FORCE 1Quality of Nursing Leadership

Nursing leaders are perceived as knowledgeable, strong risk-takers who follow an articulated philosophy in the day-to-day operations of the nursing department. Nursing leaders also convey a strong sense of advocacy and support on behalf of the staff.

EXECUTIVE SUMMARY FORCE 1: QUALITY OF NURSING LEADERSHIP Nursing leaders are perceived as knowledgeable, strong risk-takers who follow an articulated philosophy in the day to day operations of the nursing department. Nursing leaders also convey a strong sense of advocacy and support on behalf of the staff.

Under the visionary leadership of the Senior Vice President for Patient Care Services and

Chief Nurse, The Massachusetts General Hospital (MGH) has created a professional practice

environment that supports growth and development of nursing staff through its excellence in

nursing services. To accomplish this, the Chief Nurse is visible in the highest governing bodies of

the organization strategically situated to influence decisions that impact nursing and patient care

delivery. Committed and talented nursing leadership is also essential to this success. Whether at an

executive or unit-based level, leaders are expected to, “…challenge the process; inspire a shared

vision; enable others to act; model the way; encourage the heart” (Kouzes and Posner), an adopted

philosophy of leadership within Patient Care Services.

The Patient Care Services (PCS) Vision, Guiding Principles, Nursing Philosophy, Strategic

Plan and Professional Practice Model have been carefully designed to be congruent with the

hospital’s four-pronged mission of practice, education, research and community. Members of the

Patient Care Services Executive Team crafted these documents, seeking input from managers and

direct care staff. With this framework, a Patient Care Delivery Model was also articulated ––

interdisciplinary patient- and family-centered care. The nine components of the PCS Professional

Practice Model were revised ten years after its original design to include: vision and values; standards

of practice; narrative culture; professional development; patient-centeredness; clinical recognition

and advancement; collaborative decision-making; research; and innovation and entrepreneurial

teamwork. Collaborative decision-making, operationalized as Collaborative Governance, gives

direct care staff a prominent voice in the organization in decisions that impact their practice and

quality of work-life. The development of the Clinical Recognition Program embodies the MGH

narrative culture and creates opportunities for professional recognition and growth. Examples

provided reflect nurse leader’s ability to successfully articulate patient and staff needs and secure the

appropriate fiscal and human resources.

Retreats with PCS Executive Team, Nursing Directors and members of the Collaborative

Governance Committees were the primary interactive strategy for creating and disseminating

information about the Vision, Guiding Principles, Nursing Philosophy, Professional Practice Model

and Strategic Plan. Patient Care Services and Hospital publications such as Caring Headlines,

Hotline, PCS News You Can Use; as well as Hospital, Departmental and Unit Committees, staff

meetings and conferences broaden the audience and reinforce messages about patient care. The

budget process and resulting reports in combination with the quality dashboard provide vital

operational, clinical, staff and fiscal information for leaders to make informed decisions. Examples

are imbedded throughout the Force.

Enculturation of the values of the organization are most aptly reflected in the MGH

Patient Care Services evaluation of nurse satisfaction through the Staff Perceptions of the

Professional Practice Environment Survey (SPPPE), administered every 12 - 18 months since 1999.

In 2006, 92% of the nursing staff respondents reported being satisfied or very satisfied with the

professional practice environment at MGH. The high degree of participation in the Collaborative

Governance Committees from within and outside of the Department of Nursing has contributed to

the staff satisfaction and the organization’s success. Decisions about staffing and resources reside at

the unit level, closest to the staff and the patients. Nurses at all levels are committed and engaged in

professional growth and development with nurses at MGH belonging to more than 60 different

professional organizations.

TABLE OF CONTENTS Volume 1

Force 1: Quality of Nursing Leadership

Sources of Evidence 1.1

1.2

1.3

1.4

1.5

1.6

1.7

1.8

Pages 1-10

Pages 11-28

Pages 29-40

Pages 41-55

Pages 56-69

Pages 70-84

Pages 85-96

Pages 97-149