Title: The Power of the Magnet Hospital Credential: Excellence in Nursing
1The 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
2(No Transcript)
3Overview
- Brief History of Magnet Hospitals
- Magnet Standards Methods for Achievement
- Research Related to Magnet Hospitals
- Magnet Prize Evidence-Based Practice
4History 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
5History (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
6History 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
7Standards
- 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
8Standards (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.
9Internal 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
10Submission of Materials
- Notebooks that include write-up of how hospital
met standard and documents that provide
supporting evidence
11Magnet 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
12Magnet 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)
13Research 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
14Aiken (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
15Study 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)
16Magnet 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
17International 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)
18Magnet 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
19Magnet 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)
20Kramer 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
21Further 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)
22Interrelationship 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
23Magnet Prize for theUniversity of Colorado
HospitalAwarded in 2004
24Evidence-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
25Evidence-Based Practice ProjectManagement of
Alcohol Withdrawal
Results of Study
26Evidence-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
27Evidence-Based Practice Project Pain Management
Pain Reassessment Scores
28Skin 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
29Evidence-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
30Summary
- 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!