Magnetic pull, The

Magnetic pull, The

Taylor, Nicole T

The U.S. health care infrastructure now boasts more than 100 Magnet facilities-and counting.

Abstract: Discover the major attributes of the facilities that earn Magnet status from the American Nurses Credentialing Center. [Nurs Manage 2004:35(4):59-69]

According to the American Nurses Credentialing Center (ANCC), 102 facilities across the nation have achieved Magnet status. The organization cites numerous benefits of becoming a Magnet facility. Specifically, Magnet designation:

* acts as an important recognition of nurses’ worth.

* is a major factor in nurse recruitment and retention.

* offers organizations a competitive advantage.

* creates a Magnet culture at designated institutions.

* reinforces positive collaborative relationships within the organization.

* attracts high-quality providers to Magnet facilities.

* improves patient care quality.

* increases use of the health care organization by consumers and health care plans.1

The following five facilities share the key processes through which they achieved Magnet recognition.

Massachusetts General Hospital

Boston, Mass.

Massachusetts General Hospital (MGH) is the third oldest general hospital in the United States and is the oldest and largest hospital in New England. The 868-bed medical center provides sophisticated diagnostic and therapeutic care in most medical and surgical specialties. MGH admits approximately 42,000 inpatients per year and accommodates more than 1.2 million visits to its extensive outpatient programs at its main campus and four health centers. For administrators, achieving Magnet status reinforces the hospital’s high level of excellence.

“Receiving Magnet recognition confirmed what we already knew-that our patients receive the best possible care; that working together, all members of the health care team empower each other to deliver that care; and that MGH nurses set the standard for excellence in culturally-competent and evidence-based nursing practice,” says Jeanette Ives Erickson, RN, MS, senior vice president for patient care and chief nurse. “As a Magnet hospital, we must continually raise the bar on how to improve patient outcomes and the practice environment.”

Patient care model

* MGH practices an interdisciplinary, patient- and family-focused care delivery model. Operative methods of this model vary depending on the needs of the respective patient populations in each patient care setting.

* A wide variety of staffing models exists: Some units have all-RN staffs, while others have a mix of RNs and patient-care assistants. Nurse practitioners head up select units and programs.

Recruitment and retention strategies

* Leaders administer the annual “Staff Perception of the Professional Practice Environment Survey” to measure variables such as the nursing staff’s sense of autonomy, control over practice, and the strength of collaborative relationships with physicians and other members of the health care team. Results are positive and continue to improve each year.

* MGH recognizes nurses for their clinical expertise through the interdisciplinary clinical recognition program.

* Opportunities for professional development abound. Extensive support, through flexible scheduling and financial assistance, exists for certification and continuing education.

Innovative services/processes

* The Yvonne L. Munn Center for Nursing Research, the hub of MGH’s nursing research program, includes the Nursing Research Committee, the Yvonne L. Munn annual lecture and awards, post-doctoral fellowships, a visiting professor program, and a doctoral forum (comprised of over 20 doctorally prepared nurses). The research focuses on clinical, administrative/organizational, and quality and safety initiatives.

* The Center for Clinical and Professional Development oversees orientation, training, and continuing education programs, offering 45 unit-based clinical nurse specialists as key resources in facilitating the professional development of both new graduate and experienced clinical nurses.

* The Eleanor and Maxwell Blum Patient and Family Learning Center houses a rich collection of educational material to augment patient and family education. Nurses learn through mentoring and preceptoring programs.

Image of nursing

* MGH implemented a staff-led, multi-committee, interdisciplinary collaborative governance communication and decision-making model in 1997; 95% of its members are clinicians on staff. Through this model, nurses have a voice in key decisions that impact their clinical practice and quality of worklife. Committees include practice, quality, research, diversity, ethics, patient education, professional development, and staff nurse advisory.

* Word of mouth brings in over half of the nurses hired at MGH. An image campaign designed by the Staff Nurse Advisory Committee highlights MGH’s advantages with the tagline: “Nursing at MGH-Simply the Best.” As of February 1, 2004, the nurse vacancy rate is 3.1%; turnover rate is 5%.

