- Email: [email protected]
The Executive Nursing Leadership Journal Club
MAGNET INSIGHTS The Executive Nursing Leadership Journal Club ALETHA ROWLANDS, PhD, RN, CNOR; SUSAN WINSLOW, MSN, RN, NEA-BC, APHN-BC
T
he application manual for Magnet® designation states the following vision for Magnet organizations:
Magnet organizations will serve as the fount of knowledge and expertise for the delivery of nursing care globally. They will be solidly grounded in core Magnet principles, flexible, and constantly striving for discovery and innovation. They will lead the reformation of health care; the discipline of nursing; and care of the patient, family, and community.1 Nurses in all fields must remain current with an ever-expanding volume of knowledge. Using best practices enables nurses to provide the highest quality of care in meeting the multifaceted needs of patients, families, and the health care organization. To this end, nurse educators at Martha Jefferson Hospital, Charlottesville, Virginia, a not-for-profit community hospital that has had Magnet designation since 2006, established unit-based journal clubs in the oncology, obstetrics, and emergency departments; the intensive care and postanesthesia care units; and a variety of other clinical areas. These journal clubs have led to an array of evidence-based practice applications and incorporation of updated standards of nursing care for diverse patient populations. By replicating this model, we established an executive nursing leadership journal club to sup-
port evidence-based practice in administrative applications. Nurse leaders engage in discussions about nursing publications, writings, and guiding documents while considering strategies for professional growth and development specific to the formal leadership roles of directors of nursing, managers, and clinical educators. The purpose of the executive nursing leadership journal club is to stimulate intellectual inquiry that might guide policy or procedure revisions and to keep pace with important advances in nursing leadership as well as other disciplines. The following objectives were adopted for the journal club: provide a forum for nursing leaders to gather for the purpose of reading and discussing selected literature; develop a normative value within the organization that is reflective of intellectual inquiry; and reinforce the organization’s professional nursing practice model and provide applicable knowledge for nursing leaders.
BACKGROUND A journal club is a group of people that regularly meets to critically evaluate the clinical application of published material in both the nursing and medical arena. Participants typically voice their views related to a critical appraisal framework such as the methodology used, appropriateness of
The AORN Journal is seeking contributors for the Magnet Insights column. Interested authors can contact Carol Applegeet, column coordinator, by sending topic ideas to [email protected]. doi: 10.1016/j.aorn.2011.04.023
190
AORN Journal ●
August 2011
Vol 94
No 2
© AORN, Inc, 2011
MAGNET INSIGHTS the research design, the statistics used, the strengths and weaknesses of the findings, and the clinical relevance that might lead to new research or to new clinical applications. The earliest reference to a journal club is found in a book of memoirs and letters by the late Sir James Paget, a British surgeon and one of the founders of modern pathology.2 Paget describes a group of individuals at St Bartholomew’s Hospital, London, England, in the mid-1800s as a “kind of club . . . a small room over a baker’s shop near the hospital-gate where we could sit and read the journals.”2 In 1875, Sir William Osler established the first formalized journal club at McGill University, Montreal, Canada.3 Because Osler could not afford to subscribe to the numerous periodicals, the journal club served as a venue for the “purchase and distribution of periodicals.”3 During the next one and a half centuries, journal clubs took a variety of forms to meet the needs of the participants and to promote critical discussion of the clinical applicability of scholarly articles in the current literature. Throughout the years, three goals of journal clubs have persisted: keeping up with the current literature, affecting clinical practice, and 3 teaching critical reading and thinking skills.
