The Power of the Magnet Hospital Credential: Excellence in Nursing

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The Power of the Magnet Hospital Credential
Excellence in Nursing
Healthcare CongressHamburg, GermanyNovember 2,
2007

• Colleen J. Goode, RN, PhD, FAAN, CNAAVice
  President Patient Services and Chief Nursing
  OfficerUniversity of Colorado HospitalDenver,
  Colorado, USAcolleen.goode_at_uch.edu

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(No Transcript)
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Overview

• Brief History of Magnet Hospitals
• Magnet Standards Methods for Achievement
• Research Related to Magnet Hospitals
• Magnet Prize Evidence-Based Practice

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History of Initial Magnet Hospitals

• 1980 American Academy of Nurses study identifies
  factors associated with attraction and retention
  of nurses
• Data on vacancy rates gathered (survey)
• Data on work environment (interviews)
• 1983 Study published hospitals called Magnet
  Hospitals because they could attract and retain
  nurses
• 41 hospitals designated as Magnet

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History (continued)

• Fourteen Forces of Magnetism identified in Magnet
  Study and published in 1983

• Quality of Nursing Leadership
• Organizational Structure
• Personnel Policies Procedures
• Nurses as Teachers
• Image of Nursing
• Collegial Nurse/Physician Relationship
• Management Style

• Quality of Care
• Autonomy
• Quality Improvement
• Consultation Resources
• Community Involvement
• Professional Development
• Professional Models of Care

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History of CurrentMagnet Hospital Program

• 1990 American Nurses Association Board of
  Directors approved a new Magnet Hospital
  Recognition Program
• 1991 American Nurses Credentialing Center
  (branch of ANA) assigned program oversight (ANCC
  Commission on Magnet Recognition)
• Standards developed
• Appraiser selection and training
• 1994 Pilot project (study) with 5 hospitals
  using new standards
• 1994 University of Washington, Seattle,
  Washington, first Magnet Hospital
• 2007 251 designated Magnet facilities in 44
  states and 1 in Australia

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Standards

• Based upon the American Nurses Association (ANA)
  Scope and Standards for Nurse Administrators
  (purchase from ANA)
• Purchase the Magnet Services Recognition Program
  Instructions and Application Process book from
  the American Nurse Credentialing Center
• Conduct internal review to determine readiness
• Identify strengths/weaknesses
• Determine where not meeting standards
• Implement corrections

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Standards (continued)

• Manual tells what are the components of each of
  the 14 forces and what are sources of evidence
  you must provide
• Example
• Standard Quality of Nursing Leadership
• Component The Chief Nursing Officer is
  accurately perceived by all employees as
  representing nursing at the highest level of the
  governing body to the environment in which
  nursing is practiced.
• Source of Evidence Give examples from several
  nursing units of advocacy by the CNO on behalf of
  staff for FTEs, systems, equipment, personnel
  support, etc.

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Internal Process for Success

• Magnet steering committee
• Magnet director/coordinator
• CNO involvement member of steering committee
• Steering committee members write how standards
  met and gather evidence to demonstrate
• Bring write-up of how standards met and evidence
  to steering committee for further review

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Submission of Materials

• Notebooks that include write-up of how hospital
  met standard and documents that provide
  supporting evidence

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Magnet Program Appraisers

• Review written materials asks for additional
  materials, if necessary
• Scores documents according to established process
• If pass, schedules a site visit of 2 to 3
  appraisers
• Appraiser team spends 3 to 5 days at hospital,
  validating what was submitted
• Appraisers score visit and submit to the
  Commission on Magnet Recognition
• The Commission reviews reports and rates
  achievement of Magnet status
• Magnet Office notifies the applicant of outcome

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Magnet Hospital Research

• Instruments developed to measure work environment
• Survey instrument Nursing Work Index (NWI) by
  Dr. Kramer based upon her research on Magnet
  Hospitals (1989)
• NWI instrument revised by Aiken Patrician
  (2000)
• Development of Practice Environment Scale of the
  Nursing Work Index by Lake (2002)
• Essentials of Magnetism Tool developed by Kramer
  Schmalenberg (2004)

