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Magnet® Designation: Why it Matters and What You Need to Know


This blog post is an excerpt from an article by Gen Guanci, MEd, RN-BC, CCRN, Creative Health Care Management, in the current issue of PX Alert, HealthStream's quarterly e-newsletter devoted to the wide range of challenges, situations, and issues that have an impact on the patient experience. Subscribe to PX Alert.

The beauty of using the pursuit of Magnet® designation as the framework for your cultural transformation is that it sets out clear parameters for all aspects of the transformation. The very pursuit of Magnet® designation will almost certainly bring your organization a myriad of improvements in nursing excellence, nurse satisfaction, and nurse retention.

Genesis of the Magnet Recognition Program®

HealthStream Magnet SolutionsDespite a serious nursing shortage in the 1980s, it came to light that several hospitals throughout the United States were still attracting and retaining nurses. With sponsorship from the American Nurses Association, a team of nurse researchers set out to determine what was occurring at those organizations that made each of them a “magnet” for nurses. Their findings pointed to excellence in administration and professional practice, as well as a consistent and visible commitment to professional development (McClure & Hinshaw, 2002).

Several years later, Marlene Kramer and her colleagues identified more of the conditions that were present in organizations that were successful in attracting and retaining nurses. This is a compiled a list of the “essentials of Magnetism”:

  • Working with nurses who are clinically competent
  • Good RN/MD relationships (collaborative/collegial)
  • Nurse autonomy and accountability
  • Control of nursing practice and the practice environment
  • Supportive nurse manager/supervisor
  • Support for education
  • Adequate nurse staffing
  • Emphasis on concern for patient (Kramer, 2003)

In short order, a few other commonalities were discovered. Hospitals that were able to attract and retain nurses showed the following outcomes:

  • Lower morbidity and mortality rates
  • Higher patient and nurse satisfaction
  • Less nurse burnout
  • Higher levels of professional nursing practice

Nurse leaders and researchers were closer than ever to defining what must be present in an organization in order for nurses to thrive.

In 1993, the American Nurses Credentialing Center (ANCC) established the Magnet Nursing Services Recognition Program for Excellence in Nursing to formally recognize organizations that demonstrated excellence in nursing practice. Since that time, more than 401 hospitals in the United States and abroad have gone on to receive or maintain Magnet® status. This number, however, continues to comprise less than 7 percent of the hospitals in the United States.

In 2002, the ANCC, “realizing it requires an initiative on the part of the whole organization and a change in its culture, chose another name—the Magnet Recognition Program®. This change confirmed what nurses already knew and valued… it takes the whole healthcare team to ensure good patient outcomes” (Guanci, 2005). Further program revisions were made in 2005 so that the designation review process focused on the 14 Forces of Magnetism. Then in 2008, ANCC unveiled the New Magnet Model, which consists of five components:

  • Transformational Leadership
  • Structural Empowerment
  • Exemplary Professional Practice
  • New Knowledge/Innovations and Improvements
  • Empirical Outcomes

August 2013 saw the release of the 2014 Magnet Application Manual, which now offers specific instructions of the examples to submit, as well as an increased emphasis on concrete evidence. Fifty percent of the document submission must address the sustainable outcomes organizations have achieved.

What those who have designed the Magnet® designation program have given us is a set of tangible outcomes to which we can aspire. Taken together, the Magnet® components and their associated requirements help us to understand our destination, but they do far less to help us understand the route we need to take to get there. For this, an experienced guide is necessary. More than 30 percent of organizations fail on their first attempt at Magnet® designation. While it is quite likely that their organizations have benefited in some intangible ways from the process itself, pursuing Magnet® is costly, and failing to achieve designation means the measurable ROI on that investment is nonexistent.

Ready, Set…Pause

There’s no doubt about it: the pursuit of Magnet® designation has a lot more in common with a marathon than it does with a sprint.

The full article also describes:

  • 7 essential things to do before embarking on your Magnet® journey
  • 10 Lessons Learned from Multiple Magnet® Journeys
  • The value of having experienced Magnet® partners

Link to the Full article.

Become a Stellar Perioperative Nurse: Education and Professional Development


Carol Alexander, RN, MS, HealthStreamBy Carol J. Alexander, RN, MS, Director of Nurse Accreditation/Lead Nurse Planner, HealthStream

Why settle for being an average clinician when one can be an outstanding, competent performer? Proficiency at an expert level takes self-confidence, personal motivation, commitment, dedication, and time; but it CAN be achieved. Importantly, the benefits to patients, the patient experience, employers, and self in terms of exceptional clinical outcomes, extraordinary job performance, and progressive career advancement makes the journey to become stellar worth any associated struggles and sacrifices.

Becoming a Stellar Perioperative Nurse Requires Ongoing Education

Becoming a stellar perioperative nurse starts with a solid, quality basic nursing education
that instills the belief that there is always a need to seek ongoing continuing education and formal academic advanced educational opportunities, as well as stimulating, complex work experiences that will foster the refinement and enhancement of specialty skills. Capitalizing on guidance from nursing and non-nursing preceptors, mentors, coaches, and leaders throughout your career is imperative. Plus, one must constantly refine interpersonal and interdisciplinary
collaborative skills, so productive collegial relationships and team functioning are cultivated.

HealthStream Learning COurseware from AORNThe Importance of AORN Membership

Joining one’s specialty organization, the Association of periOperative Registered Nurses (AORN), is essential so that you are fully cognizant of the most current AORN standards and recommended practices, along with professional issues facing perioperative nurses. Being a member of AORN will also assist you to pursue specialty certification. Furthermore, I believe that membership in the American Nurses’ Association (ANA) is critical for understanding the priorities facing the nursing profession at large; since advocacy designed to create the preferred future for the nursing profession is a skill of exceptional nurses.

