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SE 4: How the organization sets goals and supports professional development and professional certification, such as tuition/registration reimbursement and participation in external local, regional, national, and international conferences or meetings.

In the mission of Massachusetts General Hospital (MGH), the importance of an educated clinician is clearly stated: “Guided by the needs of our patients and their families, we aim to deliver the very best health care in a safe, compassionate environment; to advance that care through innovative research and education; and to improve the health and well-being of the diverse communities we serve” (OOD 1). Similarly, the Patient Care Services (PCS) Vision Statement, “our every action is guided by knowledge,” and Guiding Principles, “We view learning as a lifelong process essential to the growth and development of clinicians striving to deliver care” (OOD 1), set the expectation that in order to deliver excellent care, MGH clinicians must continue to develop in their professional roles.

The Senior Vice President for Patient Care and Chief Nurse (CNO) has created a practice environment which values and supports ongoing development of nurses at all levels through formal academic education (SE 3), continuing education programs (SE 5), conferences, and professional and specialty certification. The CNO has established multiple support mechanisms to help employees achieve his or her potential for professional fulfillment and career development including policies and procedures that guide reimbursement practices for expenses related to professional certification and attendance at external local, regional, national, and international conferences or meetings; flexible staff scheduling practices; award and recognition programs that provide financial support for staff; and the Norman Knight Nursing Center for Clinical & Professional Development’s continuing education programming and certification preparation courses.

As part of the strategic planning process, biannual goals for increasing the percentage of PCS direct care Staff Nurses with professional or specialty certification are set by the CNO and Nursing Executive Operations Team ( SE 3 EO.a). A two-year goal of increasing the number of certified nurses by 4% by the end of 2011 was set after the calendar year 2009 certification rate of 12.1% was reviewed. Results are presented in TL 4 EO.

This source of evidence will describe how the CNO and nurse leaders support nurses in achieving professional and specialty certification and participation in professional organizations including attending local, national, and international conferences and meetings.

Policies, Procedures and Flexible Staff Scheduling The support for nurses to attend and present at professional meetings and conferences allows nurses to not only gain and share knowledge and skill but to network with colleagues locally, nationally, and internationally. Their participation in these forums informs not only their own practice but also their colleagues’ practice when they return and share their knowledge with others.

Employees may be reimbursed for expenses related to attendance at local, national, and international conferences and professional meetings with the approval of the appropriate Nursing Director or Associate Chief Nurse. Approval for attendance at, and support for, conferences and meetings outside of MGH are based on the nature of the program, its relevance to the care of MGH patients and families, its alignment with MGH strategic initiatives, and our commitment to facilitate professional sharing. Requests for attendance at conferences and for funding of conference expenses must be approved in advance of the actual conference.

Staff must comply with the “Partners Policy and Procedures for Employee Business Expenses” (attachment OOD 8.d). Financial data regarding staff participation in conferences and seminars outside the organization, including paid educational time, is displayed in OOD 4. Source of evidence SE 2 contains specifics about the volume of nurses, at all levels of the organization,

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that have been supported to attend and/or present at their professional organizations conference through receipt of paid educational days and conference funding.

The Department of Nursing promotes professional and specialty certification and recertification across all nursing roles and specialties because it is a demonstrable recognition of achievement, advanced knowledge, skills, and experience. The process for reimbursing nurses for the cost of professional certification and re-certification examinations, offered by nationally recognized nursing organizations is outlined in the policy “Professional and Specialty Certification/Recertification Examinations” in attachment OOD 8.c. Data related to the number of nurses who were reimbursed for expenses related to certification and recertification is provided in OOD 4.

