Medical Library Association | Resources : Vital Pathways for Hospital Librarians

Magnet Recognition Program ® Collaboration Proposal

The American Nurses Credentialing Center and the Medical Library Association

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[This paper is also available as a downloadable PDF file]

Excellence in nursing care and patient outcomes begins and ends with appropriate, relevant information to guide health care decisions. The American Nurses Credentialing Center (ANCC) Magnet Recognition Program® and Medical Library Association (MLA) core values and goals serve as foundations for collaborations to support nursing excellence and enhanced nursing practice. MLA, the premier organization for health sciences information professionals, has a commitment to quality information for improved health – a commitment that can augment the goals of the ANCC Magnet Recognition Program®.

This paper identifies shared core objectives of MLA and the ANCC Magnet Recognition Program®, and ways that MLA as a professional association and health sciences librarians in general can support these common core objectives.

It’s about time

Nursing excellence requires access to information resources necessary to provide evidence-based care. Not just access to any information; but the right information for clinical and research needs. This requires knowledge of information resources and effective skills to use them. It is not as easy as it sounds. Although technology has made access to information easier, it has created new challenges. As with nursing and medical knowledge, changes regarding information resources are continuous and exponential. Keeping current requires a great deal of time, not something that most nurses have to spare. Nurses are working in a highly dynamic environment. Very few nurses have the luxury of enough time to teach themselves how to master new databases.

It’s about expertise

When one needs expert health care one goes to a health care specialist. When one needs expert ‘information care,’ a librarian specialist is at your service. Librarians are information experts. They are specialists in the organization, management, dissemination, and use of information resources. As one must be knowledgeable about a myriad of evolving resources and products to provide information resources and services, librarian services are invaluable in supporting evidence-based professional practice and excellence in the delivery of nursing services.

Institutional fit of new resources and products requires expert knowledge management skills. It requires a comprehensive understanding of what resources are available, what resources are needed, how to negotiate license agreements, and how to manage electronic and print collections. In addition to selecting journals, books, and other publications, librarians use knowledge management skills to process, organize, disseminate, and monitor use of collections. Information resources are a huge financial expenditure for an institution and it is crucial that resources are presented and used effectively. Librarians are also concerned with content and access. They have the expertise to train users on how to use databases and how best to search for topics of interest. Health information literacy is crucial to locating the best information available on a needed topic.

The need for comprehensive information, not just summaries, requires sophisticated information retrieval skill. This skill is ingrained in a health sciences librarian. Information expertise provided by librarians allows nurses to use their precious and limited time to practice nursing. Health sciences librarians are essential partners in attaining and sustaining ANCC Magnet goals.

It’s about standards

The expertise of MLA member librarians can further the goals of ANCC Magnet Recognition Program® through standards that best exemplify the information resources and services necessary to support nursing excellence in healthcare settings. “MLA Standards for Hospital Libraries 2002 with 2004 Revisions” is a guide to ensure that hospitals have the resources and services to effectively meet their needs for knowledge-based information <http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1082947>.

MLA’s Nursing and Allied Health Resources Section (NAHRS) is currently identifying specific information resources and services necessary for the practice of evidence-based nursing in health care settings. These standards will define how best to support the information needs of nurses. It will clarify what institutions need to do to support best practices, what nurses can expect, and what librarians can deliver. MLA is the organization with the expertise, credibility, and resources to create these standards.

It’s about collaboration

The core values of the Medical Library Association and the goals of the American Nurses Credentialing Center (ANCC) Magnet Recognition Program® are complementary and support collaborations that can advance these shared objectives.

MLA Core Values

ANCC Magnet Recognition Program® Goals

Improve the knowledge and skills of health information professionals
Advance health information research and evidence-based practice
Advance the role of health information professionals in providing the best health information to all who work in healthcare, health education and research
Promote the use of scientific evidence in making healthcare decisions
Improve the public's awareness and use of quality health information
Promote a sense of community and collaboration with similar organizations to ensure that the best health information is available to all

Promoting quality in a setting that supports professional practice;
Identifying excellence in the delivery of nursing services to patients/residents; and
Disseminating “best practices” in nursing services.