A Daily Pursuit of Clinical and Leadership Competencies

However, the key principle to becoming a stellar performer is the daily pursuit of clinical and leadership competencies that result in effective outcomes. Competency is the ability to apply one’s knowledge, skills, and behaviors in real life situations in a manner that strives to mitigate or resolve health/illness issues, problems, and challenges that we encounter. Maintaining and enhancing competency occurs on a continuum ranging from taking advantage of onboarding/orientation processes, quarterly/annual competency assessments, performance
evaluations, self-evaluation measures, and available educational offerings/courses.

Online Learning Opportunities

Nurses desiring to refine perioperative clinical competencies definitely want to explore whether their employing institution uses the online resources available through HealthStream which includes five major categories of courses by AORN. Nurses new to the perioperative specialty area want to be able to work with departmental educators/preceptors in taking the 25 online learning modules embedded in Periop 101: A Core Curriculum. The curriculum consists of evidence based topics, such as introduction to perioperative nursing, critical thinking, professionalism, aseptic practice, patient care, patient/worker safety, sterilization, and equipment safety. The modules also include interactive activities, required readings and suggested videos to complement the content presented. Periop 101: Individual Modules allows the purchase of select offerings within the total curriculum that a nurse might want to purchase for themselves. This allows a user the ability to review content frequently at a pace of their own choosing, thus reinforcing retention.

As perioperative nurses become more confident of their clinical competencies, they may want to take the 30 contact hour course called Preparing for the CNOR Exam Online. This self paced course allows nurses to refine their knowledge of perioperative nursing, learn effective test-taking strategies, and review the latest standards and recommended practices in preparation for becoming certified. This process is a major step towards the goal of being a stellar
perioperative nurse.

Some perioperative nurses want to become preceptors to mentor and coach other nurses within the operating room setting. By taking the online course titled AORN-Preparing the Preceptor, they can be effective role models who showcase outstanding clinical skills that result in positive outcomes for patients and family members. They also demonstrate the successful implementation of recommended standards of practice, regulatory criteria, policies, and procedures. There is also a course titled Periop 101: A Core Curriculum for the OB RN-Circulator, that perioperative nurses who further specialize in obstetrics may wish to take to enhance additional competencies.

Testing Your Proficiency

AORN also has a unique Periop Mastery Program that tests both the user’s level of knowledge
and well as confidence in that knowledge, so that knowledge gaps are identified. The mastery program allows organizations and individual nurses to take advantage of additional learning modules on high risk and high or low volume patient care issues such as moderate sedation/analgesia, malignant hyperthermia, or radiation safety that assist with competency validation during quarterly/annual skills fairs or performance reviews. Reports track individual
learner progress, including knowledge gaps, so education can be targeted to remediate those deficits and improve competencies. Finally, AORN offers webinars and journal articles that award approved contact hours. These resources also contribute to becoming proficient.

Refining Nursing Leadership Competencies

Finally, the Frontline Nurse Leader: A Charge Nurse Program course offered by HealthStream
is an online resource that focuses on developing and refining leadership competencies. This curriculum enables clinical nurses to cultivate additional competencies that are pivotal in terms of overall career success. Patient safety, positive clinical outcomes, quality care, and patient/employee/physician satisfaction are strengthened by leaders who create a constructive work environment where such goals can be achieved regularly and consistently. In fact, such leaders often strive to achieve Magnet status, which recognizes a work environment in which nurses can flourish, as well as being creative and innovative. The latter characteristics are hallmarks of stellar performers.

In summary, the above suggestions are only a few among many that enable nurses to far
surpass mediocrity and excel at becoming stellar perioperative nursing clinicians and leaders. Numerous life experiences, along with educational opportunities, will hone the wisdom, skills, and behaviors inherent in seasoned exceptional performance. There will be “high mountains” and “deep valleys” as you progress on your journey toward the goal of being stellar. Remember, proactive actions, plus a mixture of hope and faith, will enable you to be steadfast.

What Hourly Rounding is NOT and Why It Often Fails


This blog post continues our series of patient experience Best Practices from Baptist Leadership Group, a HealthStream Company. Every week we will share information from BLG that demonstrates their expansive understanding of the challenges faced by healthcare organizations and the solutions they have identified for improving the patient experience and patient and business outcomes.

We are currently focusing on hourly rounding as a component of improving the patient experience. Hourly rounding is a structured means of promoting patient-centered communication in a healthcare setting between staff, patients, and their loved ones to ensure the best outcomes.

What Hourly Rounding is NOT

  • Solely for patient satisfaction - There’s much more at stake here that just making patients and their families happy.
  • A magic bullet for service and quality - To see true improvements, care organizations need to be in it for the long haul. Successful hourly rounding is hard work, and organizations that do it successfully and see results often take a long time to do so.
  • Robotic - There’s definitely more to hourly rounding than just checking a box or making a rote visit at certain intervals. Connection is part of this communication, and caregivers have to act from their emotional motivation for why they are engaged in this career in the first place.•
  • Only nursing’s responsibility - Anyone who communicates with patients and families is responsible for the success of hourly rounding. That includes physicians, technicians, therapists, non-clinical staff, AND nurses.
  • Just a log that gets tucked away - One reason for rounding is to gather data, another is to ensure understanding. Communicating the why, when, and how of care can go a long way towards ensuring that the outcomes of care are more successful.
  • A skill that is easily learned and a behavior that is easy to hardwire - It takes work, patience and coaching. Hourly rounding is intense, and doing it well requires motivation and commitment. Everybody involved needs to be engaged in making it a success.

Learn About BLG's Training for Purposeful Rounding. 