Community involvement

* MGH nurses’ impact extends well beyond the hospital campus through community-based health centers and initiatives fostering community health and offering resources to those in need. Such a program is the MGH Senior HealthWise Program, a nurse practioner-led outreach program for the elderly.

Medical City Dallas Hospital and the North Texas Hospital for Children at Medical City

Dallas, Texas

Medical City, a 598-bed tertiary care center, is located in nursing officer. “Throughout the hospital, nurses are valued for their expertise and contributions.”

Patient care model

* Medical city operates on a primary care and team-nursing model.

* Nursing staff employs a nursing-as-caring philosophy and “The Caring” model.

Recruitment and retention strategies

Medical City offers:

* a chief retention officer strategy.

* unit-level retention committees.

* a new-hire support coordinator to facilitate transition of new employees.

* communication by way of strategy, clinical quarterly nursing staff meetings with the chief nursing officer (CNO), and monthly employee meetings with the chief executive officer and CNO.

Innovative services/processes

* Medical City employs a PICC Line Nursing Service, which consists of RNs trained in using ultrasound technology for peripherally inserted central venous catheter placement.

* An advance practice nursing model serves high-risk populations.

* Staff participates in a career enhancement program for professional development.

Image of nursing

* Nurses have a voice in practice and facility operations through a participative leadership model.

* Medical City practices evidence-based nursing and views its nurses as experts in their field.

* Nurses serve on the investigative review board and conduct nursing research.

Community involvement

* Medical City has a relationship with Habitat for Humanity. In March 2003, Medical City was the first hospital in Dallas to fully sponsor and construct a new home for purchase by a deserving low-income family.

* Medical City supports Genesis Women’s Shelter and offers health screenings at multiple community organizations.

Miami Children’s Hospital Miami, Fla.

Miami Children’s Hospital (MCH), a 268-bed hospital, is South Florida’s only hospital exclusively for children, treating more than 185,000 children from various locations throughout the United States, South and Central America, and the Caribbean. It features over 600 highly skilled pediatric nurses. The nursing department received ANCC Magnet recognition July 2003. Working toward achieving Magnet designation was a tremendous boost to staff pride and morale, says vice president and chief nursing officer Jacqueline L. Gonzalez, ARNP, MSN, CNAA,BC.

“When nursing staff members began to openly recognize and celebrate their achievements within their department and across departments, it was contagious,” she says. “The nursing staff of MCH has received recognition in many areas, some of which include the 2003 Florida Nursing Association (FNA) Award, the 2003 FNA District V ‘Promoting an Environment for Excellence in Nursing,’ and the 2003 FNA Media Award for our ‘Excellence in Pediatrics’ CD/video.”

Patient care model

* MCH operates on a family-centered care model. The vice president/chief nursing officer and the nursing leadership team value collaboration among departments in providing optimal interdisciplinary care for patients. They also recognize the importance of having appropriate resources available to enhance the RN’s ability to provide optimal nursing care.

* The plan of care, designed under the leadership of clinical nurse specialists (all of whom are master’s prepared), is interdisciplinary and outcome-based. A computerized multidisciplinary progress note meets individual patient needs and integrates with computerized charting and the laboratory system.

Recruitment and retention strategies

* Programs include an extra shift pay program, a nursing scholarship program, an on-site NCLEX review program, an employee referral/recruitment program, and a recognition program for the decreased use of sick time.

* MCH holds open houses throughout the year to showcase different nursing units.

* MCH increased tuition reimbursement from $2,000 to $4,000 per year per employee to promote career advancement.

* MCH’s nursing student-loan payment program helps new graduates payback student loans. This strategy helped to dramatically decrease the RN vacancy rate from 20.1% in 1998 to 2.6% in 2003.

* The “New Nurse Support Group,” a half-day program for new nurses with less than one year at MCH supplements orientation. Lunch with the VP/CNO and the nursing leadership team follows the program.

