TL - Transformational Leadership

TL4EO: Advocacy and Influence. Describe and demonstrate one (1) CNO-influenced organization-wide change.

Example of CNO-influenced organization-wide change

The purpose of the Electronic Medical Record (EMR) is to provide efficiency in record-keeping as well as allowing for important medical information to be shared, such as blood type, prescribed drugs and medical conditions and other aspects of the patient’s medical history. Safety is a huge benefit to the EMR; consistency in obtaining all your medical information is a huge advantage. Cost-effectiveness is also an issue, savings occurs relative to the cost of paper, file folders, labor and space.

In 2010, a decision was made to implement an Electronic Medical Record at Jersey City Medical Center. The ultimate goal was to improve documentation in all patient care areas. This process will enable the Medical Center to drive and be accountable for care. The goal was to achieve “meaningful use” within an 18 month period. Senior leadership determined that Rita Smith DNP, RN, NEA-BC, Chief Nursing Officer would function as the Executive Champion for the EMR project (see organizational chart below).

Organizational Chart
Organizational Chart

Ms. Smith organized a plan of action beginning with an overall evaluation of systems capable of performing this function. Ms. Smith engaged the services of Stephen Li, Chief Information Officer. A team of senior leaders went on several field trips to area hospitals to assess their systems and determine ease of use and implementation and the ability to integrate with existing systems. A product fair was conducted with several systems featured whereby the nursing staff and leadership could meet with company representatives, ask questions and express their needs. It was eventually determined that the Siemens Soarian system would be ideal and a good fit for Jersey City Medical Center.

This project incorporates the entire hospital, but primarily targets nurses, Pharmacy and physicians. An outside consultant was hired to function as the project manager. Rita Smith DNP, RN, NEA-BC, CNO and the Chief Information Officer (CIO) assembled a design and planning team. Ms. Smith recruited the Clinical Nurse Leaders (CNLs), Janice Kozzi MSN, RN, CNL and Winnie Cherubin MSN, RN, CNL, WCC, to the project because of their depth of clinical knowledge, systems training and communication skills.

Ms. Smith’s primary role in this process was:

  1. Insure the availability of resources
  2. Insure the availability of an executive level sponsor available on an ongoing basis to remove barriers and make executive level decisions

A project management team was established and assumed a share of the implementation team’s responsibilities. A time-line for the building and design of the system was developed. This team included the following individuals:

Project Management Team

Prior to building the system, Ms. Kozzi held sessions with the nursing staff, PCTs and Ward Clerks in order to ascertain the process flow. This involved taking each procedure and breaking it down into process components. This process was important because it involved the key stakeholders in the preparation of the system. The nurses on this team also provided education for the staff and functioned as resources during the implementation process.

The timeline for completion of the project is outlined below:

Timeline for completion of the Project



On May 15, 2012, the Pharmacy module was successfully implemented. This system profiles all physician orders and medications, contains the formulary, and interacts with the Pyxis system.

Essential to the successful implementation, acceptance, and adoption of the EMR is adequately preparing staff. Super users from each unit were trained prior to the roll-out to the entire nursing staff. Superusers were trained in two-four (2-4) four hour educational sessions. Ms. Smith ensured that training and educational sessions of the nursing staff were instituted in four hour blocks of time. These four (4) hour sessions consisted of 20 students each session from multiple areas, two (2) trainers and one (1) superuser. The sessions covered: Basic Navigation, Orders, and Clinical Documentation. The nursing staff was required to complete competencies in this class Appendix TL4EO-A, Appendix TL4EO-B, Appendix TL4EO-C. Tip sheets and manuals were posted on the EMR page of the Intranet to make them available to all staff review sample tip sheet Appendix TL4EO-D 

Once the initial training period was completed, attendance records were reconciled with the staffing in ResQ to identify staff that had not completed training. Based on feedback from trainers and end users, classes were divided to make them more specific to each `end users needs. Classes were established to include: Basic Navigation, Order-Entry, RN Training and Service Provider Workspace. Superusers were dispatched to the units with carts to answer questions and provide practice exercises for the nursing staff. Superuser open labs were established where staff members could go and practice in the training environment while under the supervision of one of the trainers. Regular users could become super users by working with the trainers and completing the super user competency Appendix TL4EO-E 

Ms. Smith further ensured that the nursing staff was well supported throughout this process by insuring that they were paid for attending class, and working with the managers to provide adequate staffing in order to allow the staff to be off for that time period. Ms. Smith’s efforts insured that we would have a good and viable product.

Ms. Smith ensured that the choosing of the hardware was primarily nurse driven. Teams spearheaded by Winnie Cherubin MSN, RN, CNL, WCC demonstrated different

Hardware configurations via hardware fairs held at the Medical Center. The nursing staff selected their own mobile carts, Workstations on Wheels (WOWs), or wall mounted workstations. They also decided how many work stations would be placed at the nurse’s station. The carts chosen incorporate the Medication Administration System, which efficiently allows nurses to deliver their medications as they round and document at the patients bedside. Sufficient carts were ordered per unit to ensure each nurse has her/his own individual cart.

During the building of the system, Ms. Smith ensured that all quality and safety initiatives are built into the system and trigger appropriate care protocols. For example, Congestive Heart Failure (CHF) patients, once identified by diagnosis, will have mandatory fields which trigger protocols such as smoking cessation.

Marlin Besra BSN, RN 5E The Nurse Documentation and Order-Entry segments of the EMR system were implemented successfully on July 24, 2012. Much support was provided by the Information Technology (IT) team as well as Siemens. The Nursing Informatics Team was available as resources to the nursing staff. Specially trained super-users from each unit were available to assist with the implementation process. They were very visible on the units and were identified by t-shirts which said “ask me.” The organization had a successful

Marlin Besra BSN, RN 5E

EMR implementation as a result of Ms. Smith’s efforts and careful planning.
Please review a sample of the screen from the Siemens Soarian system:

Siemens Soarian system