BLG Purposeful Rounding Training

Hourly Rounding Compared to Traditional Practice

Traditionally, interactions with patients can be characterized as:

  • Reactive
  • Driven by call bell or patient care delivery
  • Inconsistent use of Rounding Log
  • Observation only no “active interaction with patient about “why” rounding

Purposeful rounding is different. It is:

  • Part of “Exceptional care” introduced on admission to patient
  • Prescriptive, with times based on day/night
  • Responsibility between nursing and nursing support are outlined
  • Ancillary and Support Staff are trained
  • No Pass Zones are established
  • Validated through Leader Rounding
  • Included in Annual competency measures
  • Visible Rounding Log is maintained and checked

Why Hourly Rounding Fails?  

We have already mentioned that establishing a successful hourly rounding program is not easy. There are lots of reasons that, as we have mentioned earlier, “Despite significant efforts being made in terms of staff time, training, and re-training, most organizations are failing to see improved outcomes, and therefore are experiencing significant frustration due to the perception that their efforts are not producing results. Here are some reasons we have seen hourly rounding efforts falter: 

1. Staff ownership and motivation

Oftentimes, hourly rounding can be perceived as optional. Staff would never “skip” quality
requirements of Core Measures, checking vital signs, medication administration; however, we have encountered perceptions that Hourly Rounding is a luxury for when staff has time and is not short-staffed or in peak volumes. This has to change. Leaders need to engage staff to be a part of owning hourly rounding as non-negotiable; as well as contributing and giving feedback in the process.

Motivation is also critical. Leaders need to celebrate those staff members that excel with hourly rounding. Additionally, improvements in quality (e.g., Falls, Pressure Ulcers), decreases in call lights, and improvements in HCAHPS and patient experience results should also be recognized. Failure to celebrate wins (even small gains) can have a negative impact on staff engagement. 

2. Staff skills

It is often thought that hourly rounding can be rolled out in a classroom setting with DVDs, articles and worksheets, and then staff would know how to round. However, conceptually hearing about the practice of hourly rounding and actually changing behaviors and developing the communication to be effective is a very different skill set. BLG spends significant time coaching, skill developing, and certifying to support adoption among our clients. 

3. Leader accountability

Leaders must first hold up the mirror to themselves. It is unfair for leaders to expect
staff to round on every patient, every time, if they themselves are not:

  • Conducting leader rounding on patients to validate hourly rounding
  • Rewarding and recognizing
  • Coaching for Performance
  • Reviewing rounding logs

About BLG, a HealthStream Company

BLG provides Patient-Centered Excellence Consulting, where the patient is at the center of
everything we do. Our tools, tactics, and best practices are evidence-based and outcomes driven.  We provide custom, individualized coaching that produces measurable, sustainable increases in patient satisfaction, employee engagement, quality outcomes, and profitability.

Learn more about BLG products and services.

We Honor Our Former Nurses Committed to Nursing Workforce Development


To continue our month-long celebration of Nurses, in conjunction with National Nurses Week, we are excited to highlight more of our own employees who are also nurses and discuss with them their experiences working in the field. These two employees demonstrate a passion for the nursing profession that translates into work devoted to nursing workforce development.

HealthStream Workforce Development Solutions for NursesTo all nurses, we thank you all for your service and continued dedication to improving patient outcomes.

Lynn Howe, HealthStream Talent ManagementLynn Howe, RN MS CEN CCRN, Director of National Accounts, Talent Management

How many years did you work as a nurse: 31

Nursing Degree(s) held: AAS Beth Israel Medical Center NY NY

BSN Alfred University

MS New York Institute of Technology

Would you share an overview of your nursing experience?

My primary focus as a staff nurse was in Emergency Nursing. I loved the chaos and quick turnover of patients in the ED. I also spent several years as a staff nurse in Critical Care areas. For a change of pace, I worked for a brief period of time as an Adjunct Nursing Professor, a Public Health Nurse, and a County Jail nurse. Eventually I returned to the hospital setting and became a Nurse Clinician responsible for education of the cardiovascular nursing staff. My units included the Cath + EP Lab, Acute Open Heart, and Telemetry. This lead to a critical care/emergency educator position, and few years later I became the Director of Education of multiple hospitals in my health system. 

What did you like most about being a nurse? 

What I like most is the variety of opportunity—there are so many sub specialties within nursing. It is easy to move from one to another until you are able to find a position which is an exact fit or your career objective. 

Why did you decide to join the HealthStream team? 

I am passionate about competency, and I realized traditional paper checklists were not an effective measurement of professional nursing competency. So I sent Bobby Frist a long e-mail explaining how competency needed to evolve. After a few interviews, HealthStream offered me my dream job—to help them transform competency assessments in healthcare, and I jumped at the chance. 

Will you share a fun memory from your time in nursing with us?

My fondest memory occurred during a massive snow storm. Nurses were not permitted to leave if they couldn’t guarantee they could return the next day and a huge blizzard was predicted. About 100 nurses camped out in a lecture hall overnight. Everyone told nursing war stories, decided how we would run thing differently if we were in charge, ate pizza, and bonded with each other. Twenty-five years later and it is one of my greatest memories. 

Pam Wagner, HeartCode Training SpecialistPam Wagner, HealthStream HeartCode Training

How many years did you work as a nurse: 20

Nursing Degree(s) held:  Associate Degree in Nursing/Columbia State University 

Would you share an overview of your nursing experience?

Pediatric Extern in Vanderbilt Pediatric Intensive Care Unit, Step Dow n Surgical ICU, Public Health Nurse for Davidson County, Asthma Specialist/Pediatric Clinic, After Hours Emergency on-call nurse for Pediatric Clinic. 

What did you like most about being a nurse? 