MLA and ANCC collaboration can enhance and strengthen each other’s goals, furthering the core values and goals of each organization. As illustrated in the accompanying document “Librarians’ Contribution to their Institutions’ Magnet Journey”, health sciences librarians contribute to many of the Forces of Magnetism described in the Magnet Application Manual. Professional librarians can ensure that funds for evidence-based knowledge resources are used efficiently and that nurses are trained in their effective use to improve patient care and nursing professionalism.

Specifically, librarians support the following Forces of Magnetism:

Forces of Magnetism	Librarians can:
Force 5 Professional Models of Care	Help provide the evidence for care delivery models.
Force 6 Quality of Care	Select the best resources to support quality care and patient safety; provide and disseminate current literature to change administrative and clinical practices; support nursing research activities.
Force 7 Quality Improvement	Provide the evidence-based resources and support training for nursing staff to be involved in quality improvement efforts.
Force 8 Consultation and Resources	Offer the resources and training in research skills to contribute to enhancing the knowledge and skills of nursing staff.
Force 9 Autonomy	Ensure that nurses not only have access to the Internet and other literature sources but also that these sources are of high quality and as much as possible are evidence-based: help the nursing staff develop the skills to critically appraise these resources.
Force 11 Nurses as Teachers	Respond to the educational needs of nurses at all levels and provide resources for patient education.
Force 12 Image of Nursing	Partner with their nursing colleagues to promote the image of nursing within the organization.
Force 13 Interdisciplinary Relationships	Support guideline development, patient education resource acquisition, and policy updates.
Force 14 Professional Development	Support and encourage nursing research and publication and acquire the library resources to allow self-directed learning opportunities by nursing staff.

For future information, contact:

Carla J. Funk, MLS, MBA, CAE
Executive Director
Medical Library Association
65 East Wacker Place, Suite 1900
Chicago, Illinois 60601-726
312-419-9094, ext. 14
funk@mlahq.org

Authors:

Melody Allison, RN, BSN, M.S.L.I.S., Assistant Biology Librarian and Assistant Professor of Library Administration
Chair, MLA Nursing and Allied Health Resources Section (NAHRS) 2006-2007
Biology Library, University of Illinois at Urbana- Champaign
101 Burrill Hall
407 S. Goodwin Avenue
Urbana, IL 61801
217-333-7461
mmalliso@uiuc.edu

Margaret Bandy, M.A.L.S., AHIP, Manager, Library and Media Service
Member, Medical Library Association Board of Directors 2006 - 2008
Chair, Standards Committee, MLA Hospital Libraries Section 2005 – 2007
Exempla Saint Joseph Hospital
1835 Franklin St.
Denver, CO 80218
303-837-7848
bandym@exempla.org

Librarians’ Contribution to their Institutions’ Magnet Journey

Examples, Presentations, and Publications

Health sciences librarians are uniquely qualified by knowledge and skills to assist institutions on their Magnet journey. The following presentations and publications highlight librarians’ collaboration with nursing personnel. Members of the Medical Library Association‘s Hospital Libraries Section and Nursing and Allied Health Resources Section provided this document. Their institutions have either achieved Magnet status or are on the journey. The hospitals are large and small, urban and suburban. As one librarian at a Magnet facility stated, “Every hospital going for Magnet status NEEDS a library and a masters-degreed librarian if they are to demonstrate excellence. They need to have the expertise of a degreed professional librarian to rely on just as they rely on the skills of the advanced practice nurses on our staff. Hospitals hoping to become magnets--to attract and keep nurses and to exemplify the excellence in nursing--need to provide nurses with the knowledge resources essential to provide excellent care and to grow and develop as a nurse.”

Actual examples of nurse/librarian collaborations

1. A private, not-for-profit, urban hospital that has achieved Magnet Recognition:

The Clinical Librarian for Nursing attends progressive nursing rounds
The Clinical Librarian for Medicine attends medical rounds and responds to the needs of the doctors and nurses in our ICUs
The librarians support the work of Advanced Practice RNs and continuing education of nurses in Bachelor and Masters programs with mediated searches, teaching search skills, teaching Evidence Based Nursing Practice, and document delivery
The librarians provide just-in-time library orientations and teaching.
The librarians are actively involvement in curriculum development and as teaching faculty for the hospital’s Evidence-Based Nursing Practice Fellowship
The librarians support nursing research with teaching, literature searching and document delivery.

