane murphy, Judy Farley

and cheryl mullan

n Magnet Champions: Way too many

to name!

n ISD: shelley norton and Jay Duda

n Nurse Leaders: eileen sporing and nec,

nurse managers, clinical coordinators

n Public Affairs: matt cyr, erin graham

and Patrick Bibbins

n Staff Development, Wolbach

Administrative staff and Media Services

Martha Curley PhD, RN, FAAN

From left, Lynne Hancock, RN, MSN, Linda Connor, RN, BA, Diane Hanley, MS, RN, BC

� nursing | October 2007

Caption

throughout her 20 year nursing

career, Cheryl Toole, MSN, RN,

nurse manager in children’s Hospital

Boston’s nIcU, has experienced many

aspects of nursing, both as a nurse and

anxious parent on the receiving end of our

nursing care. as a result, toole was chosen

to represent children’s as a Journey nurse

for Force 3 in the magnet document.

Using her experiences as nurse and parent

of a children’s patient, toole has developed a

personal management philosophy that

reflects magnet Force 3 goals: to demonstrate

how children’s work environment supports

participation and feedback. Her management

style encourages an environment in which

nurse leaders are visible, accessible and com-

mitted to communicating effectively with staff.

since joining children’s, toole has served

as a staff nurse, nurse educator and clinical

nurse specialist. Last year, she took on the

new role of nurse leader, a move she didn’t

plan on making, but one that she’s grown to

love. “children’s leadership philosophy is to

support the staff and foster enthusiasm un-

der the assumption that if the staff thrives,

then the patients thrive as well,” says toole.

“Fortunately, the nurses here are incredible

leaders, allowing me to really build upon a

foundation of excellence.”

One of the important lessons toole has

learned as a new nurse leader is to consider

every moment as a learning opportunity. “I

don’t place hierarchical limitations on who I

Children’s Hospital Boston’s focus on

safety, for both patients and nurses,

was highlighted in the Magnet docu-

ment. Part of the document reviews the many

initiatives that are in place to cover all aspects

of safety at the hospital.

The Program for Patient Safety and Quality

ensures that patients receive the best possible

care. Four times a year, the program gathers

data on 35 key outcome measures, which are

broken down into clinical, community, clini-

cal research and teaching.

Children’s Hospital Applications Maximiz-

ing Patient Safety (CHAMPS) integrates many

of the key computer-based systems used to

care for patients into an electronic medical

record. CHAMPS makes it easier and faster to

access detailed information, improving patient

care and reducing errors.

The basis of nurses’ professional care is

the Professional Behavior for Clinicians. This

series of recommendations is based on the

American Association of Critical-Care Nurses

position statement that stresses collaboration,

constant attention and nurturing through the

formal hospital channels.

Some of the services that are currently in

place to protect Children’s’ nurses include

the hospital’s Occupational Health Services

Department, which monitors work-related

injuries, and the Health Surveillance Pro-

gram, which is responsible for anesthetic

monitoring.

One common problem that nurses face

is the possibility of needle sticks, and the

Bloodborne Exposure Control Committee

(BECC) is in place to monitor these occur-

rences. The BECC has added new products,

like safety intravenous catheters, scalpels,

lancets and butterflies, to reduce needle

sticks, and has added more education and

training classes.

nursing profile: Cheryl TooleJourney nurse in magnet Force 3

can learn from or quantify the value of a learning opportunity based on the status or experi-

ence of the individual,” she says. this opportunity played out in an unexpected way when

her daughter, avery, was born with critical congenital heart disease three years ago. toole

says she was able to better understand her unique role in this institution by looking at it from

an outside perspective.

“Being on the receiving end of the phenomenal care offered here at children’s is a bit ex-

traordinary,” she says. “It’s helped me realize the impact of everything I do here and appreciate

the fact that everyone here makes a difference.”