I still consider myself a nurse. I enjoy helping people and children understand their illness, and being a part of the physical or emotional treatment. Also, doing "nursey" things: Shots, procedures, medication, and experiencing the adrenaline rush. 

Why did you decide to join the HealthStream team? 

I wanted to focus on the education aspect of my clinical experience. HeartCode provided me that opportunity. A perfect blend of clinical knowledge, and affecting a positive change in an educational environment. 

Will you share a fun memory from your time in nursing with us?

Well there was the time that a kid hopped off the exam table and ran out to the parking lot to avoid a shot. Yes I had to chase him. So many memories so little space.    

To show our appreciation for everything nurses do, we are offering discounts on select online courses for nurses now through May 31, 2014. Learn more.


Celebrating Nurses Week--Nurses in Our Training and Courseware Depts


We’re continuing to celebrate National Nurses Week 2014, and sharing the stories of our very own nurses and their experiences on the floor.

HealthStream Training and Workforce Development Solutions for Nurses

To all nurses, we thank you all for your service and continued dedication to improving patient outcomes.

Elle Varnell, Specialty Clinical Courseware ManagerElle Varnell, Specialty Clinical Courseware Manager, HealthStream

How many years did you work as a nurse? 4

Nursing Degree(s) held: Samford University BSN, RN

Would you share an overview of your nursing experience?

ED, ICU, Pediatrics, Nursing Education

What did you like most about being a nurse?

Serving others while encouraging patients and families. As a nurse, you are positioned perfectly to make a significant impact in someone's life. That demands incredible responsibility to conduct yourself with an empathetic and compassionate heart. 

Why did you decide to join the HealthStream team? 

I am passionate about healthcare and improving patient quality of care. As a nurse, I understand how exhausting and sometimes frightening your role can be. I wanted to join HealthStream to impact a nurse's job satisfaction--knowing that a happier nurse almost always leads to happier patients!

Will you share a fun memory from your time in nursing with us?

An elderly woman came to our ED via ambulance. As I was getting her situated, put in a gown, ECG attached, etc I noticed what I thought was a fur handbag between her knees. I reached to grab it, and discovered it was a dead mouse!

James Wilber, Senior Heartcode Trainer James Wilber, HeartCode Senior Trainer, HealthStream

How many years did you work as a nurse? 6

Nursing Degree(s) held: Associates Degree of Nursing (Registered Nurse), Western Kentucky University

Would you share an overview of your nursing experience?

Pediatric Cardiac Critical Care Unit at Vanderbilt Children's Hospital. I started out as a staff nurse and became a charge nurse two years into my career. I specialized in caring for post-cardiac surgery for neonates through teenagers. I also specialized in taking care of ECMO patients. As a charge nurse, I was highly involved in the Code Team and the Rapid Response Team for Children's. I also volunteered in a hospital in Tenwek, Kenya, teaching Kenyan nurses how to take care of pediatric patients post cardiac surgery.

What did you like most about being a nurse?

Helping families though the most difficult moments of their lives. As a parent, I could truly empathize with them, and was able to not only medically care for their child, but was able to emotionally care for and support the family as well. 

Why did you decide to join the HealthStream team? 

I've always enjoyed teaching. I taught many classes and trained many nurses throughout my career at Vanderbilt. I wanted to be able to continue to do that, and be able to positively affect fellow nurses. Also, 6 years of nightshift may have had something to do with the decision.

Will you share a fun memory from your time in nursing with us?

After spending about 3 hours recovering an infant after open heart surgery, I finally had a chance to sit down and start charting. We had to give many cc's of blood, numerous medications, and several other medical interventions. My plan was to chart and then to sit down to see if the family had any further questions. They had been in the room the entire time and were at the bedside holding their infant's hand, trying to process what had just happened. As I was charting, the grandfather came up to me, with tears in his eyes, and put his hand on my shoulder and said, "I need to apologize to you." I racked my brain to think what had happened, but I couldn't think of anything he had done. I asked him, "Why are you apologizing?" He looked at me and said, "All these years I thought that nurses only gave pills, changed beds, and bathed patients. After watching you all the last three hours with my grandbaby, I now have a new found respect for what you do. Thank you."

To show our appreciation for everything nurses do, we are offering discounts on select online courses for nurses now through May 31, 2014. Learn more.

HealthStream Celebrates Nurses Week--Meet Our Former Nurses


At HealthStream our vision is to improve the quality of healthcare by assessing and developing the people who deliver care. During 2014 National Nurses Week we want to celebrate and thank those who deliver that care—you, the nurses. You are the backbone of our hospitals, physicians’ offices, hospices, your households, and so much more: You deliver exceptional care and positively impact the lives of many.

HealthStream Online Education for Nurses












We Honor Our Employees Who Were Also Nurses

As part of our celebration, we want to recognize HealthStream employees who came to us from the nursing profession. A number of our own employees have stood in your shoes, and understand first-hand the importance of caring for individuals, families, and their communities, and the impact nursing has on improving the overall patient experience and quality of healthcare. We understand the challenges you face and recognize the job is far from easy, but know that with the tough times there are often fulfilling moments, even humorous ones.

We recently sat down with our nurses to discuss their memories and experiences on the floor and throughout the week will be sharing highlights of those moments with you. Our first nurses are Cynthia Key and Kathy Frossard. 

Cynthia Key, Operations Manager, HealthStreamCynthia Key, Operations Manager, 8 years

How many years did you work as a nurse? 30+

Nursing Degree(s) held: BSN from East Tennessee State University

Would you share an overview of your nursing experience?