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Research Related to Magnet Hospitals

• First study by Aiken, Lake, et al. (1997) 20
  urban hospitals
• 10 had dedicated AIDS units and 10 did not
• 3 of the comparison hospitals were Magnet
• 2 medical units and dedicated AIDS units (when
  present) were studied)
• Studied 1,205 patient records and interviewed 594
  patients regarding satisfaction with care
• Nurse survey using revised Nursing Work Index

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Aiken (1997) Study (continued)

• Outcomes
• Both Magnet Hospitals and dedicated AIDS units
  had
• Greater autonomy
• Better nurse-physician relationships
• Nurses in Magnet Hospitals had lower levels of
  emotional exhaustion (Aiken Sloane, 1977) and
  lower level of needle-stick injuries (Aiken,
  Sloane Klocenski, 1997)
• Patient satisfaction highest in Magnet Hospitals

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Study of Mortality Rates

• Matched 39 Magnet Hospitals with 195 control
  hospitals
• Magnet Hospitals had 7.7 mortality rate 9
  fever deaths per 1,000 discharges than control
  hospitals (Aiken, Smith Lake, 1994)

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Magnet Research by Frederick (2003)Relationship
of Magnet Hospital and Nurse Job Satisfaction

• Nurses employed at Magnet Hospitals compared to
  non-Magnet
• Magnet Hospital nurses experienced higher levels
  of empowerment and job satisfaction
• Elements accounting for differences
• Accessibility of Magnet nurse leaders
• Support of nurse decision-making
• Greater work empowerment, structures and resources

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International Study by Aiken

• Used NWI-R 700 hospitals in 5 countries (USA,
  Canada, England, Scotland, Germany)
• 43,000 nurses surveyed
• In each country, a sizeable minority of hospitals
  (20) ranked high on traits common to Magnet
  Hospitals in the USA
• Suggests hospitals in other countries could
  qualify for Magnet status
• (Aiken Sochalski 1997, 1999)

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Magnet Status Registered Nurse Views of the
Work Environment

• Random sample of 3,500 RNs US licensed nurses
• Compared Magnet on journey and non-Magnet
• Magnet organizations were more likely not to see
  the shortage as a problem
• Magnets more likely to report overtime as
  strictly voluntary and not required
• 45 of nurses in Magnet hospitals, and those in
  process to become Magnet, believed emphasis on
  patient care as a strong priority in the
  organization, while 26 of those in non-Magnet
  strongly agreed

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Magnet Status Registered Nurse Views of the
Work Environment (contd)

• Opportunities for professional development and
  decision-making rated higher by organizations in
  process of Magnet status
• Magnets rated relationship between nurses the
  highest
• Magnet and in-process organizations were
  significantly more likely to observe increased
  efforts for recruiting and retention
• (Ulrich, Buerhaus, Donelan, et al., 2007)

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Kramer Schmalenberg (2002)8 Essentials of the
Work Environment

• Interviewed 289 staff nurses in 14 Magnet
  hospitals
• What are essential elements of the work
  environment to delivery quality care (rank order)
• Working with clinically competent nurses
• Good nurse-physician relationship and
  communication
• Nurse autonomy and accountability
• Support nurse manager/supervisor
• Control over nursing practice
• Support for education
• Adequate nurse staffing
• Culture where concern for the patient is paramount

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Further Evidence on the Magnet Recognition
Program (Schwartz, 2005)

• Sample of 470 RNs 173 from Magnet Hospitals
  297 from non-Magnet direct-care providers
• Random invitations 6 hospitals agreed to
  participate 3 Magnet, 3 non-Magnet
• Outcomes
• Magnet hospitals significantly higher levels of
  overall job satisfaction (McCloskey-Mueller
  Satisfaction Scale, 1990)
• Magnet nurses more likely to remain in current
  position intent to stay (Anticipated Turnover
  Scale, 1982)

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Interrelationship of Organizational
Characteristics of Magnet Hospitals, Nursing
Leadership and Nursing Job Satisfaction
(Upenieks, 2003)

