The New Magnet Model

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The New Magnet Model Raising The Bar
Elaine Graf, PhD, RN, PNP, NE-BC Childrens
Memorial Hospital Sue Herrmann, MS, RN Delnor
Hospital Colleen Klein, PhD, RN, FNP-BC St
Anthonys Hospital Vicky Goeddeke, MS, RN, CEN,
CPEN Northwest Community Hospital
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Why Magnet? Term magnet was chosen in 1982 for
use by the American Academy of Nursing to
describe hospitals that attract and retain
nurses because of the quality of the nurses
working environment.
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• History of Magnet Program
• 1983
• The American Academy of Nursing's (AAN) Task
  Force on Nursing Practice in Hospitals conducted
  a study of 163 hospitals to identify and describe
  variables that created an environment that
  attracted and retained well-qualified nurses who
  promoted quality patient/resident/client care.
  Forty-one (41) of the 163 institutions were
  described as "magnet" hospitals because of their
  ability to attract and retain professional
  nurses. The characteristics that seem to
  distinguish "Magnet" organizations from others
  became known as the "Forces of Magnetism".
• 1990
• The American Nurses Credentialing Center (ANCC)
  was established as a separately incorporated
  nonprofit organization through which ANA offers
  credentialing programs and services.
• The initial proposal for the Magnet Hospital
  Recognition Program for Excellence in Nursing
  Services was approved by the ANA Board of
  Directors.
• 1994
• The University of Washington Medical Center in
  Seattle became the first ANCC-designated Magnet
  organization.
• 1997
• Program name changed to the Magnet Nursing
  Services Recognition Program. Program criteria
  were revised using The Scope and Standards for
  Nurse Administrators (ANA, 1996).
• 2000
• In response to requests, the Magnet Recognition
  Program was expanded to recognize healthcare
  organizations abroad.
• 2002
• Program name officially changed to Magnet
  Recognition Program.
• 2007
• ANCC commissions analysis of program leading to
  development of new Magnet Model

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Forces of Magnetism Force 1 Quality of Nursing
Leadership Force 2 Organizational
Structure Force 3 Management Style Force 4
Personnel Policies and Programs Force 5
Professional Models of Care Force 6 Quality of
Care Force 7 Quality Improvement Force 8
Consultation and Resources Force 9
Autonomy Force 10 Community and the Healthcare
Organization Force 11 Nurses as Teachers Force
12 Image of Nursing Force 13 Interdisciplinary
Relationships Force 14 Professional Development
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New Magnet Model Reflects current research on
organizational behavior Forces of Magnetism
embodied in 5 Domains Transformational
Leadership Structural Empowerment Exemplary
Professional Practice New Knowledge, Innovations,
Improvements Empirical Outcomes Includes Global
Issues in Nursing Health Care
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Focus on outcomes ANCC definition Quantitative
and qualitative evidence related to the impact of
structure and process on the patient, nursing
workforce, organization and consumer. Outcomes
are dynamic and measurable.
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Focus on outcomes Assuring that what we are
doing is making a difference.
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Examples of Patient Outcomes Falls and injuries
associated with falls HAPU occurrence/prevalence
Patient satisfaction Specialty
population-specific outcomes
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Examples of Nurse Outcomes Nurse satisfaction
scores Perception of nurse autonomy Perception of
culture and work environment Turnover and vacancy
rates
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Examples of Organizational and Consumer
Outcomes CNO impact on system level
changes Impact of community outreach
programs Consideration of community health and
welfare Organizational system efficiency
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• Evidence-based Practice
• An integration of the best evidence available,
  nursing, expertise, and the values and
  preferences of individuals, families, and
  communities who are served.
• Sigma Theta Tau International Position
  Statement (2005)

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How do we move from the Definition to use?

• Starts with Asking a Clinical Question
• Use of a Model to guide the process of
  determining how to proceed
• Several models available for organizations to use

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Models in Use Across the US

• Iowa Model for EBP Research
• University of Colorado Model
• ACE Star Model of Knowledge Transformation
• The Stetler Model of Research Utilization
• Johns Hopkins Nursing EBP Model

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Review and Evaluation of the Literature

• Search for the best evidence.
• Need for nurses to critically review the study
  population, findings, generalizability of study,
  validity of the results
• Evaluation of the application of the
  intervention in the practice setting
• (Lynn et all, 2007, p. 667)

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• Key to use of EBP are well-designed studies that
  can adequately support changes in clinical
  practice
• Need to ensure there is strong support from the
  literature
• Collaboration with APNs and Nurse Researchers to
  facilitate critical analysis/leveling of evidence

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• Examples of Evidence-based Practice
• Animal Assisted Therapy Program
• Comparison of knee-high vs. thigh-high pneumatic
  sequential compression devices
• Recovery of post-operative critically ill
• patients in the ICU/CCU

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Performance Improvement
Definition from 2008 Magnet Manual Quality
Improvement Systematic, data-guided activities
designed to bring about immediate improvement in
healthcare delivery in particular settings (Lynn
et all, 2007, p. 667)
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Performance Improvement

• May be known as
• QI
• PI
• CQI
• Used often with Benchmarking
• Definition from 2008 Magnet Manual
• Comparing data from the organization and other
  sources for the purpose of goal setting and
  performance measurements.