As a new graduate, I worked in a large community hospital in Pediatrics. I then worked in Public Health as a nurse in Sullivan County, TN. I was out of the workforce for 7 years while I raised 3 small children—I still used my nursing skills. I went back to Med/Surg nursing and then to Long Term Care as a Director of Nursing and then as a Nursing Home Administrator. I returned to acute care as a nurse manager and then Clinical Educator for a number of years. During my staff development years, I was able to be on the HCA HealthStream Implementation Team and eventually joined HealthStream in 2006.

What did you like most about being a nurse?

Through all of my work experience, it was most rewarding to help patients understand more about their illness and care. Assisting staff to improve care through education has always been a main goal of mine.

Why did you decide to join the HealthStream team?

To continue to work with a team to offer online education to healthcare workers.

Will you share a fun memory from your time in nursing with us?

During the time that I worked in a nursing home, the residents knew that I liked the song, "I'll Fly Away" and they always asked guest musicians to sing or play it for me. When I would hear the song, I would always try to come out to the dining room and sing along with them. It was special that they thought of me. I also received a lot of satisfaction from seeing patients progress through major illnesses and be able to go home and continue their lives.  

Kathy Frossard, Senior Director of Regional Client SalesKathy Frossard, Senior Director of Regional Client Sales, 15 years

How many years did you work as a nurse? 17

Nursing degree(s) held: LVN, Associates of Nursing, from Illinois Central College, Certification in Adult Education at Arapahoe Community College, Advanced Nursing Practice at Regents College

Would you share an overview of your nursing experience?

I held several nursing education positions over seventeen years including as Director of Risk Management and Education for Summit Care Corporation, Director of Staff Development for Coronado Nursing Center, and direct patient care positions at Presbyterian/St. Luke’s Health System. In addition, I currently serve on the Texas Collation of Nursing Advancement.

What did you like most about being a nurse?

I enjoyed my role as a caregiver and the ability to provide a comforting and support environment for healing. As an educator I enjoyed sharing my passion for caregiving and impacting the patient experience.

Why did you decide to join HealthStream?

The excitement in the mission—I cannot imagine a more fulfilling undertaking as a profession.

Will you share a fun memory from your time in nursing with us?

During the early years of developing an Alzheimer’s Unit we sat all the patients at a large table to have lunch. The man at the end of the table stood up and said, "I guess you are wondering why I have asked you all here.” They all turned to him with expectation in their eyes. He promptly sat down without another word, in a blink many of them applauded and went back to eating. We nurses smiled at the fact that many times showing a sense of dignity can be fulfilled in just a moment in time.

We plan to feature more HealthStreamers who were formerly nurses throughout the remainder of this week and month.

To show our appreciation for everything nurses do, we are offering discounts on select online courses for nurses now through May 31, 2014. Learn more.

Primary Nursing Improves Outcomes

By Janet Weaver, MSN, RN, NE-BC, Consultant at Creative Health Care Management

Janet Weaver, Consultant, Creative Health Care ManagementThere have been times in my career when a change has been introduced, and I cannot for the life of me figure out why the decision was made to alter how we were currently doing things—why we’re changing structures or processes that seemed to be effective and working fine. Sometimes my immediate manager would have an explanation, a hope that this change would effect, and other times … well, there was no good explanation of the why. Still, there was always an assurance that we would have improved outcomes if we would embrace the proposed change and put forth our best efforts into making it work.

When I work with clinical nurses and those supporting the RN to assist them in determining how to implement Primary Nursing, I’m often asked, “Why?” Why should we change our care delivery system to Primary Nursing? What will be different? What about it will be better than how we currently provide care to the patients?

Every essence of my being tells me having a Primary Nurse partnering with patients, their loved ones, and colleagues WILL positively influence all types of outcomes. Sounds pretty strong, I know, but I’ve experienced it first hand from both sides of the bed, and I know the difference of when there is a Primary Nurse and when there is not one. 

What I will do is share with you outcomes of Primary Nursing, from my personal perspective and from evidence, both qualitative and quantitative, of how Primary Nursing improves patient/family and staff outcomes.

Learn About HealthStream\u0026#39\u003Bs Specialized Online Training for Nurses

There are many types of outcomes; a few general categories include:

  • Patient satisfaction
  • Patient safety
  • Staff satisfaction and professional fulfillment

HealthStream online Nurse Training

Patient Satisfaction

In one organization patient satisfaction increased from the 89th to the 94th percentile for nurse attention to personal preferences; patient satisfaction for having their emotional needs met increased from 86.3th to the 96.2th percentile; patient perception for nursing response for their concerns improved from 86th to the 96.2th percentile and patient satisfaction for being kept informed went from the 89th to the 93rd percentile in a two year period after implementing Primary Nursing.

Patients have a better perception of the healthcare experience when a registered nurse takes the time to get to know them, to find out what is most important to them, and to plan and communicate that plan to others.

Patient Safety

The Joint Commission and the IHI have increased awareness about the importance of teamwork and colleague communication as it relates to patient safety and improved patient outcomes. One organization reported improved patient and family perceptions of how staff worked together from the 91st percentile prior to the organization implementing Primary Nursing, and three years later survey results showed they were at the 96.3rd percentile for the same question. Staff also stated an improved perception of communication with one another as well as a general impression of improved colleagueship.

An acute psychiatric facility stated that since implementing Relationship-Based Care and Primary Nursing they now rarely make calls to law enforcement or security. They stated that the primary care giver takes responsibility to connect with the patient and other care team members in such a way that violent outbreaks have all but ceased.

Staff Satisfaction and Professional Fulfillment

Nurses repeatedly report that when they state out loud that they are responsible for coordinating care and communicating the patient preferences that they discover by creating a therapeutic relationship with the patient, they experience a sense of great professional satisfaction.

