For the Love of Health

Nursing Excellence in Action with Michelle Collins and Paige Merring

• ChristianaCare • Season 2 • Episode 22

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At ChristianaCare, excellence is at the foundation of our nursing practice, having recently secured a fourth consecutive Magnet® designation - the gold standard and ultimate benchmark for measuring quality of care, administered by the American Nurses Credentialing Center (ANCC). Magnet designation signifies belonging to an elite group representing just 10% of hospitals nationwide, and ChristianaCare is the first health system in Delaware to achieve a four-peat.

To explain the significance of this milestone, we're joined by Michelle Collins, Vice President of Nursing Professional Excellence at ChristianaCare, and Paige Merring, ChristianaCare Nursing Excellence Manager. Michelle and Paige unpack what makes ChristianaCare unique, including the use of a comprehensive system-wide approach; a transformation to a professional practice model that has led to an increased BSN rate to 83% and an increased certification rate to 65%; and a collaborative spirit that encourages teamwork across all disciplines.

Ready to experience the difference nursing excellence makes? Listen now to discover how ChristianaCare is shaping the future of healthcare through innovation, advanced education, and unwavering commitment to exceptional patient care.

Michelle L. Collins, DNP, APRN, CNS, ACNS-BC, NPD-BC, NEA-BC, LSSBB, leads ChristianaCare's systemwide efforts to support nursing practice innovation and problem-solving. She also has led ChristianaCare to achieve its fourth Magnet designation, a preeminent excellence designation from the American Nurses Credentialing Center.

Paige Merring, MSN, RN, CCRN, is the Nursing Excellence Manager at ChristianaCare. In this role, she facilitates strategic planning for nursing, supports professional governance councils to empower nurses, and leads teams to improve patient experience.

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Speaker 1:

We are living it. We are embodying excellence every single day in our nursing practice across ChristianaCare.

Speaker 2:

You're listening to For the Love of Health, a podcast about delivering care and creating health, brought to you by ChristianaCare. Hello everyone, I'm Jason Tokarski.

Speaker 3:

And I'm Megan McGuhrman. Welcome to For the Love of Health brought to you by ChristianaCare.

Speaker 2:

The concept of excellence is usually used to describe athletes, restaurants and film, but how often do you associate excellence with health care?

Speaker 3:

At ChristianaCare. Excellence is in our DNA and our nurses are internationally recognized for their excellence. Here to talk more about nursing excellence, we're joined by Michelle Collins, vice President of Nursing Professional Excellence at ChristianaCare, and Paige Maring, christianacare Nursing Excellence Manager. Michelle and Paige, thank you both so much for your time today.

Speaker 4:

Thank you, we're so excited to be here. It's an absolute pleasure.

Speaker 3:

Let's start by expanding a bit on your titles and the concept of excellence. Michelle, you are a doctor of nursing practice. Paige, you are a master of science in nursing, but your titles include nursing excellence. Explain to us what that means.

Speaker 4:

So nursing excellence is the embodiment of not only what we do from a nursing practice support position, but it's also how we go about engaging our nurses, our nurse leaders. It's the programs, processes that we create, endorse, support and program around.

Speaker 1:

Our role allows us to work at the system-wide level, which means in Nursing Excellence, we get to support excellence throughout every single practice area. At Christiana Care, which is just an extraordinary honor to be a part of, we get to work with our nurses that are in acute care practices across campuses, at ambulatory practices and home health. So excellence is integrated throughout the entire system and in our roles in nursing excellence, we get to support nurses throughout all of those practice areas.

Speaker 3:

And how rare is having nurses who are specifically focused on nursing excellence.

Speaker 4:

I wouldn't say it's necessarily rare, but the way that we do it at Christiana Care is unique in that we are much more encompassing than other programs, especially for the size of our team. We are quite efficient and very dedicated to this work and have been for a number of years. I believe it's what we embody and encompass. So in part of that for instance, in helping to support the governance structure of nursing across the entire nursing community that is something that's unique at the system level. Other organizations may do that by campus. We are at the point where we can do that across the system and I think it helps to drive the efficiencies that we have and the level of engagement.

Speaker 2:

So Christiana Care and the nursing program here have received the magnet designation recognition and in fact in March of this year just received it for the fourth consecutive time, which is exceedingly rare and impressive. Explain what that means. What is that designation?

Speaker 4:

So Magnet designation comes from the American Nurses Credentialing Center and it means that an organization has exceeded the expectation, has been above the bar for a number of different outcomes for customer experience, nurse satisfaction and clinical outcomes. So across the world there are just over 600 organizations that have earned that same distinction of being magnet designated and we are one of those 600. What becomes more exceedingly rare is the number of continuous designations. So, as a four-time designated organization, that puts us in a much smaller bucket of organizations that continue to achieve those results and earn that distinction.