2. An urban health care system on the Magnet journey:

Librarians e stablished an online "survival kit" for nurses on the library web site. It includes all information about writing & publishing, links and tutorials for RefWorks, bibliographies for Certification Resources and other topics of interest to nurses, library request forms, tutorials for searching and more.
The librarians provide a Nursing Journal Watch current awareness service each month
The librarians routinely present workshops on using library resources more effectively. The service is so popular with nurses that they are writing an article on staff development and will include the librarian as co-author.

3. A private, not-for-profit health care system that has achieved Magnet Recognition:

Librarians are active participants in the Nursing Research Council subcommittee to promote nursing research
Librarians collaborate on the Nursing Research Journal Club to assist members in effectively analyzing research articles
Librarians assist the Nursing Research Council in developing an exciting presence on the hospital Intranet to promote research to staff nurses.

4. A private, not-for-profit urban hospital beginning their Magnet journey:

The librarian is an active member of the Nurse Practice Council
The librarian is a member of the subcommittee working on Force 9
As producer of the nursing newsletter, the librarian provided education and information to the nursing staff on the Forces of Magnetism.

5. A large, urban hospital that has achieved Magnet Recognition:

The librarians perform searches and identify articles to back up/assure that policies & procedures are accompanied by evidence
The librarians collaborated with a near by academic center to provide training for nurses at other system hospitals to learn how to search the literature for the best evidence.

6. A medium-sized urban hospital that has achieved Magnet Recognition:

Magnet surveyors interviewed the librarian because the staff nurses, randomly chosen for meals with the reviewers, talked about the great library services they receive
As a member of the Area Coordinating Team, a group made up of the project group leaders of the nursing units, the librarian teaches evidence-based health care concepts to the staff nurses.

7. A suburban community hospital that has achieved Magnet Recognition:

The librarian provides in-depth research to interdisciplinary teams reviewing nursing practice, updating policies, and doing research, all to improve patient care
The librarian has developed a print and electronic collection to support nursing practice in the continuous examination of options in patient care
The librarian provides Interlibrary Loan services to supplement the in-house collection.

8. A large, urban, not-for-profit health system that has achieved Magnet Recognition:

The librarian is an active member of the Nursing Research Council, supporting research conducted in support of proposed changes in hospital practice
The librarian supports nurses working on advanced degrees by providing literature searches and document delivery

9. A regional, not-for-profit health system that has been redesignated as a Magnet facility:

The librarians are actively involved in the Nursing Research Committee
The Magnet surveyor examined the collection and services that support nursing research and practice
During the survey the librarian was called upon to provide information relevant to the topics discussed during the interviews.

A not-for-profit community hospital that has achieved Magnet recognition:

The librarian created a Nursing Research Blog to communicate the nursing research activities of the hospital to staff. Communications may include, but are not restricted to, announcements of Nursing Grand Rounds, Nursing Journal Clubs, Nursing EBN classes, ongoing nursing research and relevant medical library announcements and news. The blog also serves as an open discussion forum for nurses and librarians interested in evidenced based nursing.

Presentations

American Nurses Credentialing Center Tenth National Magnet Conference, Denver, CO. October 6, 2006. SC304 - PICO's Peak: A Program for Staff Nurse. Liz Lemiska, BSN, RN, WOCN and Nancy Goodwin, MLS, Middlesex Hospital, Middletown, CT

Abstract:

The session was a re-enactment of two research education programs aimed at demystifying research for staff nurses and at teaching basic skills to identify and frame clinical questions, conduct a literature search, select best evidence, critique research articles, and refer to the IOWA Model as a decision making matrix.
Objectives:
1. Identify effective strategies to demystify the research process for staff nurses.
2. Describe specific techniques for writing clinical research questions, searching the literature, critiquing findings, and applying a model to make practice decisions.

Get Magnetized: Magnet Recognition, Libraries, and Excellence. Sponsored by the Nursing and Allied Health Resources Section and the Hospital Libraries Section of the Medical Library Association. Annual Meeting of the Medical Library Association, Phoenix, AZ, May 21, 2006.

