ArticlePDF Available

Telling Our Stories: Writing Exceptional Exemplars

Authors:

Figures

Content may be subject to copyright.
MAGNET INSIGHTS
Telling Our Stories: Writing
Exceptional Exemplars
MICHELLE R. TINKHAM, MS, BSN, RN, PHN, CNOR, CLNC
One component of the MagnetÒapplication
process involves writing narratives that
demonstrate evidence-based initiatives
with positive outcomes.
1
These narratives are often
referred to as exemplars of professional practice.
Exemplars receive Magnet appraisal, either through
a document review or during a site visit, and should
serve as examples of why the practices of a facil-
ity’s professional personnel are exceptional.
2
It is
essential that exemplars demonstrate not only the
highest levels of practice that a facility has to offer
but also that the facility has met the American
Nurses Credentialing Center application criteria,
which have changed for 2014 and go into effect
August 1.
3
Exemplars are part of the “Empirical Outcomes”
section of the Magnet application. The new ex-
emplar format is described in Table 1. The new
format includes the following:
nthere have been terminology changes (ie,
interprofessional is now used rather than
interdisplinary);
nsupporting evidence is limited to five docu-
ments, so what is submitted must be chosen
wisely; and
nmeeting minutes carry more weight than simply
listing committee members’ names.
Determining what contributors should write
about can affect how well the organization portrays
itself as a Magnet facility. To help determine what
to write, it is important to ask and answer some
basic questions. For example,
nHas the facility gained a specialty certification
or designation as a Center of Excellence?
nAre there exceptional employees who have
demonstrated their leadership as educators or
through community service?
nDoes the facility have any new staff-initiated
programs that have had positive outcomes with
its patient population?
If the answer is yes to any of these questions, then
those topics are good choices for the written ex-
emplars. There are many online resources and
programs available to team members who want
to learn more about how to transform their facili-
ty’s practices into written exemplars. For instance,
members can join the American Nurses Creden-
tialing Center Magnet Learning Committee,
4
which
gives members online discussion forums and var-
ious educational topics to help with the Magnet
process. Also, many professional organizations
often offer educational sessions regarding Magnet
designation, for example, AORN at its annual
Surgical Conference & Expo.
SAMPLE EXEMPLAR IN THE NEW FORMAT
The following sample exemplar illustrates how to
use the new format. This example is an updated
The AORN Journal is seeking contributors for the Magnet Insights column. Interested authors can contact Michelle
R. Tinkham, column coordinator, by sending topic ideas to journalcolumns@aorn.org.
http://dx.doi.org/10.1016/j.aorn.2014.01.019
ÓAORN, Inc, 2014 May 2014 Vol 99 No 5 AORN Journal j633
adaptation of an exemplar previously written at my
facility during a Magnet application. It may help
those who wish to understand the new format re-
quirements or spark ideas for those who are new
to writing exemplars.
Background/Problem
Cardiac care begins in the prehospital setting,
where paramedics trained in recognition of acute
coronary syndrome are available to provide care.
Members of the emergency department (ED) chest
pain team (eg, physicians, nurses, and ED techni-
cians) provide 24 hours a day seven days a week
advanced cardiac care for patients presenting with
cardiac problems. In April 2013, our facility un-
derwent cycle III accreditation through the Society
of Chest Pain Centers. Receiving designation as
an ST-elevation myocardial infarction (STEMI)
receiving center carries with it the responsibility of
providing ongoing education to prehospital emer-
gency personnel, hospital personnel, and com-
munity members. Therefore, after the successful
TABLE 1. Empirical Outcomes: Format for Exemplar
1
Content must be organized with the following headings:
Background/problem nProvide relevant background information.
nDescribe the problem(s) that exist(s) in the health care organization.
Goal statement(s) nState the goal(s), that is, the desired improvement(s)/change(s)/result(s).
nIdentify the measure(s) selected to demonstrate the improvement(s)/change(s)/
result(s) (ie, hours, errors, incidents, satisfaction, indicators).