• Compared convenience sample of clinical nurses
  from two Magnet Hospitals and two comparison
  non-Magnet hospitals sampled all
  medical/surgical nurses
• NWIR questionnaire (Aiken Patrician, 20020)
• Conditions of Work Effectiveness questionnaire
  (Laschinger Wong, 1999)
• Outcomes
• Nurses at Magnet Hospitals have
• Higher level of empowerment and job satisfaction
• Greater access to nurse leaders
• Greater support of decision-making by nurse
  leaders
• Greater access to resources, information and
  opportunities

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Magnet Prize for theUniversity of Colorado
HospitalAwarded in 2004
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Evidence-Based Practice ProjectManagement of
Alcohol Withdrawal

• Protocol
• Adopted use of Clinical Institute Withdrawal
  Assessment (CIWA)
• Alcohol scale inter-rater reliability r .80 and
  construct validity
• Symptom triggered therapy
• Patients monitored using an assessment scale and
  medicated only when symptoms cross a threshold of
  severity

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Evidence-Based Practice ProjectManagement of
Alcohol Withdrawal
Results of Study
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Evidence-Based Practice Project Pain Management

• Development of Pain Performance Improvement Team
  with 5 subcommittees
• Pain assessment
• Policies and procedures
• Staff education
• Patient education
• Pain outcomes
• War on Pain Conference
• Development of Pain Champions of Change Program
• WILDA scale to measure pain

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Evidence-Based Practice Project Pain Management
Pain Reassessment Scores
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Skin Champions of ChangePressure Ulcer
Prevention ProtocolTherapeutic surfaces serve as
adjuncts to care and are NOT replacements for
frequent repositioning.

• Nursing Standard of Care of Prevention of
  Pressure Ulcers and Skin Breakdown (all patients)
• Turn patient every 2 hours and PRN 1-4
• HOB lt 30o if patient does not have pulmonary
  risks HOB gt 45 o if patient has risk for
  pulmonary complications (increase turning
  frequency)
• Moisturize skin daily and PRN1-4
• Control moisture determine and treat cause of
  moisture apply moisture barrier creams as
  needed1,2
• Nutritional Consult if albumin lt 3.4 g/dl and/or
  pre-albumin lt20 mg/dl1,2
• Maximize use of turning sheets and slide boards
  to move patient.1,2
• CWOCN RN Consult (Amie Kirkwood RN CWOCN) if
  Stage III, IV or unstageable pressure ulcer
  present

• Bariatric patients (300lbs) Braden Score 13 use
  a UCH Bariatric Bed Braden Score lt13 KCI
  Bariatric bed Braden lt9 KCI BariAir
• References
• Ratliff, C.R., et al. (2003). Guideline for
  prevention and management of pressure ulcers.
  Wound Ostomy and Continence Nurses Society. Lake
  Avenue, Glenview IL.
• U.S. Department of Health and Human Services.
  (1992). Pressure ulcers in adults prediction and
  prevention. AHCPR. Rockville, MD.
• Alleyo, E.A. et al. (2004). By the numbers
  Braden score interventions. Advances in Skin
  Wound Care 17(3) 150.
• Olshansky, K. (2004). Pressure ulcer prevention
  a total disconnect. Advances in Skin Wound
  Care. 17(5) 259
• Wall, S. et al. (2005). Development of an
  evidence-eased specialty support surface decision
  tool. Ostomy Wound Management 51 (2) 80

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Evidence-Based Practice Project Management of
Skin

• Outcome
• Pressure ulcer prevalence decrease 9 to 3
• Improved documentation on admission and daily
  assessment
• Majority of hospitalized patients at UCH at risk
  for skin breakdown scale score lt 18
• Inappropriate use of low air-loss beds
• Results are reported and benchmarked by NDNQI
  database
• Flynn, M. B. Fink, R. (2001). Committing to
  Evidence-Based Skin Care Practice. Critical Care
  Nursing Clinics of North America, 13(4), 555-567

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Summary

• Magnet hospital achievement is worth the hard
  work
• Helps to recruit and retain nurses
• In USA, nurses want to work at a Magnet Hospital
• We need more Magnet Hospitals in other countries
  including Germany!