Models of good practice for promoting staff autonomy: The Magnet Recognition Program?

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Models of good practice forpromoting staff
autonomyThe Magnet Recognition Program?

• Karen B. Haller, PhD, RN
• Vice President for Nursing Patient Care
  Services
• The Johns Hopkins Hospital
• Baltimore, Maryland, USA

khaller_at_jhmi.edu
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Objectives

• Review Magnet Programs goals.
• Relate to HPH strategies.
• Discuss implementation.

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Magnet designation is the highest level of
recognition given to health care organizations
that provide the services of professional
registered nurses.
- American Nurses Credentialing Center (ANCC)
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Magnet Recognition Program Goals

• Promote quality in a milieu that supports
  professional practice.
• Identify excellence in the delivery of nursing
  services.
• Provide for the dissemination of best practices
  in nursing.

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Hospitals can use theMagnet Program

• To assess and improve their processes for
  achieving quality outcomes.
• To acknowledge nursing staff for contributions to
  positive care outcomes.
• To achieve greater recognition within the
  community for nursing.

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Origins of the Magnet Program
1981 American Nurses Association
commissions a study of hospitals that
maintained competent nursing workforces
during a time of shortage. 1983 Researchers
(McClure et al., 1983) publish
characteristics of model hospitals and coin
the term Magnet hospitals.
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Creation of Magnet Award
1990 Accreditation program began through
the ANCC. 1994 University of Washington
Medical Center, Seattle, received the first
award. 2000 Rochdale Trust, U.K., became
the first non?U.S. healthcare organization
to receive a Magnet award.
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Magnet hospitals must meet stringent qualitative
and quantitative standards that define the
highest level of nursing practice and patient
care.
M
AMERICAN NURSES CREDENTIALING CENTER
ANCC MAGNET RECOGNITION
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Forces of Magnetism

• Quality of Nursing Leadership (visionary,
  knowledgeable, staff advocacy)
• Organizational Structure (flat, decentralized,
  unit-based decision-making)
• Management Style (participatory, valuing staff
  nurse input)
• Personnel Policies and Programs
  (employee-friendly)
• Professional Model of Care (staff nurses given
  authority and accountability)

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Forces of Magnetism

• 6. Quality of Care (an organizational
  priority)
• 7. Quality Improvement (educational, with
  staff nurses)
• 8. Consultation and Resources (availability of
  expertise, adequate staffing)
• 9. Autonomy (within scope of Nurse Practice
  Act)
• Community and the Hospital (hospital as
  corporate citizen)

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Forces of Magnetism

• Nurses as Teachers (of peers as well as
  patients and families)
• Image of Nursing (RN is integral member of
  team)
• Interdisciplinary Relationships (mutual
  respect, collegial RNs - MDs)
• Professional Development (education,
  competency)

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Six Principal Health Promotion Strategies for
Staff
Pelikan et al., 2003
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Magnet research shows

• Improved recruitment
• Improved retention
• Less agency usage
• More control of practice environment
• Greater autonomy
• Better relationships with physicians

• Fewer needlesticks
• Lower mortality rate(CMI-adjusted Medicare
  mortality rate)
• Lower disease-specific mortality rate
• Higher patient satisfaction
• Decrease in falls

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Summary of the Research
indicates the study variables.
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Lower Medicare Mortality Among a Set of Hospitals
Known for Good Nursing Care

• 4.6 lower mortality rate
• 0.9 to 9.4 fewer deaths per 1,000 (95 confidence
  interval)
• Aiken, Smith, Lake, 1994

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• a greater proportion of nursing service
  personnel being registered nurses is not the
  sole explanation for their lower mortality. This
  finding reinforces our belief that the mortality
  effect derives from the greater status, autonomy,
  and control afforded in the Magnet hospitals ...
• Aiken, Smith, Lake, 1994, p. 783

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• The practical importance of our findings is
  influenced by the extent to which the
  organizational characteristics of Magnet
  hospitals can be replicated elsewhere.
• Aiken, Smith, Lake, 1994, p. 783

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Relationship betweenthe practice of nursing and
the mortality rates in hospitals

• Aiken et al., 2002
• Blegen, Goode, Reed, 1998
• Czaplinski Diers, 1998
• Kovner Gergen, 1998
• Mitchell Shortell, 1997

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Hospital Organization, Nurse Staffing, and
Patient Outcomes
Hospital organization
Nurse autonomy Nurse control Nurse
intra-organizational status
Patient outcome
Nurse patient ratios / nursing skill mix
Surveillance / early detection of complications
Nurse-physician relations Rapid institutional
response
Medical staff organization and qualifications
Aiken, 1999
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Implementing the Magnet approach
Structure
Process
Outcome
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Characteristics of Effective Nursing

• Organizational structure
• Quality of nursing leadership
• Personnel policies and programs
• Professional models of care
• Levels of autonomy
• Source
  ANCC (www.ana.org)

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• Organizational structure
• Chief Nursing Officer is at the executive level.
• Decentralized departmental structures allow
  strong nursing involvement in the committee
  structure across departments.
• Equal attention is given to the quality of staff
  and the quantity of staff.

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• Quality of nursing leadership
• Leaders are knowledgeable and strong risk-takers
  who convey a sense of advocacy and support for
  the staff.
• The nursing directors and managers are pivotal to
  the success of the organization.

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• Personnel policies and programs
• Salaries and benefits are competitive.
• Shift rotation is minimized.
• Significant administrative and clinical
  promotions reward expertise with both title and
  salary changes.

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• Professional models of care
• The model of care gives the nurse the
  responsibility and related authority for patient
  care.
• Nurses are accountable for their own practice and
  are coordinators of care.
• Nursing management is responsible for developing
  an environment where care can flourish.
• Nurses are involved in the development,
  implementation, and evaluation of nursing care.

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• Level of autonomy
• Nurses exercise independent judgment.
• Autonomy is viewed as self-determination.
• Interdisciplinary decision-making is essential.

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Conclusion

• The Magnet Program provides a good framework for
  granting high levels of staff autonomy
  (empowerment).
• http//www.nursingworld.org/ancc/magnet.html

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