Flexible scheduling practices that support attendance at conferences, meetings, or certification exam preparation courses are described in EP 8 and EP 9. Unit processes for scheduling vary, but all include mechanisms for staff to request needed time off to attend educational programs including external local, national, and international conferences. Nursing leaders consistently support and demonstrate scheduling flexibility and offer paid educational days to make staff participation in conferences, meetings, and certification preparation courses possible. Award and Recognition Programs

As described in SE 3, the Institute for Patient Care’s Award and Recognition Program rewards clinical and support staff in PCS for their service to MGH patients, families, and their colleagues. Fifteen different awards recognize excellence in clinical practice, precepting, advocacy, research, and service (attachment SE 3.k). Fourteen of the fifteen awards, scholarships, and fellowships are associated with a monetary award. Most of the awards funds are “unrestricted” in that the recipient is able to utilize funds in any manner; however, a number of the awards are meant to support the fulfillment of educational goals. Two awards specifically mention that award funds may be used to support attendance at conferences and/or professional organization meetings (Norman Knight Preceptor of Distinction Award and the Jeremy Knowles Nurse Preceptor Fellowship). One, the Mary Forshay Scholarship, awards one $1,000 scholarship to support attendance at the National ALS Conference. Nursing Continuing Education ANCC Provider Unit

As described in OOD 8, The Norman Knight Nursing Center for Clinical & Professional Development (Knight Center) within the Institute for Patient Care (IPC), is an American Nurses Credentialing Commission on Accreditation/Ohio Nurses Association Approved Provider of Continuing Education (CE) of Nurses. Contact hours awarded as part of the CE process are used by nurses to meet the state of Massachusetts’ requirements for licensure renewal; in addition, nurses are also able to utilize these contact hours as part of the process for recertification in a professional nursing specialty. Most certifications require a significant amount of ANCC nursing CE contact hours as part of the process for recertification. As an example, starting in 2014, all applicants for recertification through ANCC will be required to complete 75 contact hours as half of their professional development requirement. As MGH provides free CE programs for nurses who are employees, this is a significant workplace benefit for nurses seeking certification or recertification in a specialty. A chart which lists all of the didactic, simulation, and web-based educational programs that awarded contact hours for nursing CE for the period July 1, 2010 to June 30, 2012 is included in attachment OOD 10.a. An impressive compendium of 352 classroom/simulation programs and 37 web-based programs were offered during this time period.

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CE Support in Response to New Certification Requirements Effective January 1, 2014, all Advanced Practice Nurses (APRN) who are certified through the ANCC will be required to complete 25 hours of continuing education related to pharmacotherapeutics as a portion of their recertification requirements. While there were several options available to meet this new criterion such as external conferences, online courses and academic courses, the majority of MGH APRNs expressed an interest in meeting this requirement through an on-site program. Several Nurse Practitioners agreed to work with a Professional Development Specialist in The Knight Center to develop a course to meet this new requirement (attachment SE 4.a). The first course, entitled Pharmacology Update: Innovation and Evidence (attachment SE 4.b), was held on March 24, 2012 with over 140 APRNs from MGH, as well as Partners HealthCare affiliates, in attendance. On-site Certification Exam Preparation Courses

As previously discussed, PCS has multiple structures and processes to support nurses in their professional development. One initiative – professional and specialty certification – enables staff to be recognized for their specialized knowledge, skills, and experience by a professional nursing organization. Certification demonstrates that both MGH and its nurses are committed to life-long learning and professional growth. In PCS, the commitment to promoting

professional certification is evident with the Knight Center’s engagement of nursing leadership in a presentation showing support of National Certified Nurse Day (attachment SE 4.c) as well as the CNO’s “Fielding the Issues” column in Caring Headlines (attachment SE 4.d).

Certification preparation courses can be quite expensive and this can be a deterrent to staffs’ participation in the process. To assist nurses as they prepare for the exams, the Knight Center has sponsored on-site certification review courses that are free to MGH staff. The Knight Center’s support of two on-site certification review courses demonstrates not only the organizational commitment to professional and specialty certification, but also the importance of inter-organizational collaboration.

In 2010, the Knight Center Director reached out to educators from across the Partners system to discuss opportunities for support and collaboration. Since that time, the group, now named the Partners Education Group (PEG), have met on a quarterly basis to dialogue and identify opportunities for collaboration on professional development initiatives. The work of this group described in SE 5.