Title: History of Magnet Hospitals . Invited speaker: Richard Barry, AHIP, Librarian/Archivist, American Nurses Association, Silver Spring, MD

Abstract:

Mr. Barry opened the presentation with a brief overview of the original study and research conducted by the American Academy of Nursing of characteristics leading to the recruitment and retention of nurses from the early 1980s. How this study, combined with other factors, lead the American Nurses Credentialing Center to launch an ambitious program in 1990 to promote and recognize hospitals based upon standards of nursing care and nursing service administration. A review of developments from the past fifteen years showed the growth of the Magnet Recognition Program.

Title: The Elements of Magnetism. Invited speaker: Christina Joy, DNSc, RN, Senior Magnet Program Specialist, American Nurses Credentialing Center, Silver Spring, MD.

Abstract:

Dr. Joy presented the current process and procedures that are involved with the Magnet Recognition Program. In her role as Senior Magnet Program Specialist she is involved with the ongoing research and evidence need to maintain the high quality of the program as well as working with those facilities that apply for Magnet Recognition.

Title: Magnet Recognition in the Real World, A Panel Discussion

Abstract:

The panelists shared their organization’s experience with the Magnet Recognition process, which includes lots of documentation and research. They also shared how much or how little they were involved in the process, stories, tips, insights and learned experience and how Magnet status has changed the information needs of the nursing staff in regards to research and evidence based healthcare.

Invited panel:

Jan Baum, Coordinator/Medical Librarian, John C. Lincoln Health Network, Phoenix, AZ, "Magnet Status: Looking for Quality Patient Outcomes;” Sally Harvey, AHIP, Director, Learning Resources and CME, Banner Good Samaritan Medical Center, Phoenix, AZ, "Banner Good Samaritan Medical Center Library Activities Related to Magnet;" David Howse, Arizona Health Sciences Library, University of Arizona, Information Services, Tucson, AZ, "Evidence Based Practice for Positive Patient Outcomes;" Dorice L. Vieira, Associate Curator; Coordinator for Search Services, Ehrman Medical Library, New York University School of Medicine, New York, NY; Pamela Sherwill, AHIP, Librarian, College of Nursing, University of Florida, Gainesville, FL.

Implementing Evidence-Based Practice in the Real World. Sponsored by the Nursing and Allied Health Resources Section, the Hospital Libraries Section, the Chiropractic Libraries Section and the African American Medical Librarians Alliance SIG of the Medical Library Association. Annual Meeting of the Medical Library Association, Phoenix, AZ, May 22, 2006 .

Title: Building a Culture of Best Practice Requires Collaboration Among Librarians, Scientists, & Clinicians. Invited speaker: Ellen Fineout-Overholt, Director, Center for Advancement of Evidence-Based Practice; Associate Professor, Clinical Nursing, College of Nursing, Arizona State University, Tempe, AZ.

Abstract:

Dr. Ellen Fineout-Overholt, co-author of Evidence-Based Practice in Nursing and Healthcare: A Guide to Best Practice discussed how collaboration among librarians, scientists & clinicians is essential to advancing a culture of best practice. Foundational issues such as a common definition of evidence-based practice (EBP) and knowledge of the steps of and barriers to EBP were discussed. The roles of librarian, scientist, and clinician in using EBP to improve healthcare were described, with the Arizona Consortium for the Advancement of EBP (AZCAEP) as a case study to demonstrate outcomes that can be achieved through collaboration

Title : I t Takes Two: Librarians and Nurses Collaborate to Establish a Magnet Hospital Evidence-Based Nursing Project. Contributed paper speakers: DeDe Leshy, Irene Lovas, Cedars-Sinai Medical Center, Los Angeles, CA.

Abstract:

Objective : Inspired by the Pravikoff study in AJN, September 2005, about nurses relying on colleagues to answer clinical questions, two librarians and three nurses at a large Magnet hospital collaborated to assist interested nursing staff to become familiar with evidence-based nursing skills.

Methods : At a nursing Magnet hospital, the Medical Library serves a large nursing and medical staff and provides several electronic bibliographic databases for medical literature and information. Two staff librarians offered their expertise to a core nursing group of two clinical nurse specialists and a nurse practitioner charged with establishing and promoting evidence-based research among the clinical nursing staff. The goal is to educate the nurses to develop clinical questions, and then find answers using evidence-based practice. Their original research is to be presented at a Nursing Symposium held in conjunction with Nurses Week. The librarian-nurse team organized three research pre-conferences covering question building and database searching skills. These sessions offer nursing CE credits for the participants. The librarians are available for consultations as the nurses develop their research topics.