�www.childrenshospital.org/nursing

Safe environments for patients and nurses

Children’s Hospital Boston Nurses: Dedicated to Excellence A publication of Children’s Hospital Boston Department of Nursing

Editorial Board

Diane Hanley, RN, MS

Anna Gonski

Pam Dockx, RN

Pam Gorgone, RN

Marge David, RN

Deb Krepcio, RN

Diane Stanley, RN, MS

Pam Schubert, RN

Larraine Bossi, RN

Camilla Cook, RN

Matthew Cyr

Editors

Erin Graham

Matthew Cyr

Louise Cobb

Writers

Jennifer Gundersen

Eric Bland

Designer

Carolyn Bowes

© 2007, Children’s Hospital Boston. All rights reserved.

NUR

SES

We are the Champions

From left, Patti Branowicki, Eileen Sporing, Joseph Madsen

�

Evid

ence

-bas

ed t

ips

nurses aren’t the only ones who use evidence-based practice at children’s Hospital

Boston. nursing management also bases administrative practices on the best avail-

able evidence to improve the workplace for nurses—an approach cited in the magnet

document. “changes are made when opportunities for improvement are identified,”

it reads. annual surveys are one way for nursing administration to find ways to

improve the quality of care at children’s.

changes were made in 2005 after data revealed children’s was below the national

average in two categories. When asked questions about adequate discharge plan-

ning and moving and lifting concerns on the nDnQI Rn satisfaction survey, only 28

percent and 49 percent of nurses, respectively, said they received enough help,

compared to the national average of 64 percent and 63 percent, respectively.

to raise these numbers and improve patient care, nurses identified a role focused

on discharges and charge nurses were put in facilitator roles. In 2006, the numbers

jumped dramatically—up to 95 percent satisfaction for adequate discharge planning

and 90 percent for lifting and moving.

Opportunities for change led to jumps in satisfaction scores for discharge planning and moving/lifting

Magnet Document fun facts:n It weighed

nearly 40 pounds

n It was more than 15 inches thick

n It was about 2,500 pages

n It took 10 months to write and edit

Eileen Sporing, MS, RN, CNAA, BC

senior vice president of Patient Care Operations

and chief nursing officer

Thanks to Sporing, members of our non-phy-

sician clinical staff have had this in common

for the last 18 years: a gifted and dedicated

leader. Committed to the highest standards

of care for patients, families and employees,

Sporing was integral in the planning and con-

struction of the clinical building expansion.

This expansion has been embraced by all who

step inside. “My job is to make patient care

work,” says Sporing. “Wherever it happens.”

Patti Branowicki, MS, RN, CNAA

vice president of Medicine Patient Services and

director for Nursing Patient Care Service for

Pediatric Oncology at Dana-Farber Cancer Institute

During her 27-year pediatric nursing career,

Branowicki has dramatically improved the

experience of families of children with can-

cer, especially as they face end-of-life issues.

She understands the crucial role nurses play

in defining that experience. “Nurses at the

bedside have the ability to make change,”

says Branowicki. “My role is to listen to

their ideas, eliminate barriers, and support

the passion and desire that nurses have to

provide excellent patient care.”

Joseph Madsen, MD

associate in Neurosurgery

Call him the Edison of pediatric neurosurgery.

Madsen’s six patents and numerous products

in development are changing the way physi-

cians everywhere treat neurological diseases in

children. His insights into hydrocephalus may

one day lead to a drug-only treatment. “A true

surgical innovator tries to find ways to make

surgery obsolete,” says Madsen.

As part of its annual Health Care Champion’s Awards, the Boston Business Journal

recently recognized three Children’s Hospital Boston “visionaries.” The Champions in

Health Care awards are bestowed on the best and brightest health care professionals

throughout all of Massachusetts. Congratulations to these Children’s winners:*DOn’t FORget that

the magnet site visit

will be november

14, 15 and 16. In

preparation, the

magnet

Recognition Pro-

gram is looking for

public feedback

about children’s

prior to their visit.

You can submit

your comments

by november 1 to

magnet@ana.

org, or by phone to

866-588-3301 or by

fax at 301-628-5217.

children’s looks for-

ward to this exciting

opportunity.

Magnet feedback in preparation for the site visit