The Knight Center Director shared the CNO’s commitment to increase the number of nurses who were certified in their specialty. Representatives from the other institutions agreed that this was a goal common to all. In November 2011, after months of planning, the Knight Center hosted an ANCC Medical-Surgical Certification Preparation Course at MGH. The course was offered free to nurses from MGH and offered at a reduced rate to nurses from across the system. Forty-four nurses attended the program; attachment SE 4.e lists the 25 MGH staff nurses who attended the program.

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The Knight Center Director also led the members of PEG in a collaboration with the Boston ICU Consortium (SE 11) to fund a two-day critical care registered nurse (CCRN) certification course in December of 2011. A former American Association of Critical Care Nurses board member was engaged as the instructor for the program (attachment SE 4.f). A total of 161 nurses from across the city as well as from hospitals affiliated with the MGH Lunder-Dineen Health Education Alliance of Maine (SE 5), attended the program; 22 MGH Staff Nurses from multiple ICUs attended the program (attachment SE 4.g). Nursing Executive Certification As articulated in the PCS Guiding Principles “We are ever alert for opportunities to improve patient care” and “We view learning as a life-long process essential to the growth and development of clinicians striving to deliver quality patient care” professional development and a commitment to life-long learning is part of being a nurse leader at MGH (OOD 1). Part of professional development is achieving certification in one’s specialty and the following example demonstrates organizational support for professional certification for Nursing Directors. In their role, Nursing Directors have twenty-four accountability for clinical and administrative practice and outcomes on their unit. In this role, they must be current and competent in issues of professional practice and care delivery as well as leading change in today’s ever-changing healthcare environment.

Certification has served as a way for nurses to validate their knowledge and competence. On-site programs had been found to be effective in supporting Staff Nurses in seeking certification, so the Nursing Directors of the Neuroscience ICU (Lunder 6 - formerly Blake 12) and MGH West Orthopaedic ASC, wondered if a similar process could be effective in attaining Nurse Executive Certification. Both were certified as Nurse Executives through the ANCC and had encouraged their colleagues to pursue certification. They recognized that a strong peer support structure would enable the Nursing Directors to follow through to study for, and take, the certification exam.

The Nursing Directors met with a Professional Development Manager in the IPC to develop a plan to support Nursing Directors interested in achieving certification:

The IPC would purchase the ANCC Nurse Executive Review and Resource Manual for all participants. A study group would meet every Thursday from 12:00-1:30 pm. Nursing Director(s) volunteers would be accountable for developing a presentation on each chapter of the review book and review the pertinent information with their colleagues at the weekly meeting. A SharePoint site would be created where all materials would be housed (attachment SE 4.h).

Twenty-seven Nursing Directors, from inpatient and outpatient practice settings, agreed to participate in the study group (attachment SE 4.i). The group met weekly from January 12, 2012 through March 1, 2012 with an average attendance of 10 Nursing Directors at each session. As of August 1, 2012, six Nursing Directors have achieved ANCC certification as a Nurse Executive and two more have scheduled dates for testing in the fall of 2012. Wound Care Certification

In 2009, the Centers for Medicare and Medicaid Services (CMS), made a site visit to MGH. During this visit, one reviewer asked a group of Clinical Nurse Specialists (CNS), ‘“What qualified

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them to be “wound care experts?”’ The CNSs responded that they were prepared academically with Masters Degrees and had completed an internal wound care education program (SE 1 EO) modeled after the Certified Wound Care Nurse curriculum. Many CNSs had also completed mentored clinical experiences with the Co-Director of the MGH Wound Care Center and member of the IPC. The Co-Director is a doctorally-prepared ARPN who also consults, as necessary, with inpatient unit staff about patients with complex wounds. The discussion with the CMS reviewers prompted the CNSs to evaluate their clinical experiences and, in spite of their existing preparation, the CNSs decided to pursue credentialing as wound care experts. In 2010, a Tiger Team of nursing administrators and CNS wound care leaders convened to examine the options and requirements for certification by wound care certification organizations in the United States. Considerations included an analysis of prerequisites (i.e., education, years of professional experience and experience with wound care), cost of initial certification, and frequency and cost of recertification (attachment SE 4.j). The Tiger Team obtained organizational support for the CNSs to pursue certification as Certified Wound Specialists (CWS) by the American Academy of Wound Management (AAWM), now known as the American Board of Wound Management. In June 2011, three CNSs became certified as CWSs. At this time, a total of six CNSs (approximately 10%) are certified as CWS (attachment SE 4.k). Anecdotal evidence of the impact of the certification includes a request to a neuroscience CNS, who is a certified CWS, from a neurosurgeon to consult on his patient’s wound care “because you are certified.” Inclusion of CWSs on the nursing staff at MGH has also strengthened the credibility of reviewers preparing reports for regulatory agencies (e.g. reports of high grade pressure ulcers to the MA Department of Public Health).