One nurse shared her excitement about several experiences she had with patients following five minute “sit downs” as part of her Primary Nurse role. She shared:

"It feels like a partnership, jointly working on optimizing hospital stay and recovery. Even sitting at the bedside and really looking the patient in the face establishes a feeling of true connection. A surprising variety of responses is generated by questions such as 'What is most important to you that we need to accomplish this shift? I am here until 11:30 p.m.' or  'What is a central concern about your hospitalization that we can address?' or 'What key questions are on your mind that you want answered?' I am using these questions interchangeably with my patients."

A couple of the patient responses she reported in her email include:

  • “Where is my Prilosec? I take it every day but haven’t had it yet here.” [Investigated; pharmacy oversight that got corrected… patient happy and understands]
  • “This bed is killing my back [ant/post spinal fusion]; it’s like it has a hole in it, and I’m afraid it’s going to hurt my incision.” [changed beds; still no-go; got a hard plastic transfer slider for under the mattress, which made for  one happy patient and wife, who asked where to report “going the extra mile.”]

And my personal experiences:

  • As a family member I felt seen and safe and that the nurse really cared for my family member and for me. I felt confident that everything we needed would be tended to and we would all experience the care we desired.
  • As the nurse providing care, I knew in no uncertain terms that I was meeting every expectation of my patient and his family. I felt a sense of accomplishment that comes from seeing and knowing those needing care and meeting not just their physical but also their emotional needs.

I challenge and encourage you to experience the professional satisfaction and the improved patient satisfaction and outcomes possible when you say to your patient, “Hello, my name is _____ and I’m your Primary Nurse.”

Explore Clinical Orientation and Training Solutions for Nurses


As a clinical nurse, Janet connected with her patients and felt great compassion for them. As her career evolved and she moved into leadership roles, something she’s done for nearly 30 years, Janet brought that same sensitivity to her teams. As a consultant for CHCM, Janet’s areas of focus include Primary Nursing, orchestrating the implementation of Relationship-Based Care (RBC) and facilitating Re-Igniting the Spirit of Caring (RSC).


Relationship-Based Precepting: Defined & Why It Matters in Healthcare


Traci Hanlon, Consultant, Creative Health Care ManagementBy Traci Hanlon MN, RN, Consultant at Creative Health Care Management

I recently conducted a preceptor focus group of 35 preceptors at a hospital in the Southern region of the United States. Preceptors in this focus group, who came from multiple specialty areas, reported not feeling adequately prepared to teach or facilitate critical thinking or clinical judgment.

Of the 35 preceptors polled:

  • 40% stated they had never taken a preceptor course, but had learned how to precept by watching other staff and or being mentored by a preceptor on the job. 
  • Almost 70% stated they did not feel their work was recognized adequately or that their organization rewarded them for the work they did on a consistent basis.

Participants indicated that this perceived lack of preparation and reward contributed to their feelings of burnout and lack of desire to continue engaging in the preceptor role.

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What is Needed for a Successful Preceptor Program?

Careful preceptor selection, preparation, reward and recognition, and a solid infrastructure that supports these elements are necessary components for the development and implementation of a comprehensive, structured preceptor program. Another often overlooked component necessary for a successful preceptor program and transition to practice is the use of a framework or model to guide the day-to-day practice of precepting. Below is an example of a precepting model: 

The Relationship-Based Precepting Model (RBP) integrates four core elements that must be addressed in the day-to-day application of precepting. These elements are: supervision, socialization, professional practice, and resiliency.


Supervision is defined as the observation of preceptee interactions with patients, families, and clinical support staff; this includes direct observation of hands-on skills, as well as indirect observation (listening) to interpersonal interactions.


Socialization is defined as inviting individuals to participate in the formal and informal processes and/or routines that create social networks, friendships, and attachments. Without this sense of belonging, individuals often have difficulty assimilating into new routines and environments without a significant amount of stress. High levels of stress can affect an individual’s ability to process new information, and learning can be delayed or even stunted. Precepting methods or strategies must include a thoughtful and formal process of integrating and socializing new staff into their teams.

Professional Practice

Professional practice is the commitment to owning your practice as a preceptor. Preceptors have an obligation to be competent in

  • assessing critical thinking,
  • teaching using effective adult learning strategies,
  • providing feedback using competent communication skills, and
  • modeling healthy interactions between co-workers.

Formal Leadership Role

In the Relationship-Based Precepting Model, preceptors are included as part of the unit leadership team. Preceptors receive the same leadership development as charge nurses and others who are considered part of the unit-based leadership team. Preceptors are socialized into this role by the unit manager in a way that staff recognize them as part of the leadership team and expect them to function in that role outside of the orientation process.


Resiliency is defined as the ability to navigate stress by engaging healthy attitudes, thoughts, communication strategies, and behaviors that build a healthy and emotionally safe working environment. When an individual’s capacity to handle stress is fully developed, he or she is able to more fully engage in a therapeutic relationship that inspires trust and healing.

The Relationship-Based Precepting Model

Relationship-Based Precepting ModelThe Relationship-Based Precepting Model embraces all practices that build capacity and it inspires an authentic connection with others. However, it is the addition of the therapeutic practices contained in the work of Mary Koloroutis and Michael Trout’s Therapeutic Relationship Workshop and their book, See Me as a Person, that really ensure that resiliency is addressed. In the Relationship-Based Precepting Model, the therapeutic practices outlined in these two works are considered an interpersonal competency for both preceptors and preceptees.

