Magnet Documentation Tip

Magnet Documentation Tip

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Magnet® Documentation Tip

Batcheller Anderson

Avoiding Document Deficiencies Related to Attached Evidence

By Joyce Batcheller, DNP, RN, NEA-BC, FAAN
ANA NKC Consultant and Educator

By Teresa Anderson, EdD, MSN, RNC-OB, NE-BC
ANA NKC Consultant and Educator

Avoiding supplemental recommendations and recordkeeping along the journey:

One common theme of organizations with document deficiencies is the lack of appropriate attachments that meet expectations of the Magnet Recognition® source of evidence examples. It is not difficult to write clear and concise descriptions of past work, but the writing team often comes up short when looking for attachments that prove the necessary elements of completed work. Avoiding document deficiencies and creating strong narratives are easiest when work is documented correctly as it occurs. Our clients shared some ideas that will be useful to your team.

  • Meeting Rosters and Minutes – Sign-in rosters should clearly identify nurses in attendance and their roles both in the organization and on a team. Minutes should mention specific ideas that come from clinical nurses, and attach data or resources that informed the discussion or decision to the final approved minutes. A strong minute template is helpful, and many use a format that includes item, discussion, follow-up actions, and assigned team members. Some place assignments again in a summary section at the top of the final minutes, so that members clearly see their assignments when they open the document. Setting dedicated time in meetings to discuss goals and results can also provide the right summary in the minutes.
  • Follow-Up E-mails and Thank-You Notes – E-mail dialogues are powerful evidence with both sides of a conversation presented. Chief nursing officers or nurse leaders should always reply to e-mail inquiries from clinical nurses, explaining actions taken or rationales for current processes, or thanking the sender and promising more information following further investigation. During our readiness assessment interviews, clinical nurses state that leaders who “close the loop” are often perceived as accessible and visible and are seen as more trustworthy by their staff members.
  • Rounding Logs – Executive and top-level leaders are steadily increasing “rounding” as a method to connect with staff, observe processes in action, and validate their own perceptions of performance and engagement. It is a missed opportunity if rounds are not recorded. Trended concerns can point to bigger system issues or the failure of some leaders to provide closure and follow- up for staff. These rounding logs or formal notes make great evidence of communication around any number of concerns, and expedite the successful resolution of problems. Typical reports include names of staff encountered, issues identified, a time frame for action, names of appropriate staff to effectively improve the situation, the resolution, and results of a follow-up with the person initiating the concern.
  • Proactive Access to Personal Folders and E-mails When Leaders Leave the Organization – Turnover of key staff members is a reality in health care. Retirements, promotions, medical leave, and terminations can happen with very little advance notice. A proactive process is necessary to assure that remaining immediate employees have access to emails and electronic records of reports in the event of unexpected turnover. Personal files may contain needed evidence of project plans, approved budget proposals, meeting minutes, or e-mail exchanges. If this evidence is lost, it cannot be re-created, and a strong and successful project cannot be included in submitted documentation.
  • Newsletters – These concise and timely communications are a great way to provide chronologic evidence of project progression, and may serve as recognition for staff members and successful teams. "A picture is worth a thousand words,” and a well-placed newsletter article with an image can prove dates of work, the team members involved, and the success of a project.

Other quick tips for evidence attachments include:

  • Unit–level dashboards with current and easy data to which staff can speak with confidence
  • Cheat sheets and reminders (bathroom banners worked in the dorm, and they work in hospitals!)
  • Thank–you notes from grateful patients and families
  • Monthly reviews and reports of individual and team accomplishments
  • Quarterly project assessment evaluating progress toward goals, and barriers and successes
  • Sharing of best practices as meeting openers or roundtable summaries of meetings
  • Assignment grids for interprofessional teams documenting the timely goals, actions, and accomplishments of each discipline contributing to a project or outcome
  • Requiring each project proposal to document the cascade of information from the bedside to strategic priorities or goals of the organization or division (connect dots early in the project)

Here are some questions that might stimulate communication and appropriate vetting of projects to determine if the work could make a strong Magnet example:

  • Why is it important and why should we invest in this?
  • Have you done a literature review?
  • Is there an evidence-based practice we should consider?
  • Have you checked for best practices?
  • What metrics will you track?
  • What did you learn from the conference you attended?
  • Are there expectations for sharing lessons learned?
  • What national or regional poster or podium presentations were supported for clinical staff? What tangible and non-tangible support was provided?
  • Is there organizational support (tuition reimbursement, loan forgiveness, scholarships, flex time) for nurses who are in school, and how do their projects tie in with organizational, divisional, or unit goals? What is the return on investment on these students?

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