Page 295

Advanced Practice Pharmacology Planning Group

Name Role/Department Virginia Capasso, RN Clinical Nurse Specialist, Institute for Patient Care

Co–Director and Nurse Practitioner, MGH Wound Care Clinic Mary McAdams, RN Professional Development Specialist, Norman Knight Nursing

Center for Clinical &nd Professional Development Rhaea Photopoulos, RN Nurse Practitioner, Outpatient Hem/Onc (Yawkey 7/9)

Kathryn Post, RN Nurse Practitioner, Gillette Center for Women's Cancers Theresa McDonnell, RN Nursing Director/Nurse Practitioner,

Outpatient Hem/Onc (Yawkey 7/9) Karen Pickell, RN Nurse Practitioner, Hem/Onc (Lunder 9 – formerly Phillips 21)Mary Sullivan, RN Nurse Practitioner, Clinical Research (White 13)

Attachment SE 4.a Page 296

PHARMACOLOGY UPDATE:INNOVATION AND EVIDENCE

SATURDAY, MARCH 24, 2012Simches Research Center 3110

7:30 AM – 4:00 PM

This course features an update on the pharmacodynamics and pharmacotherapeuticsof common categories of drugs that are core to the practice of advanced practice

nurses across specialties and settings. Content relates to drugs used in the evidencebased management of diabetes, pain, selected psychiatric conditions, hypertension,

hyperlipedemia, infection, and anticoagulation.Target: MGH Advanced Practice Nurses

6.0 pharmacology contact hours have been requested

MGH employees No Fee - Partner’s employees $ 100 per day - Non-Partner’s employees $ 150 per day

Massachusetts General Hospital (OH-239/10-01-14) is an approved provider of continuing nursing education by the Ohio Nurses Association (OBN-001-91), an accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation.

Criteria for successful completion includes attendance at the entire event and submission of a complete evaluation form.

Attachment SE 4.b Page 297

1

INSPIRATION | INNOVATION | TRANSFORMATION

National Certified Nurses DayMarch 19, 2011

INSPIRATION | INNOVATION | TRANSFORMATION

National Certified Nurse Day

• E-Card with personal message to certified staff from Jeanette on Wednesday

• Eat Street table on Thursday from 11 – 2 with promotional materials and announcing to staff on-site certification exam prep courses

• Marketing to begin

INSPIRATION | INNOVATION | TRANSFORMATION

The Institute for Patient Carethrough The Norman Knight Nursing Center

for Clinical & Professional Developmentis pleased to announce, in celebration of Certified Nurses Day

ANCC Medical – Surgical Certification Exam Prep CourseThis special course is designed to prepare general care staff for the ANCC

Medical – Surgical Certification Exam.Detail regarding dates, time and registration will be announced soon.

In addition, arrangements are underway to sponsor the AACN Critical Care Certification Prep Course

for Adults, Pediatrics and Neonates.Stay tuned for more details.

These certification prep courses are part of a growing menu of prep courses offered through the Institute and Knight Nursing Center.

National Certified Nurse Day

Attachment SE 4.c Page 298

Page 14 — Caring Headlines — March 15, 2012

Question: What is Certifi ed Nurses Day?