Historically, nurses have used journal clubs to familiarize themselves with research and to promote evidence-based practice in the clinical setting. As part of a structural framework to ensure that nursing leaders in our organization are disciplined with regard to critical literature review and application of evidence-based findings related to leadership, our use of an executive nursing leadership journal club has been instrumental in the interpretation, analysis, and application of written documents and findings in our organization. THE EXECUTIVE JOURNAL CLUB Our organization has successfully held an executive nursing leadership journal club since early 2007. The invited audience consists of the chief
www.aornjournal.org
nursing officer, directors of nursing, nurse managers, clinical educators, staff nurse chairs of the central shared governance councils, and nurses designated as clinical nurse 5 (ie, the highest level of clinical nurse at our institution). Monthly meetings are organized by the director of nursing education or the coordinator of nursing research. Readings vary from leadership articles on nursing research to foundational documents of the American Nurses Association to classic works such as Florence Nightingale’s Notes on Nursing.4 The following are examples of journal club selections from the past two years: Classic 5 Nursing’s Social Policy Statement Nursing: Scope and Standards for Practice6 7 Guide to the Code of Ethics for Nurses Landmark To Err is Human: Building a Safer Health System8 “Educational levels of hospital nurses and surgical patient mortality”9 4 Notes on Nursing Current “Magnet Recognition Program: the next generation”10 “Leadership character: antidote to organizational fatigue”11 “Workplace empowerment and Magnet hospital characteristics as predictors of patient safety climate”12
Participants identify evidence from the selected article by using an established outline to identify new practice or policy recommendations that are incongruent with our current culture, philosophy, policy, or practice. The facilitator presents a synopsis of the major findings of the article, and the journal club attendees compare existing policy or procedures with the new evidence. Attendees agree on action steps for follow-up and the facilitator documents the information for accountability. To support attendance, a contact hour is AORN Journal
191
August 2011
Vol 94
provided for participation through our continuing education provider. The facilitator ends each session by conducting a verbal program evaluation with participants to rate satisfaction with the continuing education session.
ESTABLISHING AN EXECUTIVE JOURNAL CLUB When establishing an executive nursing leadership journal club, nurse leaders or educators should strategically identify the purpose and goals. The purpose may be as simple as generating discussion centered on a specific topic or the dissemination of new knowledge. Next, designated facilitators or leaders should choose the format based on the targeted participants. A multidisciplinary approach could include several disciplines (eg, respiratory therapy, pharmacy, physicians). A hospital-based format could include all nurses within an organization who are in a leadership role. After the format is determined, research or evidence-based practice leaders should focus on selecting a design for the journal club. The design identifies what is presented at each meeting (eg, discussing one article at each meeting). Another approach may be topical, including several articles centered on a specific topic. It is imperative to enlist nursing leaders’ support not only for the concept of an executive journal club but also for the commitment to financial support to provide snacks and coffee or nursing contact hours. Another key component is to designate someone to be the leader of the group. This person must be committed to the journal club concept and have a basic knowledge of research methodology and analysis. The designated leader schedules the meetings, disseminates articles or readings, and leads the discussion. The discussion during a journal club meeting is not only intellectually stimulating, it may be the impetus for organizational change. By emphasizing organizational 192
AORN Journal
MAGNET INSIGHTS
No 2
implications and following up with an action plan, an executive nursing leadership journal club can go beyond information sharing to improving patient care outcomes.
CONCLUSION An executive nursing leadership journal club can play a valuable role in the development and promotion of critical reading and thinking skills, the dissemination of scientific information, and the generation of transformational leadership within the organization. As a result of our executive nursing leadership journal club, we revised job positions (eg, RN, director of nursing, nurse manager) to reflect characteristics of transformational leadership, expanded use of National Database of Nursing Quality Indicators13 for strategic oversight, created training programs and image-of-nursing events, sustained our commitment to Magnet designation, established a change theory curriculum for leadership, and made clinical practice changes, such as scripting of patient hand offs. Moreover, this forum has led to an enhanced focus on critical analysis with a commitment to intellectual inquiry as a strong normative value of our organization. Editor’s note: Magnet is a registered trademark of the American Nurses Credentialing Center, Silver Spring, MD. References 1.
Magnet Recognition Program Manual—Recognizing Nursing Excellence. Silver Spring, MD: American Nurses Credentialing Center; 2008. http://www .nursesbooks.org/Main-Menu/Magnet/MagnetRecognition-Program-Manual–Recognizing-NursingExcellence-.aspx. Accessed April 27, 2011. 2. Paget S. Memoirs and Letters of Sir James Paget. 4th ed. London, England: Longmans, Green and Company; 1901. 3. Linzer M. The journal club and medical education: over one hundred years of unrecorded history. Postgrad Med J. 1987;63(740):475-478. 4. Nightingale F. Notes on Nursing: What It Is and What It Is Not. New York, NY: D Appleton and Company; 1860.
MAGNET INSIGHTS 5.
6. 7.
8.
9.
10.
11.