Expected outcomes from implementing the Relationship-Based Precepting Model in conjunction with a comprehensive preceptor program are:

  1. Improved preceptor satisfaction
  2. Improved preceptee satisfaction
  3. Improved readiness to practice of orientee/preceptee
  4. Decreased orientation time
  5. Improved staff engagement
  6. Improved staff satisfaction

With today’s challenging healthcare landscape it is imperative that we continue to develop and retain a talented workforce. Relationship-Based Precepting provides a comprehensive model for preceptors to follow during the transition to practice phase. Providing a theory-based model founded on best practices ensures that preceptors have the tools necessary to provide a quality orientation and that staff ultimately experience a smooth, nurturing onboarding experience that facilitates improved staff retention and satisfaction.

Learn more about HealthStream's specialized learning courseware for nurses.


Traci Hanlon MN, RN is a consultant with Creative Healthcare Management and specializes in preceptor, nursing orientation, and transition to practice program development.  

References & Permissions 

Koloroutis, M., and Trout, M. (2012). See me as a person: Creating therapeutic relationship  with patients and their families. Minneapolis: Creative Health Care Management. 

The Relationship-Based Precepting Model is used by permission of Creative Health Care Management, Copyright 2013, all right reserved.

Healthcare Professional, Are YOU a Member of The A-Team?


By Mary Koloroutis, MS, RN, Consultant at Creative Health Care Management

Mary Koloroutis, Consultant, Creative Health Care ManagementEffective teamwork is more than just a “nice to have.” It is essential for safety, retention, continuity of care, positive patient/family experiences, and overall effectiveness.  The Institute of Safe Medical Practices (ISMP) recently published new findings in a study called “Unresolved Disrespectful Behavior in Healthcare.” The ISMP expected to see improvements since its last survey, 10 years prior, but the results show that disrespectful behavior continues to undermine healthcare teams. 

“The results of our 2003 and 2013 surveys expose healthcare’s continued tolerance and indifference to disrespectful behavior. These behaviors are clearly learned, tolerated, and reinforced in the healthcare culture, and little improvement has been made during the last decade.” (ISMP, 2013) 

Do you suppose that people who are behaving disrespectfully in teams are in touch with the meaning and purpose of their work? Do you suppose they are fully engaged? 

It's Very Important For Teams to Work Successfully Together

Health care professionals are consistent in their thoughts about working as part of a team. Here is what they tell us: 

“I would rather work short-staffed with a team of people who are all on board than to work with a full staff of people who aren’t in synch with the reason we’re here.” (Koloroutis & Trout, 2012) 

We have found that when people hear that they will be working with those whom they consider members of their “A” team they feel energized enough to take on more, knowing that the time and workload will flow smoothly. 

Some Team Members are Energizing

Here are the characteristics of the team members who energize their peers:

  • positive
  • helpful (fully responsible and accountable)
  • self-motivated
  • proactive
  • fully engaged
  • highly committed 

If people hear that they’re going to have to work with team members who demonstrate lack of responsibility and a victim mentality, they are suddenly “too tired” to take on more or become hyper-responsible trying to compensate for the lack of teamwork; either way the workload will be heavy and the time will be difficult to manage. 

Some Team Members are Energy Drainers

Here are the characteristics of the team members who drain the energy out of their peers: 

  • engage in frequent complaining,
  • show little, if any, initiative
  • demonstrate an apparent apathy toward good patient care or helping their fellow team members 

Self-Assessment: Am I Part of the “A” Team? 

Now let’s look at what sort of team member you are in a little more nuanced way. I invite you to reflect on your answers to the assessment below and then ask yourself this question: Would I be considered a member of the “A” team? 

Healthcare Employee Assessment and Engagement

Note the pattern of your responses to the self-assessment and reflect on the following questions. You may also wish to use these questions in a team huddle or reflection session. 

  • What helps me sustain a high level of contribution to my work and to my team?
  • What stops me from making a higher level of contribution to my work and to my team?
  • What have been moments or longer periods of times when I have definitely worked as an “A” team member?
  • What was it about those times that tapped into the best in me?
  • What have been times that I have not worked as an “A” team player?
  • What do I need from others, from my supervisor, and from my colleagues to help me be an even more valuable member of my team?
  • What might I do more of (or less of) to make sure that I am taking care of myself so that I can contribute to my fullest capacity? (Koloroutis & Trout, 2012, pp. 255-259) 

The stakes are high. People’s lives are in our hands. Because our work is about people’s lives, we don’t have the option of not working well as fully participating and highly engaged members of health care teams. Your commitment to being positive, helpful, self-motivated, proactive, and fully engaged is a commitment to the very best patient care possible. And that is a noble commitment.  

As a co-creator, author, and editor of the Relationship-Based Care series of books and seminars, Mary helps health care organizations create a framework for delivering world-class care with strong underlying values and principles, and then works with them to implement that framework. Her most recent book, See Me as a Person: Creating Therapeutic Relationships with Patients and their Families, co-authored with Michael Trout, helps clinicians in all disciplines to connect authentically with the patients and families in their care no matter how chaotic their care environments may be. Contact Mary at


Institute for Safe Medical Practices, (October 3, 2013). Unresolved disrespectful behavior in healthcare. Medication Safety Alert! 18 (20) 1-4.

Koloroutis, M., & Trout, M. (2012). See me as a person: Creating therapeutic relationships with patients and their families. Minneapolis, MN: Creative Health Care Management.

Better Preceptors Promote an Engaged and Competent Nursing Workforce


By Traci Hanlon MN, RN, Consultant at Creative Health Care Management

Traci hanlon, Consultant, Creative Health Care ManagementThere has been plenty written on developing an engaged workforce with recommendations that point to hiring the right people in the first place (Bowen, Ledford, Nathan, 2013, and Kristof, 2006). The importance of manager competence in screening, interviewing, and identifying the personal characteristics and competencies of individuals who will best complement their teams cannot be overstated. However, as a consultant with more than 20 years assisting in the development, implementation, and evaluation of many acute and long term care institution’s orientation programs, I have observed a gap in how many of us facilitate the transition of new staff to practice. If we are not thoughtful in how we transition new staff into practice, we reduce the effectiveness of our teams and decrease job satisfaction in our newly hired staff. On a larger scale, we may unintentionally pose a threat to patient safety by hampering the ability of our new staff members to develop solid critical thinking skills, healthy communication practices, and a collegial interdependence within teams. 