Jeanette: Certifi ed Nurses Day is observed on March 19th every year. March 19th was the birthday of Margretta ‘Gretta’ Madden Styles, a champion of nursing certifi cation before widespread awareness of its value had been achieved. Styles led the fi rst compre-hensive study of credentialing in the 1970s and was a leadership fi gure in a number of national and interna-tional nursing organizations. On this day, nurses who contribute to better patient outcomes by becoming board-certifi ed in their specialties are honored world-wide. A nursing license (RN) allows nurses to practice. Certifi cation attests to a nurse’s advanced knowledge, skill, and practice in a particular specialty.

Question: What is certifi cation?

Jeanette: The American Nurses Association defi nes certifi cation as, “a process by which a non-governmen-tal agency or association certifi es that an individual li-censed to practice a profession has met certain pre-de-termined standards specifi ed by that profession for spe-cialty practice. Its purpose is to assure various publics that an individual has mastered a body of knowledge and acquired skills in a particular specialty.”

Question: How many nurses at MGH are certifi ed?

Jeanette: Based on responses to our 2011 survey, 643 nurses in direct-care positions and 200 nurses in leadership positions are currently board-certifi ed.

Question: What resources are available to sup-port nurses in becoming certifi ed?

Jeanette: Through The Norman Knight Nursing Center for Clinical & Professional Development, re-view classes are available to assist nurses in preparing for certifi cation exams in Oncology, Neuroscience, Advanced Trauma Care, Gerontology, Cardiovascu lar, Medical-Surgical, and Adult Critical Care Nursing. Currently, a review course/study group is underway to prepare nurse leaders to take the Nurse Executive certifi cation exam.

In addition to review courses, funding is available through the Demetri Souretis Fund and the Berke Geron tology Fund. These funds reimburse nurses for certifi cation and re-certifi cation test fees. The reim-bursement form can be obtained from the Nursing Support Offi ce in Bigelow 1034 or by e-mailing: pcsmsobig1034@partners.org.

Question: Does certifi cation apply to other disci-plines?

Jeanette: Certifi cation boards associated with nationally recognized professional organizations devel op and implement certifi cation examinations and procedures for nurses and allied health profes-sionals. More specifi c information about certifi ca-tion opportunities across the health professions can be found on this month’s Excellence Every Day por-tal page (http://www.mghpcs.org/eed )

For more information, contact Gino Chisari, RN, director, Norman Knight Nursing Center, at 3-6530.

Fielding the Issues II

Professional Nursing Certifi cation

Professional Nursing Certifi cation

Certifi ed Nurses

Day is observed on

March 19th every

year. March 19th

was the birthday

of Margretta

‘Gretta’ Madden

Styles, a champion

of nursing

certifi cation

before widespread

awareness of its

value had been

achieved.

Attachment SE 4.d Page 299

MGH Nurses Attending the ANCC Medical Surgical Nursing Review Seminar November 12 – 12, 2011

Name Role/Department Jennifer Beninati , RN Staff Nurse, General Surgery (White 7) Sharon Brothers, RN Staff Nurse, ORs (Gray 3/Lunder 2, 3, 4) Kristine Cote, RN Staff Nurse, Vascular (Bigelow 14) Allison Fisher, RN Staff Nurse, Respiratory Acute Care & Medicine (Bigelow 9) Andrea McCarthy, RN Staff Nurse, Thoracic/Medicine (Ellison 19) Karyn Murray Staff Nurse, General Medicine (White 11) Kimberly Nolan, RN Staff Nurse, General Surgery (White 7) Amy Reece, RN Staff Nurse, General Medicine (White 11) Tamara Schneider, RN Staff Nurse, Surgical ICU (Ellison 4) Jennifer Solis, RN Staff Nurse, Vascular Surgery (Bigelow 14) Veronica Anglin, RN Staff Nurse, General Medicine (White 9) Christine Taber, RN Staff Nurse, General Surgery (White 7) Sarah Ballard Molway, RN Staff Nurse, Thoracic/Medicine (Ellison 19) Gail Carson-Fernandes, RN Staff Nurse, General Surgery (White 7) Meghan Crann, RN Staff Nurse, General Medicine (Ellison 16) Daphnee Magloire, RN Staff Nurse, Cardiology Division Elba Gibson, RN Staff Nurse, Neuroscience (Lunder 7 - formerly White 12) Rachael Hyler, RN Staff Nurse, Respiratory Acute Care & Medicine (Bigelow 9) Jennifer Mills, RN Staff Nurse, General Medicine (White 10) Sally Morton, RN Staff Nurse, Plastics/Burn (Bigelow 13) Clara Namkoong, RN Staff Nurse, Respiratory Acute Care & Medicine (Bigelow 9) Christen Page, RN Staff Nurse, Thoracic/Medicine (Ellison 19) Laura Prout, RN Staff Nurse, Vascular Surgery (Bigelow 14) Erin Salisbury, RN Staff Nurse, Orthopaedics (Ellison 6) Kristen Wilson, RN Staff Nurse, General Surgery (Ellison 7)

