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Posted March 31, 2009 | Copyright © The Northern Virginia Daily
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Designation comes with morale boost for hospital

Registered Nurse Catherine Selby checks on newborn, Jordan Scott Arnold. Jordan is the son of Kyra Arnold and Barry Thompson of Winchester. Photos by Dennis Grundman/Daily

Melissa Ogle is attended to by registered nurses Pam White and Crissy Van Horn.

The trophy given to the Winchester Medical Center for receiving “magnet” status is on display.

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By Garren Shipley - gshipley@nvdaily.com

WINCHESTER -- Give people a chance to improve how they do their jobs, and the entire organization will benefit.

It's a concept that's shared in workplaces as diverse as manufacturing to the military. Now it's pushing nursing to higher levels at Winchester Medical Center.

Winchester was recognized as a "magnet" hospital for nursing by the American Nurses Credentialing Center in September.

The hospital is one of only 10 in Virginia and 291 in the U.S. to achieve such a recognition for quality nursing.

But the years-long process to become a "magnet" facility required major work, including significant changes to the institutional culture.

Now that the changes are in place, people involved at all levels say they couldn't be happier with the outcome.

In a magnet hospital, nurses aren't there to just carry out instructions -- they're charged with being an active part of the process to improve patient outcomes.

Those on the front lines are given responsibility for results.

They also get the authority they need to make sure results are positive.

That means if rank-and-file nurses see a procedure that needs to be changed, they can bring the idea forward to fellow nurses. If a council of nurses and other managers agree, the changes get made.

For hospitals, it's a cultural change, said Carolyn Guinn, the hospital's lead official in seeking accreditation.

"You have the front-line worker able to stop if they see an issue that's going to produce a bad outcome," she said, "having [nurses] make decisions at the bedside because they're the one's doing the work."

Giving nurses a voice in how things work has made a visible impact in the labor -delivery and mother-baby units on the fourth floor, according to Dr. Richard Fieo, an obstetrician.

The change "has given them a new outlook on their individual importance in taking care of patients," Fieo said.

"I think the process has definitely been very productive," he said. "I see improvements in the quality of care, and I see improvements in the niceties of care."

Most of the changes initiated by nurses aren't visible to patients and visitors, but their impact has been tremendous.

Streamlining the digital paperwork is one area that's made a huge difference for nurses, said Michelle Heishman, a charge nurse in the mother-baby unit.

Nurses were spending vast amounts of time logging information into electronic patient charts that had little if any relevance to the patients they were treating.

"You could hear on the floor, 'This is taking forever,"' she said.

So a group of nurses sat down to look at what information they were collecting, w hat was needed and what wasn't, paring out redundant entries.

Now nurses spend less time at the keyboard and more time with patients.

"It's really decreased the amount of time the nurses are at the computer," Heishman said.

Improvements to patient care have given the nurses on the front line a bit more spring in their step.

But changing an institutional culture doesn't happen overnight. Shared governance has been in place for more than three years, but significant benefits and improvements to morale have only really taken hold in the recent past.

"Morale probably this past three or four months has really increased," Heishman said. "We were at a point where morale was very low. Nurses felt like they couldn't do it ... you could hear their voices, but you couldn't do anything about it."

Other nurse-initiated changes seem obvious in hindsight, but have made life better for everyone on the floor -- such as enforcing visiting hours.

Nurses simply started closing the doors to the mother-baby unit when visiting hours were over, and signs were posted with the hours.

"Moms get so tired, they're so overwhelmed, they're inundated with visitors constantly," said Janet Nordling, the hospital's director of women's and children's services.

Closing the doors also gives harried new parents a polite way to tell overzealous friends and families that it's time to go.

"It's quieter, patients are getting more rest," Nordling said. And nurses can spend more time with patients, helping new mothers learn the ins and outs of infant care.

Hospitals have good reason to make sure their nurses are happy and engaged in their profession.

More than 1 million new and replacement registered nurses will be needed by 2016, according to the federal Bureau of Labor Statistics.

Virginia will be 18,000 nurses short of what it needs by 2015, according to a study by the U.S. Department of Health and Human Services.

Winchester Medical Center isn't participating in the shortage.

"We have a waiting list," said Guinn.

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