In the healthcare industry, preceptors are used to socialize, mentor, evaluate, and assist in the transition of new staff into the workforce. Traditionally, preceptors were used only for new graduate nurses and students, but since a key role of the preceptor is to supervise, evaluate, and validate a new staff member’s competency, then it makes sense to use preceptors with all new staff as a model to introduce the norms and nuances of a particular unit and to assess and validate a preceptee’s competency. The length of preceptorship should be determined by the level of experience new staff members have with the profession in general, their familiarity with the hiring organization, their familiarity with the role they are being hired for, and their experience in the specific nursing specialty. 

Specialty Online Nursing Education from HealthStreamManagers invest a great deal of time and energy in the hiring process with the aim of finding the right combination of skill, attitude, and engagement necessary to add value to their teams. What managers often fail to recognize is that if they do not invest that same time and energy into selecting the right combination of skill, attitude, and engagement in the preceptors who will be transitioning their new hires into the work environment, all of their hard work in finding the right fit for their team may end up going down the drain. Preceptors can make or break the new hire’s experience; in fact, I have seen bad precepting experiences lead to increased stress during the orientation phase, which has the potential to impact the development of good critical thinking skills. Poor critical thinking skills can contribute to poor outcomes, which in the long term can reflect negatively on patient safety. Preceptors set the tone for the level of professional practice expected on a unit and make clear the norms and behaviors that are deemed acceptable in the workplace. In other words, everything your new hire learned in orientation, from behavior standards to infection control policies and best practices, can be undone by a preceptor who does not exemplify best practices in his or her own professional practice or lacks crucial critical thinking or interpersonal competencies.

So what criteria should a manager use to select who will orient and precept new hires?

There is a significant body of literature that provides ample recommendations for determining preceptor selection criteria (Eddy, s. 2010, Altmann, T. 2006, Hartline, C. 1993).  Upon review of the most recent research articles articulating preceptor best practices, several preceptor characteristics and competencies stood out to me as providing the best indicators for preceptor success. They are:

  1. Demonstrates self-directed advancement of professional practice
  2. Demonstrates authentic leadership
  3. Demonstrates exceptional performance  in clinical  and interpersonal competencies
  4. Demonstrates the desire to become a preceptor (self-selection)

Demonstrates Self-directed Advancement of Professional Practice

People demonstrating this characteristic have taken ownership for their own professional development. They are the ones who volunteer for quality improvement projects and participate in life-long learning as evidenced by attending conferences, classes, or in-services that expand their clinical and critical thinking and their interpersonal competency.

Demonstrates Authentic Leadership

Individuals who engage in authentic leadership have a track record of treating others with kindness and respect. They do not engage in gossip, and often these individuals hold others accountable for destructive behaviors by having kind, yet firm peer-to-peer conversations related to observed unhealthy work behaviors.

They have a clear vision and purpose for the work they do and can often articulate how their personal values align or complement the organizational mission, vision, and values. These individuals are engaged and committed to their organization. This is demonstrated by their ability to embrace change with a positive attitude and their early adoption of initiatives, processes, and philosophies that may stretch their current way of thinking and or practice.

Demonstrates Exceptional Performance in Clinical and Interpersonal Competencies

These individuals are self-directed learners who will typically be the first to complete any competency or learning requirements. In other words, they will not be the individuals you have to hunt down, remind, and micro-manage to provide evidence of their competency. These are also individuals who continually seek to improve their current skill levels; they are receptive and value constructive feedback.

Demonstrates the Desire to Become a Preceptor (self-selection)

This characteristic speaks to the importance of choosing only individuals who have an authentic desire to precept and (ideally) who proactively seek the opportunity to do so.  Managers who mandate precepting as an expectation for all staff risk entrusting individuals who are not suited to precepting or lack the skill to undertake such an important and critical role with one of the most important jobs in health care.  

Selecting preceptors who demonstrate competency in the four areas described above to facilitate the transition of new staff into your team is a crucial part of the hiring process.  To neglect this step and allow individuals who lack the necessary desire and skills to precept is setting up the entire team to fail, especially the new person. 

An engaged and competent workforce relies on a solid foundation that begins the first day they step onto their unit. The preceptor plays a vital role in this process and can make or break a new person’s experience.  It is for this reason that managers must focus their attention on the entire continuum of hiring, from the first screening phone call, to the interview, all the way through their orientation of which preceptor selection is a most vital aspect.

Learn more about HealthStream Specialty learning courseware for nurses.


Traci Hanlon MN, RN is a consultant with Creative Healthcare Management and specializes in preceptor, nursing orientation, and transition to practice program development.


Bowen, D., Ledford, G., Nathan, B., (2013). Hiring for the organization, not the job.  Academy of Management Perspectives. 27(3).

Kristof, A.  2006. Person-organization fit: An integrative review of its conceptualizations, Measurement, and Implications.  Personal Psychology, 49(1).

Eddy, S. 2010. Lesson learned from formal preceptorship programs.  Creative Nursing, 16(4).

Altmann, T., (2006). Preceptor selection, orientation, and evaluation in baccalaureate nursing education.  Nursing Education. 3(1).

Hartline, C., (1993). Preceptor selection and evaluation: A tool for educators and managers.  Journal of Nurse Staff Development. 9(4).

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