Description of the intervention/
initiative/activity
nDescribe the actions(s) that had a positive effect on the problem and resulted in
achievement of the goal(s).
nInclude where the intervention(s)/initiative(s)/activity(ies) occurred (eg, unit,
department, product line, organization).
nInclude the date(s) when the intervention(s)/initiative(s)/activity(ies) took place
(ie, timeline).
nThe intervention(s)/initiative(s)/activity(ies) must have occurred within the 30 months
before the document submission.
Participants nList the participants involved (ie, names, disciplines, titles, departments), preferably
through the use of meeting minutes.
Outcome(s) nDemonstrate achievement of the desired improvement(s)/change(s)/result(s) with
data displayed in a clearly labeled graph(s) with data table(s).
nTrended data must be displayed to show change(s)/improvement(s)/result(s).
nThe selected measure(s) must correlate with the desired goal(s).
nPre-intervention/initiative data and post-intervention/initiative data must
nuse the same measure(s) to demonstrate the effect of the intervention(s)/
initiative(s).
nbe clearly identied with dates on the graph(s) and data table(s).
nThe intervention timeframe/date(s) must be clearly identied on the graph(s) and
data table(s).
Empirical outcomes: data display
requirements
nDisplay of data by using graphs and charts is an excellent way to illustrate
outcomes; therefore, a table and graph are required for each empirical outcome.
nLabel axes with dates, times, and title of graphs.
nLegends are required for the display of data and must indicate on the graph(s)
the date(s) of the pre-data, intervention(s)/initiative(s)/activity(ies), and post-data
(ie, measurement[s]) need to be the same for pre- and post-data.
1. American Nurses Credentialing Center (ANCC). Empirical Outcomes: Criteria for Nursing Excellence. Silver Spring, MD: ANCC; 2013.
634 jAORN Journal
May 2014 Vol 99 No 5 MAGNET INSIGHTS
completion of the STEMI receiving center accred-
itation process, ED and cardiac catheterization
laboratory personnel formed an ad hoc committee
to the existing chest pain team. These chest pain
committee members’ targeted purpose was to
provide better education to emergency medical
service (EMS) personnel in an effort to decrease the
facility’s door-to-open-vessel time (ie, the time it
takes for a patient experiencing a cardiac emer-
gency to arrive and undergo intervention). The ED
team members coordinated a two-day educational
program about STEMI recognition for ED nurses
and prehospital personnel.
Goal Statement(s)
The goals of the two-day educational program were
to improve early recognition of cardiac emergen-
cies, early notification of key personnel, and early
activation of treatment protocols. More than 250
medical personnel, including prehospital personnel,
ED nurses, and paramedic students, attended the
program.
Description of the Intervention/Initiative/
Activity
The STEMI education program resulted in re-
duced door-to-open-vessel times by educating EMS
personnel in identification of a potential myocardial
infarction and empowering them to begin early
treatment options. The ad hoc committee also de-
veloped a chest pain audit tool, to be used by the
mobile intensive care nurse when the ED received
calls from EMS personnel. This audit tool provided
prompts for the mobile intensive care nurse about
which information to ask of EMS personnel via
radio to determine whether transmission of the
electrocardiogram (ECG) was warranted for early
determination about whether the patient was a
candidate for intervention in the cardiac catheteri-
zation laboratory. For example, the mobile inten-
sive care nurse would say “tell me what you see”
and ask “where is the elevation?” Based on in-
coming data and his or her determinations, the
mobile intensive care nurse would alert the cathe-
terization laboratory and other personnel to the
patient’s arrival and possible need for intervention.
In addition to providing the educational pro-
gram, the ad hoc committee raised more than
$25,000 during the annual “Go Red” luncheon
sponsored by the American Heart Association.
Proceeds from the event were used for the purchase
of upgrades to the EMS monitors and BluetoothÒ
technology necessary for the wireless transmission
of ECGs to receiving hospitals. The ECGs, in turn,
Figure 1. Sample graph, showing door-to-open-vessel times.
AORN Journal j635
MAGNET INSIGHTS www.aornjournal.org
were made available to the ED physician on duty
for early problem recognition, resulting in notifi-
cation of the cardiac catheterization laboratory
personnel before the patient’s arrival in the ED.
Additionally, by using a wireless transmission,
the ED physician could scan the patient’s ECGs
and, if warranted, send the scan to the on-call
cardiologist before the patient’s arrival.