Title: The Hospital Library as Magnet Force for a Research and Evidence-Based Nursing Culture: A Case Study of Two Magnet Hospitals in One Health System. Contributed paper speaker: Diane R. Rourke, AHIP, Baptist Health South Florida, Miami, FL.

Abstract:

Objective: With two Magnet award-winning hospitals in a five hospital health care system, the hospital library's role seemed large enough. What more could be done to enhance the research culture and provide expertise for the development of evidence-based practice in the "real world" of nursing?

Methods: Answers were many: get involved in two separate research committees and one system-wide research collaborative; work with those committees reviewing ("scrubbing up/editing") nursing research proposals before submission to the IRB; justify adding lots of nursing e-resources and including links to them in the new online catalog; teach basic evidence-basedpractice concepts to onsite critical care and emergency nursing academies; and participate in the development of a model for evidence-based practice in one Magnet hospital. This case study reveals the value of an active participatory role for the hospital librarian in the shift to a research and evidence-based culture in two Magnet hospitals, underscoring the value of the parent organization's investment in library-based electronic resources as well as adequate professional library staffing.

Title: Strategies for Creating an Evidence-Based Practice Nursing Culture. Contributed Paper Speakers: Tanya Feddern, AHIP, University of Miami Miller School of Medicine, Louis Calder Memorial Library, Miami, FL, Kathryn M. Ewers, Jackson Health Systems, Miami, FL.

Abstract:

Purpose/Setting/Participants/Resources:

The purpose of the project was to develop a strategic action plan to create a nursing culture that values and utilizes evidence-based practices for the delivery of nursing care. This paper summarized how to identify and develop educational interventions for fostering an evidence-based nursing culture at a university-affiliated public hospital. These interventions were implemented via collaboration between nurse educators and a medical librarian.

Brief Description:

To evaluate nursing culture and readiness for evidence-based practice, the nurse educators utilized the PARIHS (Promoting Action on Research Implementation in Health Services) framework and adapted the RNAO’s (Registered Nurses Association of Ontario) Action Template. A descriptive survey was developed from the PARIHS framework and was used to assess cultural readiness for evidence-based practice. The RNAO template was used for identifying educational interventions. The nursing educators and medical librarian then collaborated on targeted educational interventions, such as selecting evidence-based filters for Ovid CINAHL, creating a unique evidence-based practice (EBP) certificate program consisting of collaborative continuing education classes, and brainstorming on other educational activities for the busy nurse clinician and researcher, such as an EBP online discussion list and an online journal club.

Results & Conclusions:
Inter- and intra-collaboration between nursing educators and the medical librarian have led to the successful creation and/or modification of educational assessments and interventions to bring about a change in nursing culture towards using EBP in clinical practice. Our survey results suggest that intensive educational strategies are resulting in a higher rate of evidence-based practice change, and that nurses’ knowledge and skills about evidence-based practice are above the national average.

We would like to thank the following health sciences librarians who contributed to these scenarios:

Arlene Freed, AHIP Harford Hospital Hartford, CT 06102	Lois Culler Inova Fairfax Hospital Falls Church, VA 22042
Richard Maxwell Porter Adventist Hospital Denver, CO 80210-5876	Margaret (Peg) Allen, AHIP Stratford, WI 54484
Linda Bunyan, AHIP Summa Health System Akron, OH 44304	Gay Taber, AHIP Harris Methodist Ft. Worth, TX 76104
Linda Counts Grossmont Hospital La Mesa, CA 91942	Jim Lander Mercy Medical Center Dubuque, IA 52001 .
Carmen Urich North Colorado Medical Center Greeley, CO 80631-5199	Deniz Ender, AHIP Rex Healthcare Library Raleigh, NC 27607 .
Dixie A Jones, AHIP Overton Brooks VA Medical Center Shreveprot, LA 71101	Nacny Goodwin Middlesex Hospital Middletown, CT 06457
Christine Chastain-Warheit, AHIP Christiana Care Health System Newark, DE 19718	Joy C. Kennedy Northwest Community Hospital Arlington Heights, IL 60005-2392

June 25, 2007