MASSACHUSETTS GENERAL HOSPITAL TTHHEE NNOORRMMAANN KKNNIIGGHHTT NNUURRSSIINNGG CCEENNTTEERR FFOORRCCLLIINNIICCAALL && PPRROOFFEESSSSIIOONNAALL DDEEVVEELLOOPPMMEENNTT

Attachment SE 4.e Page 300

Attachment SE 4.f Page 301

MGH Staff Attending the CCRN Review December 3 and 4, 2011

Name Role/Department

Sarah Abbott, RN Staff Nurse, Surgical ICU (Blake 12) Jamie Bray, RN Staff Nurse, Department of Cardiology (Blake 2)

Kathleen Flynn, RN Staff Nurse, Cardiac ICU (Blake 8) Mary Hardiman, RN Staff Nurse, Plastics/Burn (Bigelow 13) Amanda Kane, RN Staff Nurse, Medical ICU (Blake 7) Marc Maloney, RN Staff Nurse, Neuroscience ICU (Lunder 6- formerly Blake 12) Klare O'Keefe, RN Staff Nurse, Neuroscience ICU (Lunder 6- formerly Blake 12)

Jill Pallotta, RN Staff Nurse, Medical ICU (Blake 7) Tara Riva, RN Staff Nurse, Cardiac Surgery (Ellison 8)

Mary Toomey, RN Staff Nurse, Surgical ICU (Ellison 4) Kerri Voelkel, RN Staff Nurse, Medical ICU (Blake 7)

Lillian Ananian, RN Clinical Nurse Specialist, Medical ICU (Blake 7) Amanda Connors, RN Staff Nurse, ORs (Gray 3/Lunder 2, 3, 4) Dominic Gentile, RN Staff Nurse, Cardiac ICU (Blake 8)

Mariaj Indruh, RN Staff Nurse, Plastics/ Burn (Bigelow 13) Crystal Kariores, RN Staff Nurse, Plastics/ Burn (Bigelow 13) Elizabeth Mover, RN Staff Nurse, Cardiac ICU (Ellison 9)

Amy Pacious, RN Staff Nurse, Cardiac ICU (Blake 8) Richard Piccuito, RN Staff Nurse, Plastics/ Burn (Bigelow 13)

Emily Shell, RN Staff Nurse, Medical ICU (Blake 7) Kathleen Vanvorst, RN Staff Nurse, Neuroscience ICU (Lunder 6- formerly Blake 12)

Ellen Walsh, RN Staff Nurse, Family/Newborn (Ellison 13)

Attachment SE 4.g Page 302

Attachment SE 4.