Speaker 1:

Out of that, 600, what we're looking at is about 10% of hospitals across the country. So when you think about the percentage, it is a small number of hospitals that achieve nursing excellence to the extent that we are, and with magnet designation. It's not just about creating these things for our nurses to do, we are living it. We are embodying excellence every single day in our nursing practice across Christiana Care, and it is a culture change. And it's to the point, now that we're so established with nursing excellence, our nurses aren't just participating in these processes, they are leading them. It's not just a credential, it's the culture, and every day we're making it happen.

Speaker 4:

I couldn't have said it better. I think that that is one of the reasons why we were the first magnet designated organization in the state of Delaware, because that has been our culture since that very first designation.

Speaker 1:

Our fourth magnet designation includes Newark campus, Wilmington campus, home health and ambulatory care practices. Cecil campus is currently on the pathway to excellence journey, which is amongst the same principles as magnet, where we're all seeking nursing excellence. The reason that CECL campus is on a separate pathway to excellence journey is because when a hospital system grows, you are unable to include your new campuses or systems within the magnet application. Include your new campuses or systems within the magnet application. So when we partnered with Cecil campus, we actually were not able to include them in the magnet designation process, but they have all of the same resources as we do. We're really excited for them to be on this pathway to excellence journey.

Speaker 2:

That first magnet designation had to be feel pretty good when it came in. Now you're on number four, but I'm assuming after you got that one you didn't just rest on your laurels and that was the end of it. You kept expanding and growing and making further strides. How, what else have you done as far as nursing excellence since that first magnet designation?

Speaker 4:

Oh my gosh. So I have been here through all of our designations and I would say just the formation of a different professional practice model. Right, it's an evolution, it doesn't stay stagnant. I think that has been critical. So that sets the vision and the mission for nursing in alignment to the way Christianic care way Also, I'd say.

Speaker 4:

Another distinction is how governance is addressed. That is a completely different model than what we had before and enables us to engage so many more nurses across every campus and in and across the practice environments as well. I think the other thing that we have turned the afterburners on has been nursing innovation. So being able to launch three years ago a Center for Nursing Innovation where that kind of thriving can happen that Paige mentioned of providing the opportunity to think about how we could practice differently. What does it look like? Let's be futuristic. Let's think about that how we can deliver care more efficiently, more effectively, keep caregivers engaged, retain them and make the work environment such that nurses flourish in their nursing practice here at Christiana Care and they would never want to leave, because we want to retain them and their expertise.

Speaker 4:

One other thing that I think looks very different is our BSN rate and our certification rate. That alone sets a different tone for the level of practice expectations that we have of nurses. Research will tell you, the stronger those BSN and nationally board certified nurses in specialty is, the better care delivery is. We have scholarship opportunities. You know that's not the end of the journey. We have had those. They continue to exist to enable more nurses to go back to become master's prepared and our clinical ladder has expanded such that there's a role now for a master's prepared nurse to remain at the bedside to be a clinical expert where you are master's prepared and board certified in your specialty. That didn't exist in magnet designation number one.

Speaker 1:

Michelle is exactly right. When we invest in our nurses, we are investing in the future of healthcare. We professionally develop our nurses and that is one of my favorite parts about working at ChristianaCare as a magnet designated organization. One of the ways that we achieve ongoing excellence because it really is a journey is we use data to pivot when we need to pivot and we use feedback from nurses every single day in our decision making. So decisions are made with clinical nurses partaking in those decisions in every circumstance that's possible and that is a huge contributing factor of always being on the journey, for nursing excellence is a huge contributing factor of always being on the journey for nursing excellence.

Speaker 4:

So another evolution of nursing excellence has been the development of the team that I currently lead. So in addition to Paige, who is the nursing excellence lead for acute care, there's a nursing excellence lead for home health and community. That's Maria Brown. We have a nursing integrative care lead, stacey Noel, for all the nurse well-being work. That's Maria Brown. We have a Nursing Integrative Care lead, stacey Noel, for all the nurse well-being work that's being done.

Speaker 4:

So there's a specific effort and focus to address nurse well-being. That excellence just comes from building upon what we're hearing, not only from internally, from our clinical nurse practices, because they were involved in this year to help drive. What does this look like? Paige was mentioning? We have to listen. We have to listen, enable them to participate, engage. So it's exciting. It's more exciting when you see the outcomes that we have. We are a national leader in our virtual acute care nursing practice.

Speaker 4:

So I think nursing excellence is not just my team, it's not our department, it is. How do we enable clinical nurses from across the system to rethink how they practice, to innovate how they practice, to go after the financial resources? Because they're there. We've got them in our magnet document and we're able to contribute to the bottom line of the organization because of thinking differently about how they practice and the relevance and the importance of that. We just finished this fourth designation. I feel like wow, we're really on the top of our game. But there's another one to plan for and now there's work to do in partnership with the Cecil campus for their Pathway to Excellence application.

Speaker 3:

You mentioned well-being and you also mentioned the nursing innovation. Both of those were highlighted by Magnet as one of your exemplars. Talk to us about what those were and what that really means.