Participants
For this section, the American Nurses Credential-
ing Center indicates that it is preferable for meeting
minutes to be included. They can be submitted as
a separate document for review.
Outcome(s)
Early recognition and early notification of patients
requiring cardiac care resulted in earlier activa-
tion of the cardiac catheterization laboratory team.
Chart audits performed on patients with chest pain
after the implementation of those strategies dem-
onstrated a decreased door-to-open-vessel time.
The effect of nurses taking leadership roles in
interdisciplinary collaboration resulted in more
rapid intervention and improved outcomes for pa-
tients (Figure 1).
CONCLUSION
For many nurses, putting the exceptional work they
do daily into words can be difficult. As a result,
writing exemplars can be a daunting task for some.
It is important to remember that this task is an
opportunity for a facility to demonstrate what
makes it worthy of Magnet status. As with any
form of narrative, writing an exemplar can help
team members reflect on their experiences as well
as enhance their critical thinking.
4
The team mem-
ber who writes the exemplars does not need to be a
professional writer. The goal of the exemplar writer
is to provide the reader with clear, organized in-
formation about which activities facility personnel
perform well and what the personnel accomplished
to improve patient outcomes.
Although any facility attempting Magnet certi-
fication should have a Magnet director to assist
with the process of writing exemplars, there also
may be team members in a facility who have writing
experience and would welcome the opportunity to
be more involved in the Magnet experience. Each
team member contributes to superior practices that
are worthy of Magnet distinction, and each person
has a valuable story to share.
Editors notes: Magnet is a registered trademark of
the American Nurses Credentialing Center, Silver
Spring, MD. Bluetooth is a registered trademark of
Bluetooth SIG, Inc, Kirkland, WA.
References
1. In our hands. Providence St Peter Hospital. http://wash
ington.providence.org/hospitals/st-peter/about/awards/
magnet-recognition/w/media/Files/Providence/Hospitals/
WA/St%20Peter/St_Peter_PSPH_NursesAchBook_2010.
pdf. Accessed January 3, 2014.
2. Turkel M. Magnet Status: Assessing, Pursuing and
Achieving Nursing Excellence. Marblehead, MA:
HCPro; 2004.
3. Magnet manual updates. American Nurses Credentialing
Center. http://www.nursecredentialing.org/Magnet/Magnet
ManualUpdates. Accessed January 3, 2014.
4. Sorrell J. Stories in the nursing classroom: writing and
learning through stories. Language & Learning Across the
Disciplines. 2001;5(1):36-48. http://wac.colostate.edu/llad/
v5n1/sorrell.pdf. Accessed January 30, 2014.
Michelle R. Tinkham, MS, BSN, RN, PHN,
CNOR, CLNC, is an RN coordinator cardio
pulmonary rehabilitation at Eisenhower Medical
Center, Palm Desert, CA. Ms Tinkham has no
declared affiliation that could be perceived as
posing a potential conflict of interest in the
publication of this article.
636 jAORN Journal
May 2014 Vol 99 No 5 MAGNET INSIGHTS
ResearchGate has not been able to resolve any citations for this publication.
Magnet Status: Assessing, Pursuing and Achieving Nursing Excellence
  • M Turkel
Turkel M. Magnet Status: Assessing, Pursuing and Achieving Nursing Excellence. Marblehead, MA: HCPro; 2004.
American Nurses Credentialing Center. http://www.nursecredentialing.org/Magnet/Magnet ManualUpdates
Magnet manual updates. American Nurses Credentialing Center. http://www.nursecredentialing.org/Magnet/Magnet ManualUpdates. Accessed January 3, 2014.
Ms Tinkham has no declared affiliation that could be perceived as posing a potential conflict of
  • Michelle R Tinkham
  • M S Bsn
  • R N Phn
Michelle R. Tinkham, MS, BSN, RN, PHN, CNOR, CLNC, is an RN coordinator cardio pulmonary rehabilitation at Eisenhower Medical Center, Palm Desert, CA. Ms Tinkham has no declared affiliation that could be perceived as posing a potential conflict of interest in the publication of this article.