ANCC Nurse Executive Certification Study Group SharePoint Site

Page 303

ANCC Nurse Executive Study Group

Name Role Adele Keeley, RN Nursing Director, Gyn/Oncology (Phillips House 21-formerly

Bigelow 7) Aileen Tubridy, RN Nursing Director, Cardiac Medicine (Ellison 10) Ann Kennedy, RN Nursing Director, Neuroscience- formerly Ellison 12)

Barbara Cashavelly, RN Nursing Director Hem/Onc (Lunder 9- formerly Phillips House 21)

Barbara Crawley, RN Nursing Director, MGH North Shore ACC Surgery Bessie Manley, RN Nursing Director, General Surgery (Phillips House 22) Brenda Miller, RN Nursing Director, Pediatrics (Ellison 17 & 18)

Catherine Mannix, RN Nursing Director, Radiation Oncology (Cox LL, Lunder LL 2&3)

Christina Stone, RN Nursing Director, Psychiatry (Blake 11) Claire O’Brien, RN Nursing Director, MGH West Orthopaedic ASC, Co-chair

Colleen Gonzalez, RN Nursing Director, General Medicine (White 8) Colleen Snydeman, RN Nursing Director, Cardiac ICU (Blake 8)

Janet Mulligan, RN Nursing Director, IV Therapy (Jackson 104) Janet Quigley, RN Nursing Director, PACUs (White 3, Ellison 3, Lunder 2,3

Judy Silva, RN Nursing Director, Cardiac Intervention (Ellison 11) Kathryn Hall, RN Nursing Director, Clinical Research (White 13)

Kelly Santomas, RN Nursing Director, Cardiac Surgery (Ellison 8) Lee Ann Tata, RN Nursing Director, General Medicine (Ellison 16) Linda Johnson, RN Nursing Director, Massachusetts General Medical Group Lori Pugsley, RN Nursing Director, Family/Newborn (Blake 13 and Ellison 13)

Marcy Bergeron, RN Nursing Director, Bulfinch Medical Group Margaret Settle, RN Nursing Director, Neonatal ICU (Blake 10) Mary McAuley, RN Nursing Director, Surgical ICU (Blake 12)

Maureen Schnider, RN Nursing Director, Central Resource (Bigelow 14) Sharon McKenna, RN Nursing Director, Cath Lab (Blake 9)

Susan Caffrey, RN Nursing Director, Labor & Delivery (Blake 14) Suzanne Algeri, RN Nursing Director, Neuroscience (Lunder 7- formerly White

12) Tara Tehan, RN Nursing Director, Neuroscience ICU (Lunder 6- formerly

Blake 12) Co-chair Vivian Donahue, RN Nursing Director, Cardiac ICU (Blake 8)

Attachment SE 4.i Page 304

1

To: Jackie Somerville, RN, Associate Chief Nurse; Gaurdia Banister, RN, Executive Director, Institute for Patient Care

From: Jill Pedro, RN, Co-Chair, Wound Care Task Force Jacqui Collins, RN, Co-Chair, Wound Care Task Force Marian Jeffries, RN, Member, Wound Care Task Force

Gino Chisari, RN, Director, Knight Nursing Center

CC: Ginger Capasso, RN, Clinical Nurse Specialist, Knight Nursing Center

Date: August 25, 2010

RE: Wound Care Certification for the CNS ________________________________________________________________________BackgroundThe discussion of providing an opportunity for the CNS members of the Wound Care Task Force to obtain national certification in wound care has been long standing. In the more recent past, the discussion was resurrected on or about summer 2009, but placed on hold due to a routine Joint Commission reaccreditation survey, and later an unscheduled survey by CMS. Both the organization and the Wound Care Task Force co-chairs have expressed concern that pressure ulcers are now a CMS quality indicator and, beginning October 1, 2009, one of the hospital-acquired complications for which CMS will deny reimbursement. Further, the Wound Care Task co-chairs believe that the unit-based CNS who is recognized as the first line wound/skin care “expert”, they carry a higher professional liability as a result of not being certified by a national certifying body.

The discussion of wound care certification for the CNS members of the Wound Care Task Force was recently reactivated and resulted in a small task force comprised of Jill, Jacqui, Marian and Gino with consultation from Ginger, coming together to review three certification programs and to form recommendations to Nursing Executive Operations. The criteria used to evaluate the certification programs included, but the discussion was not limited to:

The credential being offered by the certifying body; Identification of approval status by the Accreditation Board for Specialty Nursing Certification or National Commission for Certifying Agencies; Eligibility criteria; Fee schedules; Recertification requirements; and Perceived quality of the accrediting body.