12.
www.aornjournal.org
Nursing’s Social Policy Statement: The Essence of the Profession. Silver Spring, MD: American Nurses Association; 2010. Nursing: Scope and Standards of Practice. 2nd ed. Silver Spring, MD: American Nurses Association; 2010. Guide to the Code of Ethics for Nurses: Interpretation and Application. Silver Spring, MD: American Nurses Association; 2008. Institute of Medicine. Kohn LT, Corrigan JM, Donaldson MS, eds. To Err Is Human: Building A Safer Health System. Washington, DC: National Academy Press; 1999. Aiken LH, Clarke SP, Cheung RB, Sloane DM, Silber JH. Education levels of hospital nurses and surgical patient mortality. JAMA. 2003;290(12):1617-1623. Wolf G, Triolo P, Ponte PR. Magnet Recognition Program: the next generation. J Nurs Admin. 2008;38(4): 200-204. Connaughton MJ, Hassinger J. Leadership character: antidote to organizational fatigue. J Nurs Admin. 2007; 37(10):464-470. Armstrong K, Laschinger H, Wang C. Workplace empowerment and Magnet hospital characteristics as predicators of patient safety climate, J Nurse Care Qual. 2009;24(1):55-62.
13.
National Database of Nursing Quality Indicators (20032011). The American Nurses Association. http:// www.nursingquality.org. Accessed May 25, 2011.
Aletha Rowlands, PhD, RN, CNOR, is the coordinator of nursing research and clinical educator for surgical services at Martha Jefferson Hospital, Charlottesville, VA. Dr Rowlands has no declared affiliation that could be perceived as posing a potential conflict of interest in the publication of this article. Susan Winslow, MSN, RN, NEA-BC, APHNBC, is the director of nursing education, community services, and Magnet project director at Martha Jefferson Hospital, Charlottesville, VA. Ms Winslow has no declared affiliation that could be perceived as posing a potential conflict of interest in the publication of this article.
Join in the Conversation with the AORN Journal Club Did you know that participating in a Journal Club can help your facility achieve and maintain Magnet status? Participating in a Journal Club also can help you develop and refine your critical thinking skills and facilitate dissemination of perioperative information. Each month, AORN Journal Club members have the opportunity to engage in discussion about one or more pre-selected AORN Journal articles. We will provide some questions and discussion points to stimulate Journal Club dialogue. AORN members benefit from accessing the full-text AORN Journal articles online for free; non-members can view the full-text articles for a minimal per-article fee. To join the group, visit www.ornurselink.org and sign in using your e-mail address (username) and member identification number (password). Non-members also can access the AORN Journal Club by registering with OR Nurse Link. Next, search for the AORN Journal Club under the Groups tab. Don’t miss out—join the AORN Journal Club today!
AORN Journal
193
T
he application manual for Magnet® designation states the following vision for Magnet organizations:
Magnet organizations will serve as the fount of knowledge and expertise for the delivery of nursing care globally. They will be solidly grounded in core Magnet principles, flexible, and constantly striving for discovery and innovation. They will lead the reformation of health care; the discipline of nursing; and care of the patient, family, and community.1 Nurses in all fields must remain current with an ever-expanding volume of knowledge. Using best practices enables nurses to provide the highest quality of care in meeting the multifaceted needs of patients, families, and the health care organization. To this end, nurse educators at Martha Jefferson Hospital, Charlottesville, Virginia, a not-for-profit community hospital that has had Magnet designation since 2006, established unit-based journal clubs in the oncology, obstetrics, and emergency departments; the intensive care and postanesthesia care units; and a variety of other clinical areas. These journal clubs have led to an array of evidence-based practice applications and incorporation of updated standards of nursing care for diverse patient populations. By replicating this model, we established an executive nursing leadership journal club to sup-
port evidence-based practice in administrative applications. Nurse leaders engage in discussions about nursing publications, writings, and guiding documents while considering strategies for professional growth and development specific to the formal leadership roles of directors of nursing, managers, and clinical educators. The purpose of the executive nursing leadership journal club is to stimulate intellectual inquiry that might guide policy or procedure revisions and to keep pace with important advances in nursing leadership as well as other disciplines. The following objectives were adopted for the journal club: provide a forum for nursing leaders to gather for the purpose of reading and discussing selected literature; develop a normative value within the organization that is reflective of intellectual inquiry; and reinforce the organization’s professional nursing practice model and provide applicable knowledge for nursing leaders.
