Earlier this year, Sallie Latty, RN, BSN, MA, one of a pair of ANCC Magnet Recognition Program® (MRP) coordinators at St. Vincent Hospital Indianapolis, set out on a very specific research project. As part of crafting the organization's application documentation for MRP recognition, her focus turned to the Source of Evidence Transformational Leadership, Advocacy and Influence (SOE TL-4).
This requirement asks organizations to describe and demonstrate how the chief nursing officer is enabled to influence organization-wide changes. Latty devised an initial list of evidence and then reached out to her colleagues in the field for additional brainstorming ideas.
"When I started writing, I talked about our CNO and how she was able to influence the organization through her participation in the board of the directors," says Latty, who provided meeting minutes, discussed presentations the CNO gave, and highlighted her attendance.
She also focused on the CNO's job description.
"Even though we include the overall job description in our organization overview, we took this opportunity in the SOE to highlight specific competencies," says Latty.
There are some administrators who have a reporting relationship to the president of the organization but also have a dotted-line reporting relationship to the CNO.
"In the SOE, I talked specifically about the level of expertise required of a CNO in our organization," says Latty. She focused on competencies that affect the ability to influence, such as:
- Coaching
- Proficiency of teamwork
- Decision-making ability
"I also focused on pieces of the organizational chart to give detail about her reporting relationships and factors that tie her in across the organization," says Latty.
Don't be afraid to ask for additional support from leadership, either.
"I also had our president write a letter summarizing his level of influence and how, in his absence, our CNO is the acting president," says Latty.
The biggest part of the document includes examples of the CNO's ability to influence the organization through her involvement with groups on multiple levels, key committees and councils where her voice would have an effect on the entire organization.
Key groups Latty discussed in the MRP document were:
- Executive committees, such as the administrative council. All of the organization's executives at the highest level meet weekly, including the CNO.
- Quality councils/committees, such as the quality committee of the board. This is a sub-council of the board of directors.
For each of these roles a roster is included, as well as minutes where appropriate, highlighting the CNO's expertise and identifying her contributions in blue ink.
"This could include any discussions she has led or where she has contributed her voice," says Latty.
Other key meetings detailed in the document include:
- Quality and safety committee
- Medical executive council
- Departmental meetings
- Business development
- Patient safety committee
- Risk and safety committee
- Nursing peer review committees
- Credentialing committee
The business development component is important because the organization is able to demonstrate the CNO's ownership over key projects and detail the progress of those projects.
"We also discuss how she's involved in our shared governance model," says Latty.
View from the field
Latty received a number of ideas from her colleagues in the field for inclusion in the report. The first, and most striking, was budget information.
"The whole focus we have here is to describe and demonstrate the ability of the CNO to influence organizationwide change—the budget can show she's put funding towards those changes," says Latty. "I hadn't thought of that!"
Others suggested information about board retreats. "We often do our strategic plan on these retreats," she says.
Still others suggested delving into further details about the CNO's role in quality improvement. Being a member of a committee is one thing, but is there anything beyond that to demonstrate the process behind her influence?
St. Vincent Hospital uses the Lean structure many hospitals are adopting, which its CNO is heavily involved in. Latty chose to include an explanation of how she influences this process and how Lean is used to influence the organization as a whole.
Challenges
There were some hiccups along the way in building the documentation needed to prove these facets of the CNO's role and influence.
"One thing I encountered was, when asking for meeting minutes for executive meetings, people don't want to let you take them," says Latty. "They're confidential documents. You have to be willing to have people tell you they can't send them to you."
Be prepared to go to the appropriate office, read through the document, and highlight the parts you need.
During this process, you may find that councils or committees don't update their charters or membership as often as they should.
"You don't want to include old information in your documentation," says Latty. "Motivate them to update their charter or membership list."
These smaller tasks can be very time-consuming, she notes. Anticipate spending more time than you would otherwise expect tracking down these items or requests.
Your CNO
Your greatest asset in creating this portion of your MRP document is your CNO.
"You need your CNO to be your advocate," says Latty. "They can be your intercessor in obtaining important documents or getting access to the right meeting minutes."
It is possible the CNO may not be comfortable standing in the spotlight—and this is a fear you need to help him or her get over.
"Once they see that what you're doing is to make them look as good as possible, they'll become your advocate," says Latty. "They're a great CNO and do all these wonderful things, and you want to capture that. Our own CNO, as we finish each SOE or component, thanks us for painting her in such a good light."
Because MRP designation is one of the organization's strategic initiatives, the board of directors has been behind the project from the start. The CNO takes on the role of keeping the board up to speed—which is key because, as Latty points out, it's important to have an open line of communication between you, the CNO, and the board through the whole process.
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This article was adapted from one that originally appeared in the August 2010 issue of HCPro's Advisor to the ANCC Magnet Recognition Program®, an HCPro publication.