Attachment SE 4.j Page 305

2

Associated discussion points included: The amount of financial/human resources needed to prepare for a certification exam; Would the entire CNS group be eligible, or just the CNS members of the Wound Care Task Force; and What are the costs.

Through a brief survey conducted by Jacqui, the first cohort is projected to be 20-25 CNS. Many participate on the Wound Care Task Force.

The three organizations assessed include: Wound, Ostomy and Continence Nursing Certification Board (WOCNCB) offering a certified wound care nurse (CWCN) credential National Alliance of Wound Care (WCC) offering a wound care certified (WCC) credential American Academy of Wound Management (AAWM) offering a certified wound specialist (CWS) credential

Each was evaluated and compared on the above criteria. This small task force would prefer to seek CWCN certification. However, a more realistic approach is to seek certification as a CWS, because many in the cohort may not meet eligibility criteria for CWCN exam at this time. Further, AAWM is a nationally respected body that offers certification to an interdisciplinary provider group.

In order to be deemed eligible to sit for the CWS exam, the applicant must: Hold a bachelors, masters, or doctoral degree in a life science, andPossess 3 years of clinical experience in wound care.

This is compared to the WOCNCB eligibility criterion that requires: An RN license; A bachelor’s degree or higher; 40 hours of didactic wound specialty education in a WOCN Society-accredited program; 20 hours of independent study; and 40 hours of a precepted clinical experience.

There are no approved WOCNCB educational sites in the New England area.

An alternative is the “experiential pathway” offered by WOCNCB, whereby the applicant produces documentary evidence of 50 CE in wound care, or the equivalent course work post-Bachelor’s degree, (50 CE is about a 3-credit college course) and verification from the employer of clinical experience with wound care.

One striking difference between the two exams is the initial cost and an annual membership fee. The CWS exam is almost double that of WOCNCB and requires an annual fee, but does not require evidence of requisite education.

Attachment SE 4.j continued Page 306

3

Estimated one-time cost based on 20 CNS

CWCN with CE CWCN without CE CWS $6000.00 total $24,000.00 total $11,000.00 total

Recommendations 1. Offer financial support to the CNS members of the Wound Care Task Force to prepare

and sit for the CWS examination.

Rationale: AAWN acknowledges the expertise and the advanced practice knowledge of our CNS colleagues, and awards the credential by measuring that expertise and knowledge through a competency-based exam, versus having them repeat course work prior to sitting for an exam.

2. Offer the resources of the Knight Nursing Center in assisting the CNS cohort with exam and application preparations.

Rationale: Fulfills the Knight Nursing Center mission to offer support and services to promote life-learning of all members of the MGH nursing community.

3. Continue to build an organizational infrastructure to support wound care.

Rationale: The initial cohort will continue their participation in the Wound Care Task Force; support their CNS colleagues with lesser expertise through peer-to-peer consultation and mentoring; and facilitate excellence in wound care practice at the unit level.

4. Continue to investigate the cost benefit ratio of MGH becoming a WOCNCB approved educational site for wound care.

Rationale: The MGH continues its tradition of supporting education and remains a leader in delivering high quality patient-centered care.

Attachment SE 4.j continued Page 307

Certified Wound Specialist Clinical Nurse Specialists

Name Department Virginia Capasso, RN Clinical Nurse Specialist, Co-Director MGH

Wound Clinic Jacqueline Collins, RN Clinical Nurse Specialist, General Medicine (Ellison 16)

Jean Fahey, RN Clinical Nurse Specialist, Neuroscience (Lunder 8- formerly Ellison 12)

Marian Jeffries, RN Clinical Nurse Specialist, Thoracic/Medicine (Ellison 19)Yassaman Khalili, RN Clinical Nurse Specialist, General Surgery

(Phillips House 22) Kate Roche, RN Clinical Nurse Specialist, General Medicine (White 8)

Attachment SE 4.k Page 308