Innovative services/processes

* MCH, a beta site, is the first free-standing children’s hospital in the nation to institute bar-code technology for medication administration.

* The information technology department implemented computerized documentation.

* Advanced registered nurse practitioners in the cardiac care unit use a system to update Web-based patient information.

* Nurses receive preventive education, including ergonomics, from a nurse practitioner in employee health. An on-site gym and a massage therapist are available in the Wellriess Center.

Image of nursing

* Education is a premium: The VP/CNO and nursing directors are master’s prepared; the nurse researcher is doctorally prepared. More than 60% of MCH nurses are already bachelor’s or master’s prepared, while others are in the process of getting postgraduate degrees.

* The nursing leadership team produced a video titled “Excellence in Pediatrics” to show at all state and national nursing programs and recruitment fairs.

* Nurses Week activities promote a positive image.

Community involvement

* The nurse researchers and clinical nurse specialists (CNS) serve as adjunct faculty at area colleges and universities. One designated CNS is supported by MCH and assigned to one local university.

* MCH sponsors its own biennial pediatric conference and is on the planning committee for the 2004 national pediatric nursing conference.

* More than 60 courses and 150 clinical, management, critical care, and advanced life support topics for continuing education and mandatory requirements are available online through an Internet-based learning system developed specifically for pediatric hospitals.

St. Marys Hospital Medical Center Madison, Wisc.

St. Marys Hospital Medical Center provides inpatient and outpatient treatment and diagnostic services in primary care and nearly all specialties. The hospital offers special focus in medical/surgical areas, including the Dean/St. Marys Cardiac Center, Family Birth Center, Pediatrics, Neuroscience Center, Geriatrics, and Emergency Services. The St. Marys campus features an outpatient surgery center and an employee childcare center. The hospital also operates an off-site adult day health center and is affiliated with the St. Marys Care Center (a skilled nursing facility).

The hospital’s wide array of services and patient care has earned the facility other awards, as well, according to administrators. “St. Marys is the only health care organization in the nation to achieve recognition as a Magnet hospital and receive the Malcolm Baldrige National Quality Award,” says St. Marys Magnet Project Director/Communicator and CNS Chris Baker, RN, PhD, CEN, CS.

Patient care model

* The nursing organization of St. Marys has a 10-year history of successful development and deployment of evidence-based practices and clinical-decision support tools called “Care Pathways.” These care pathways are interdisciplinary, span the continuum of care, and explicitly engage the patient and family as partners in care.

Recruitment and retention strategies

* Development and maintenance of a professional practice environment is a key recruitment and retention strategy. St. Marys has never used agency or travel staff and has never mandated overtime.

* The vacancy rate has never exceeded 3%; the turnover rate is 9%.

* In a recent satisfaction survey, St. Marys nurses rated their satisfaction across multiple domains 20% higher than the survey’s national norm.

Innovative services/processes

* In 1991, the nursing organization developed and implemented a professional practice model based on accountability. The underlying principle of this model is that success depends in part on committed and empowered professional nurses who are prepared to practice in a rapidly changing care delivery environment. The professional practice model encourages partnership between staff and management, enhances and builds upon the professionalism of the entire hospital, and contributes in a measurable way to the satisfaction of the nurses who practice at St. Marys.

Image of nursing

* Nurses practicing at the bedside make decisions about clinical nursing practice, clinicians manage the practice, and managers facilitate the system of care.

* The relationship of nurses in clinical, managerial, and administrative roles is collaborative, based on mutual respect, accountability, and partnership.

* Nurses in clinical roles design, implement, and evaluate all aspects of nursing practice and participate in strategic planning at all levels of the hospital and nursing organization.

* Clinical nurses are accountable for managing the core business of the hospital by managing patient care delivery outcomes, as well as clinical quality improvement and educational initiatives.