BACKGROUND A journal club is a group of people that regularly meets to critically evaluate the clinical application of published material in both the nursing and medical arena. Participants typically voice their views related to a critical appraisal framework such as the methodology used, appropriateness of
The AORN Journal is seeking contributors for the Magnet Insights column. Interested authors can contact Carol Applegeet, column coordinator, by sending topic ideas to [email protected]. doi: 10.1016/j.aorn.2011.04.023
190
AORN Journal ●
August 2011
Vol 94
No 2
© AORN, Inc, 2011
MAGNET INSIGHTS the research design, the statistics used, the strengths and weaknesses of the findings, and the clinical relevance that might lead to new research or to new clinical applications. The earliest reference to a journal club is found in a book of memoirs and letters by the late Sir James Paget, a British surgeon and one of the founders of modern pathology.2 Paget describes a group of individuals at St Bartholomew’s Hospital, London, England, in the mid-1800s as a “kind of club . . . a small room over a baker’s shop near the hospital-gate where we could sit and read the journals.”2 In 1875, Sir William Osler established the first formalized journal club at McGill University, Montreal, Canada.3 Because Osler could not afford to subscribe to the numerous periodicals, the journal club served as a venue for the “purchase and distribution of periodicals.”3 During the next one and a half centuries, journal clubs took a variety of forms to meet the needs of the participants and to promote critical discussion of the clinical applicability of scholarly articles in the current literature. Throughout the years, three goals of journal clubs have persisted: keeping up with the current literature, affecting clinical practice, and 3 teaching critical reading and thinking skills.
Historically, nurses have used journal clubs to familiarize themselves with research and to promote evidence-based practice in the clinical setting. As part of a structural framework to ensure that nursing leaders in our organization are disciplined with regard to critical literature review and application of evidence-based findings related to leadership, our use of an executive nursing leadership journal club has been instrumental in the interpretation, analysis, and application of written documents and findings in our organization. THE EXECUTIVE JOURNAL CLUB Our organization has successfully held an executive nursing leadership journal club since early 2007. The invited audience consists of the chief
www.aornjournal.org
nursing officer, directors of nursing, nurse managers, clinical educators, staff nurse chairs of the central shared governance councils, and nurses designated as clinical nurse 5 (ie, the highest level of clinical nurse at our institution). Monthly meetings are organized by the director of nursing education or the coordinator of nursing research. Readings vary from leadership articles on nursing research to foundational documents of the American Nurses Association to classic works such as Florence Nightingale’s Notes on Nursing.4 The following are examples of journal club selections from the past two years: Classic 5 Nursing’s Social Policy Statement Nursing: Scope and Standards for Practice6 7 Guide to the Code of Ethics for Nurses Landmark To Err is Human: Building a Safer Health System8 “Educational levels of hospital nurses and surgical patient mortality”9 4 Notes on Nursing Current “Magnet Recognition Program: the next generation”10 “Leadership character: antidote to organizational fatigue”11 “Workplace empowerment and Magnet hospital characteristics as predictors of patient safety climate”12
Participants identify evidence from the selected article by using an established outline to identify new practice or policy recommendations that are incongruent with our current culture, philosophy, policy, or practice. The facilitator presents a synopsis of the major findings of the article, and the journal club attendees compare existing policy or procedures with the new evidence. Attendees agree on action steps for follow-up and the facilitator documents the information for accountability. To support attendance, a contact hour is AORN Journal
191
August 2011
Vol 94
provided for participation through our continuing education provider. The facilitator ends each session by conducting a verbal program evaluation with participants to rate satisfaction with the continuing education session.
ESTABLISHING AN EXECUTIVE JOURNAL CLUB When establishing an executive nursing leadership journal club, nurse leaders or educators should strategically identify the purpose and goals. The purpose may be as simple as generating discussion centered on a specific topic or the dissemination of new knowledge. Next, designated facilitators or leaders should choose the format based on the targeted participants. A multidisciplinary approach could include several disciplines (eg, respiratory therapy, pharmacy, physicians). A hospital-based format could include all nurses within an organization who are in a leadership role. After the format is determined, research or evidence-based practice leaders should focus on selecting a design for the journal club. The design identifies what is presented at each meeting (eg, discussing one article at each meeting). Another approach may be topical, including several articles centered on a specific topic. It is imperative to enlist nursing leaders’ support not only for the concept of an executive journal club but also for the commitment to financial support to provide snacks and coffee or nursing contact hours. Another key component is to designate someone to be the leader of the group. This person must be committed to the journal club concept and have a basic knowledge of research methodology and analysis. The designated leader schedules the meetings, disseminates articles or readings, and leads the discussion. The discussion during a journal club meeting is not only intellectually stimulating, it may be the impetus for organizational change. By emphasizing organizational 192
AORN Journal
MAGNET INSIGHTS
No 2
implications and following up with an action plan, an executive nursing leadership journal club can go beyond information sharing to improving patient care outcomes.