Speaker 1:

A few of our exemplars included our BSN rates, which Michelle mentioned earlier. We are above the benchmark nationally for where our BSN rates are, so we're very proud of that. We also had exemplars around patient burns in our ambulatory practices, meaning we had very low incidents below the benchmark, which is exceptional quality and safety being provided to our patients quality and safety being provided to our patients. We also have done a lot of work within nursing over the past couple of years with our hospital-acquired pressure injury rates, and so we have a nursing quality and safety team that partners at the system-wide level and with interprofessionals across the entire organization, because magnet designation, while it is a nursing excellence designation, it encompasses every single caregiver that works at Christiana Care and that's a prime example. How do we decrease pressure injuries in our patients. We also had the Nursing Research and Innovation Fellowship as one of our exemplars. We also had our Nursing Integrative Care Program, and that work is really led by Stacey Noel, who Michelle mentioned earlier, as part of the nursing excellence team.

Speaker 4:

Two other points that I'd like to make is that one while we have a nursing excellence team, we don't do the work of magnet in a silo right.

Speaker 4:

We are so fortunate that we're able to partner very closely with the nursing quality and safety team as well as the nursing professional development and education team, in addition to others, those two teams really. We pull together and find the examples and challenge one another for the best placement or the best evidence of the programs that are most successful to drive outcomes. And Paige mentioned before the volume of interprofessional projects that are encompassed in the document and I just want to emphasize that a little bit. So, yes, we know this is a nursing recognition, but this is a recognition for the entire organization as well, because the examples that we write, the standards that we write to and the sources of evidence, many of those standards describe an interprofessional team led or co-led by a nurse that improved X or addressed a patient experience outcome. On those teams there are environmental care services, caregivers, there are pharmacists, there are food and nutrition, there are providers on those teams. So it doesn't happen in a silo but it's led by a nurse, co-led by a nurse and engaged nurses at the table driving the process.

Speaker 2:

We keep raising the bar on ourselves here, the rate this has been going and we just got our fourth one. I would assume there's already a vision out there for that fifth one in another four years. What are you doing? How do you start planning for that? How do you take that into account now, even though you just got this one, to start working on the next one?

Speaker 4:

So, true to our course, we strategically plan. So our team has their own strategic plan and we look to the future right. So within probably a year and a half, we need to begin to designate who are the magnet model component leaders that will lead us through potentially a brand new magnet manual. We already begin to start collecting Christiana Care Way awards that engaged, involved or were led by nurses. We start looking at nurses who were recognized in excellence in nursing programs or projects. We look at nurses who are leading in evidence-based practice and nursing research projects. We have our eyes wide open all the time to identify those potential nursing practice efforts, projects, specific clinicians in mind because of the work that they're doing and the outcomes that they're driving. So we start to collect that Like. We're already in fifth designation mode.

Speaker 4:

That happened on April 1st started our new window. So April 1st 2025 to April 1st 2029, our new window. So April 1st 2025 to April 1st 2029, our new window. So that process. It happens naturally for us because we're so attuned to how we go about embracing all of that work and enabling it to shine and enabling then also caregivers to be recognized for that work. What would you add, paige?

Speaker 1:

I think you're spot on, michelle, when I think about what we're doing to prepare.

Speaker 1:

You know, formally we're going to do a gap analysis, which means we're going to also take a look at what opportunities did we have to strengthen, and we are going to work on making sure that those areas of opportunity are strengthened over the upcoming years.

Speaker 1:

So one of the things that I love about our team is that we get to work with nurses across the entire organization, and so usually when we have opportunities, we get to work and network and be with friends from other departments and colleagues and caregivers to make sure that those things happen. So while we're always celebrating, we're also always looking to improve and we get to say, ok, what areas are we going to be focusing on for work now? And so that'll be one of our next steps In the magnet communities. We're always networking professionally with other hospitals across the entire country and, honestly, internationally as well, and so we're looking to other organizations and we have colleagues where we'll say, hey, we're going to be working on improving our caregiver experience what have you been doing for that? And we get ideas and then we get to bring them back here. So that's an exciting part.

Speaker 3:

If a patient is listening to this episode right now, why should they care about nursing excellence and just clinical excellence here at Christiana Care? What is in it for the patient?

Speaker 4:

I think what's in it for the patient reflects back to those BSN and certification rates. You have expert nursing clinicians at the bedside here and our outcomes demonstrate that right. Not just the outcomes for customer service but your clinical outcomes as a patient demonstrate that. That is how we outperform. You must outperform for Magnet, those national benchmarks, and we do consistently.

Speaker 1:

I think it's really simple and it can be summed up in trust. If you are a patient and you are receiving care from a Magnet-designated organization, you can trust that you are receiving exceptional care. We'll leave it there.

Speaker 3:

Michelle and Paige, thank you both so much for being here today. Thank you. Thank you. Check out the show notes for this episode for more information on magnet designation and nursing excellence at Christiana Care.

Speaker 2:

You can always keep up with For the Love of Health on social media. Just search Christiana Care on your favorite platform.

Speaker 3:

We'll be back in two weeks with another great conversation.

Speaker 2:

Until then, thanks again for joining us for the love of health.

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