Community involvement

* St. Marys, in conjunction with several faith-based communities, developed the “Partners in Congregational Nursing” program, which seeks to promote holistic and preventive health services, facilitate access to appropriate health resources, and affirm the healing mission of the faith-based community. Program services include individual and group education; home, hospital, and nursing home visits; support groups; and health maintenance clinic sponsorship. In 2003, the program ministered to eight faith-based communities and logged more than 7,000 client encounters.

University Medical Center

Tucson, Ariz.

University Medical Center (UMC), adjacent to the University of Arizona, is a private, nonprofit hospital at the Arizona Health Sciences Center (AHSC). AHSC includes the colleges of medicine, nursing, pharmacy, public health, the School of Health-Related Professions, and the University Physicians medical group. UMC offers advanced treatment procedures and medical technology on an inpatient and outpatient basis in more than 70 specialty areas. Magnet designation has impacted the facility’s recruitment numbers.

“I receive numerous calls every week from nurses who are specifically looking for the opportunity to work in a Magnet facility,” says Jayne Matte-Wilson, RN, BSN, manager, Nurse Recruitment, “They recognize the excellence and want to be part of that environment.”

Marty Enriquez, RN, MS, vice president for Patient Care Services, says the impact has gone beyond the nursing department. “Although the Magnet designation is for nursing excellence, it has a ‘halo effect’ on the entire organization. Employees want to work for a premier hospital, and Magnet recognition helps attract not only excellent nurses, but other excellent health care workers as well.”

Patient care models

* UMC practices an all-RN model, with patient care technicians providing assistance, directly supervised by an RN. With the facility’s 1:4 nurse-to-patient ratio, the nurses have the time to practice their professional role.

Recruitment and retention strategies

* Recruiters find that the facility’s 1:4 nurse-to-patient ratio is an excellent recruitment tool that also impacts retention.

* UMC’s recruitment bonus program pays nurses for brining in successful RN applicants.

* A program with the University of Arizona College of Nursing offers a nursing externship program during the summer months. A University of Arizona faculty member, who interacts with the students daily and provides weekly seminars, coordinates it.

* With the BSN Residency Program for newly graduated BSN-prepared nurses, a BSN-prepared preceptor facilitates nurses’ year-long transition to professional practice.

* This year the University of Arizona began an accelerated RN program in which those with bachelor’s degrees in other fields can attain a BSN in 14 months.

* The students who are using UMC for clinical placements have agreed to work for the facility for a period of 2 years post graduation.

* In cooperation with the local community college, UMC offers a mentoring program in which selected students receive a mentor from the UMC nursing staff. Students also receive stipends for living expenses, enabling them to stay in school and complete their RN program. These students agree to work at UMC for 2 years post graduation.

Innovative services/processes

* UMC implemented a healing environment concept in several patient care units, including fish tanks in the oncology unit, the surgical waiting room, and the pediatric playroom; and artwork on intensive care units’ ceilings.

* UMC implemented a 1:4 nurse-to-patient ratio in April 2000 on the general and adult units, and in June of 2003 in the pediatric units. It’s the only hospital in Arizona with this staffing pattern.

* At the Nursing Education Institute, national RN experts provide didactic workshops in a variety of specialty areas. In addition, the RN expert makes nursing rounds on the patient care units to discuss nursing care, and review protocols and nursing standards. These nursing experts are published, perform research, and are well-known in their fields. The conferences are free to UMC nurses.

Image of nursing

* Physicians respect the professionalism of the nurses caring for patients.

* Patients who return for subsequent visits to the hospital ask for “their” nurse.

* When the media outlets want to run a health-related story, nursing input from UMC is sought.

Community involvement

* UMC nurses actively participate in health fairs throughout the year in Tucson.

Reference

1. American Nurses Credentialing Center: “The Benefits of Becoming a Magnet Designated Facility.” Available online at http://www.nursingworld.org/ancc/magnet/benes.html.

About the author

Nicole T. Taylor is associate editor, Nursing Management.

Copyright Springhouse Corporation Apr 2004

Provided by ProQuest Information and Learning Company. All rights Reserved