CONCLUSION An executive nursing leadership journal club can play a valuable role in the development and promotion of critical reading and thinking skills, the dissemination of scientific information, and the generation of transformational leadership within the organization. As a result of our executive nursing leadership journal club, we revised job positions (eg, RN, director of nursing, nurse manager) to reflect characteristics of transformational leadership, expanded use of National Database of Nursing Quality Indicators13 for strategic oversight, created training programs and image-of-nursing events, sustained our commitment to Magnet designation, established a change theory curriculum for leadership, and made clinical practice changes, such as scripting of patient hand offs. Moreover, this forum has led to an enhanced focus on critical analysis with a commitment to intellectual inquiry as a strong normative value of our organization. Editor’s note: Magnet is a registered trademark of the American Nurses Credentialing Center, Silver Spring, MD. References 1.
Magnet Recognition Program Manual—Recognizing Nursing Excellence. Silver Spring, MD: American Nurses Credentialing Center; 2008. http://www .nursesbooks.org/Main-Menu/Magnet/MagnetRecognition-Program-Manual–Recognizing-NursingExcellence-.aspx. Accessed April 27, 2011. 2. Paget S. Memoirs and Letters of Sir James Paget. 4th ed. London, England: Longmans, Green and Company; 1901. 3. Linzer M. The journal club and medical education: over one hundred years of unrecorded history. Postgrad Med J. 1987;63(740):475-478. 4. Nightingale F. Notes on Nursing: What It Is and What It Is Not. New York, NY: D Appleton and Company; 1860.
MAGNET INSIGHTS 5.
6. 7.
8.
9.
10.
11.
12.
www.aornjournal.org
Nursing’s Social Policy Statement: The Essence of the Profession. Silver Spring, MD: American Nurses Association; 2010. Nursing: Scope and Standards of Practice. 2nd ed. Silver Spring, MD: American Nurses Association; 2010. Guide to the Code of Ethics for Nurses: Interpretation and Application. Silver Spring, MD: American Nurses Association; 2008. Institute of Medicine. Kohn LT, Corrigan JM, Donaldson MS, eds. To Err Is Human: Building A Safer Health System. Washington, DC: National Academy Press; 1999. Aiken LH, Clarke SP, Cheung RB, Sloane DM, Silber JH. Education levels of hospital nurses and surgical patient mortality. JAMA. 2003;290(12):1617-1623. Wolf G, Triolo P, Ponte PR. Magnet Recognition Program: the next generation. J Nurs Admin. 2008;38(4): 200-204. Connaughton MJ, Hassinger J. Leadership character: antidote to organizational fatigue. J Nurs Admin. 2007; 37(10):464-470. Armstrong K, Laschinger H, Wang C. Workplace empowerment and Magnet hospital characteristics as predicators of patient safety climate, J Nurse Care Qual. 2009;24(1):55-62.
13.
National Database of Nursing Quality Indicators (20032011). The American Nurses Association. http:// www.nursingquality.org. Accessed May 25, 2011.
Aletha Rowlands, PhD, RN, CNOR, is the coordinator of nursing research and clinical educator for surgical services at Martha Jefferson Hospital, Charlottesville, VA. Dr Rowlands has no declared affiliation that could be perceived as posing a potential conflict of interest in the publication of this article. Susan Winslow, MSN, RN, NEA-BC, APHNBC, is the director of nursing education, community services, and Magnet project director at Martha Jefferson Hospital, Charlottesville, VA. Ms Winslow has no declared affiliation that could be perceived as posing a potential conflict of interest in the publication of this article.
Join in the Conversation with the AORN Journal Club Did you know that participating in a Journal Club can help your facility achieve and maintain Magnet status? Participating in a Journal Club also can help you develop and refine your critical thinking skills and facilitate dissemination of perioperative information. Each month, AORN Journal Club members have the opportunity to engage in discussion about one or more pre-selected AORN Journal articles. We will provide some questions and discussion points to stimulate Journal Club dialogue. AORN members benefit from accessing the full-text AORN Journal articles online for free; non-members can view the full-text articles for a minimal per-article fee. To join the group, visit www.ornurselink.org and sign in using your e-mail address (username) and member identification number (password). Non-members also can access the AORN Journal Club by registering with OR Nurse Link. Next, search for the AORN Journal Club under the Groups tab. Don’t miss out—join the AORN Journal Club today!
AORN Journal
193