• Used to question practice
• Used to improve care processes or systems
• Generally starts with a problem
• Baseline determined
• Goal setting
• Measurement

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Types of PI, QI Models you might know
Model for improvement, PDSA or PDCA LEAN, Toyota
Production System, Six Sigma
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Hospital Acquired Pressure Ulcers(HAPU)
Baseline - Determine what needs to be improved-
Interventions - Measure progress-Use Benchmarks
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Hospital Acquired Pressure Ulcers
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RN Satisfaction

• Engage
• Survey
• Results
• Interventions/Action Plans
• Re-survey
• Pulse Survey Checks

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Many ideas of PI

• Falls
• Discharge Time
• OR Turnaround time
• Decision to Incision
• Door to Balloon
• VAP
• Overtime

• Admission process
• Handoffs
• Core Measures
• Room cleaning
• Equipment and storage
• Employee Sat
• Patient Sat

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Nursing Research What is it?

• Definition 2008 Magnet Manual
• A systematic search for knowledge about issues of
  importance to the nursing profession (Polit
  Hungler, 1995)
• of ongoing or recently completed scholarly
  research studies 1per 100 licensed beds.
• Institutional Review Board (IRB) Definition (45
  CFR 46.102(d))
• A systematic investigation, including research
  development, testing and evaluation, designed to
  develop or contribute to generalizable knowledge.
  Activities which meet this definition constitute
  research, whether or not they are conducted or
  supported under a program which is considered
  research for other purposes. For example, some
  demonstration and service programs may include
  research activities.

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Key Components

• Clear purpose generally intend to publish or
  present externally obtain IRB approval
• Design (quantitative, qualitative)
• Sample
• Methodology (protocol, tools, measures)
• Statistical Analysis
• Results
• Discussion, Implications Recommendations

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Examples

• Hospitalized Children's Perceptions of Nurses and
  Nurse Behaviors Initial Replication Study, MCN
  (2007) 32(6) 336-342
• Purpose
• The purpose of the study was to contribute to the
  knowledge concerning hospitalized childrens
  perceptions of nurses and nurse behaviors based
  on the words of the children interviewed. The
  study was completed first on a pediatric medical
  care unit and was then replicated on a pediatric
  surgical unit.
• Methods
• Both studies used a qualitative design that
  relied on a semi-structured interview guide.
  Older children provided written responses to
  questions, while younger children were
  interviewed by staff nurses. Through both studies
  a total of 65 children were interviewed. Data
  were analyzed using reductionistic and
  constructionistic steps, a methodology supported
  by Knafl and Webster, to identify themes and
  compare responses across demographic groups.

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Example

• Success of a Lactation Education Program on NICU
  Nurses Knowledge Attitudes, JOGNN (2008)
  37(4) 436-445
• Purpose
• The purpose of the study was to test an education
  intervention designed to improve lactation
  knowledge, attitudes, and beliefs of NICU nurses
  and to improve their intentions to provide
  mothers with lactation support
  quasi-experimental, time series pre/post test
  design
• Methods
• Nurses knowledge, attitudes, beliefs intentions
  tested pre education 3 month post. Mothers
  perceptions of lactation support sampled before
  and 3 months post intervention

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What is It?

• A team focused on wound care with one nurse
  representing each unit is formed - The
  Skintastics
• Establishment of hand hygiene monitoring process
• Evaluation of impact on nurses routinely working
  night shift
• Review and comparison regarding restriction of
  skin care products prior to radiation therapy
• Establishment of induced hypothermia protocol for
  post resuscitation Emergency department patients

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What is It?

• A sound monitor is placed in nursing station that
  blinks red when sound decibels get too loud
• Establishment of afternoon quiet time on unit to
  promote rest and family time
• Monitor blood stream infection rate post
  implementation of new IV pumps equipment
• Identification of predictor variables for
  pediatric inpatient falls
• Dipstick of all urine specimens of patients on
  chemotherapy medications Is it necessary?

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What is It?

• Quiet at Night campaign is initiated and
  interventions identified to try. Weekly and
  monthly measurements are provided.
• Nursing staff asked to participate in a survey to
  identify types of aggression in the clinical
  setting.
• Heartmath techniques for reducing stress.
• Tube feeding protocol.
• Monitor hourly rounding post implementation of
  competency for hourly rounding techniques.
• Nursing bundle measurement of patient care
  environment.

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What is It?

• Focused interviews with nurses to gauge
  satisfaction with environment
• Investigation into use of CNAs and modification
  of role implementation
• Review and comparison of visiting hours in the
  ICUs
• Safety and attitudes of flight paramedics

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Questions???