Coaching Corner – EP6

The ANCC Magnet^® EP6 example asks designating organizations to demonstrate that nurses ensure the coordination of a patient care across multiple care settings, by participating in interprofessional collaborative practice.

The ANCC 2023 Magnet Application Manual revised the criteria for this example, introducing setting-specific components into the key elements scored in the narrative and supporting evidence. Applicants must submit two of three possible narratives, describing and demonstrating nurse’s(s’) participation in interprofessional collaborative practice to ensure coordination of care from an inpatient setting to an ambulatory care setting (EP6a), from an ambulatory care setting to an inpatient setting (EP6b), and among multiple ambulatory care settings (EP6c). Let’s explore what makes a strong example for each choice and what strong examples tend to have in common.

EP6a

EP6a asks us to “provide one example, with supporting evidence, of nurse’s(s’) participation in interprofessional collaborative practice to ensure coordination of care from an inpatient setting to an ambulatory care setting” (ANCC Magnet Application Manual, 64). The main thing we need to demonstrate in this example is that a nurse employed by the applicant organization participated in coordinating interdisciplinary care for a patient transitioning to an ambulatory care setting, which may or may not be part of the applicant organization. Ambulatory care settings outside the applicant organization might include a home care setting, skilled nursing facility, or rehabilitation facility.

If the ambulatory setting is within your organization, then we will need to provide a narrative description of how the patient was transferred to the ambulatory unit and evidence of the handoff communication from the inpatient nurse to the ambulatory receiving nurse. Then, we will describe how the ambulatory nurse continued the care for the patient by reaching out to other disciplines, such as Medicine or Nutrition. This could also involve interprofessional rounding or family care meetings that include other disciplines in addition to the patient’s ambulatory nurse(s). Strong evidence includes documented communication between the ambulatory nurse(s) and other disciplines or meeting minutes that demonstrate the ambulatory nurse(s) interacting with other disciplines as part of the patient’s care.

If the ambulatory setting is outside your organization, then we need to demonstrate how the inpatient nurse(s) coordinated with other disciplines to prepare the patient for transfer to the ambulatory setting. For example, the inpatient nurse(s) may work with other disciplines to ensure the patient is cared for in the inpatient setting before transfer to the ambulatory setting, or an inpatient nurse may work with Case Management to coordinate discharge to an outside ambulatory setting. The “handoff” in this case may be a record of the inpatient nurse’s coordination with Transport Services, informing them of the patient’s condition. In these cases, evidence might be limited, as your nurse(s) will not have access to the records from an outside organization. What we will need to demonstrate, however, is that a nurse(s) employed in your inpatient setting performed actions that resulted in the interprofessional coordination of care.

Key Takeaway: Describe and demonstrate the inpatient nurse(s) driving the actions that ensure the interdisciplinary coordination of care from the inpatient setting to the ambulatory setting.

EP6b

EP6b asks us to “provide one example, with supporting evidence, of nurse’s(s’) participation in interprofessional collaborative practice to ensure coordination of care from an ambulatory care setting to an inpatient setting” (ANCC Magnet Application Manual, 64). Again, the secondary setting, the inpatient setting in this example, can be either internal or external to the applicant organization.

A common EP6b situation describes a patient arriving at the ED, which then leads to the patient’s stay on an inpatient unit within the applicant organization. In this case, we can describe and demonstrate the initial handoff from the applicant organization’s ambulatory care setting to the inpatient unit. We can then describe and demonstrate the inpatient nurse(s) coordinating interdisciplinary care actions throughout the inpatient setting, such as coordinating inpatient therapy, working with specialized physicians on a treatment plan, or working with a dietician for a patient’s specific nutrition needs. If the patient is transferred to an external inpatient setting, then we need to describe and demonstrate how the patient’s ambulatory nurse(s) drove the actions to coordinate care to the external inpatient setting. Once again, this can include coordinating with other disciplines in the ambulatory setting to provide care for the patient before transfer, collaborating with case managers to prepare the patient for transport, providing handoff communication to Transport Services, or coordinating care with the external inpatient setting.

Key Takeaway: The main thing is to describe and demonstrate how the applicant organization’s ambulatory nurse(s) drove the interprofessional care actions to get the patient from the ambulatory setting to the inpatient setting.

EP6c

In EP6c, we are asked to “provide one example, with supporting evidence, of nurse’s(s’) participation in interprofessional collaborative practice to ensure coordination among multiple ambulatory care settings” (ANCC Magnet Application Manual, 64). The secondary setting(s) can be internal or external to the applicant organization. We need to describe and demonstrate how the applicant organization’s ambulatory nurse(s) worked with other disciplines to coordinate patient care as they transitioned to the next ambulatory setting(s). Strong EP6c examples often describe situations like a patient receiving treatments across multiple outpatient clinics or receiving care in the ED and then follow-up appointments in other ambulatory care settings.

Key Takeaway: If the second ambulatory setting is outside the applicant organization, describe and demonstrate how the applicant organization’s ambulatory nurse(s) worked with other healthcare professionals to provide patient care in the first ambulatory setting and coordinate care with ambulatory location(s) outside the applicant organization.

Tying It Together

There are two primary things that strong EP6 examples have in common: they describe the applicant organization’s nurse(s) participating in interdisciplinary care actions, and they provide evidence “proving” the applicant organization’s nurse(s) active participation in the interprofessional activities. Often, the strongest evidence for an EP6 example is a redacted screenshot of the patient’s record that names the applicant organization’s nurse(s) as the one making the consult requests, setting up or participating in care meetings, or working with other disciplines. However, supporting documents like patient progress reports and meeting minutes of care conferences or discussions with case managers can also work. Good luck in writing your EP6 examples, and consult the Nursing Excellence Validation Team at Tipton Health for questions regarding your narrative and/or evidence!