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Becoming a magnet hospital: the role of the perianesthesia nurse
ORIGINAL ARTICLES
Becoming a Magnet Hospital: The Role of the Perianesthesia Nurse Stephanie Kassulke, RN, ADN, CPAN
In today’s health care environment, nurses often feel that the care they are giving is below the level of quality that they would like to see. The Magnet Recognition Award is a nonbiased, positive acknowledgment of quality care and excellent patient outcomes. Nursing needs that third-party seal of approval. The purpose of this article is to educate the reader, to explore what becoming a Magnet hospital means to nursing, and to also encourage perianesthesia nurses to expand their involvement in such house-wide projects. © 2004 by American Society of PeriAnesthesia Nurses.
PERIANESTHESIA NURSES often live in their own world, feeling that the issues or concerns of other units are not their concern and that the rules are different because they work in a specialty. Perianesthesia nurses, however, are usually independent thinkers, have good decisionmaking abilities, and have strong leadership qualities. These are characteristics that are invaluable to a Magnet workgroup. The purpose of this article is to educate the reader about the process and meaning of the Magnet Recognition Process and to also encourage perianesthesia nurses to expand their involvement in such house-wide projects.
ing practice that resulted in excellent patient outcomes.1
History of the Magnet Recognition Award
The Magnet Recognition Program was built on the results of that 1982 survey. The baseline for the development of the Magnet program was the Standards for Organized Nursing Services and Responsibilities of Nurse Administrators Across all Settings.1,2 The American Nurses Association’s (ANA) Board of Directors approved the Magnet Recognition Program in 1990. The program is administered by the American Nurses Credentialing Center (ANCC) and has evolved over the years from recognizing nursing practice excellence in acute care settings to including long-term facilities and an international award.2
In 1982, the American Academy of Nursing Task Force on Nursing Practice conducted a survey to identify the variables in a nursing environment that attracted and retained quality nurses, whose care subsequently resulted in positive patient outcomes. Examples of the variables that were identified included nursing autonomy, personal and job satisfaction, and nurs-
Stephanie Kassulke is a staff nurse at Aurora Sinai Medical Center, Milwaukee, WI. Address correspondence to Stephanie Kassulke, RN, ADN, CPAN, Aurora Sinai Medical Center, 945 North 12th Street, Milwaukee, WI 53233; e-mail address: [email protected]. © 2004 by American Society of PeriAnesthesia Nurses. 1089-9472/04/1902-0004$30.00/0 doi:10.1016/j.jopan.2004.01.002
Journal of PeriAnesthesia Nursing, Vol 19, No 2 (April), 2004: pp 71-77
71
STEPHANIE KASSULKE
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Table 1. Benefits of Obtaining Magnet Recognition2-5 Important recognition of nurse’s worth Improves patient quality outcomes Benefits nursing retention and recruitment Heightened consumer awareness Attracts high-quality physicians and specialists Validates a “Magnet Nursing Culture”
The first Magnet Recognition Award was presented in 1994 to the University of Washington Medical Center, Seattle, Washington. The first Magnet Recognition Award to a health care system was presented in January, 2001, to Aurora Health Care-Metro Region, Milwaukee, Wisconsin. Pernnine Acute Services NHS Trust: Pochdale Infirmary and Birsch Hall Hospital, Lancashire, England, achieved the first international award in March 2002. As of June 2003, 74 organizations had successfully obtained the Magnet Recognition Award.2
Benefits of Magnet Recognition Many clinical staff nurses will ask, “Why are we doing this?” The rationale is that the Magnet Recognition Award is the Good Housekeeping Seal of Approval for nursing practice. This stamp of approval gives the nursing division of a hospital national recognition for the quality of care that they deliver and the resulting excellent patient outcomes. The community is becoming more educated concerning their health care issues via the Internet and partnering with the physician in decision making regarding their health care. The changing health care environment is promoting competition between health care systems in their acquisition of insurance contracts, qualified physicians, and the retention of qualified nurses.3-5 The ANA is educating the community on what the Magnet Recognition Award represents while encouraging the public to seek the health care systems whose nursing division has obtained this coveted award. The Magnet award helps facilities to effectively compete. Other benefits of obtaining Magnet recognition are noted in Table 1.
Applying for Magnet Recognition: System Versus Single Hospital Approach The nursing division decision-making body should determine whether to apply for the Magnet Recognition Award as a single institution or as a system. This decision can be made by the administrative body or by the nursing shared governance structure, depending on the institution’s culture. The culture and heritage of each institution need to be evaluated for their strengths and weaknesses, which will contribute to the application. Further evaluation needs to include whether the institution is rural, urban, or community based. As a system, evidence needs to be based on what is common throughout all hospitals and/or clinics. Care management initiatives, protocols, shared policy and procedures, and standards are used as a basis for evidence documentation. The process remains the same whether the application is as a single institution or system. The difference lies in the need to show evidence for multiple sites versus one. The major concern about applying as a system is that if one site fails in any part of the process, then the whole system fails to achieve Magnet status. The process of collecting evidence, evaluating, and completing the written documentation is the same for a system as it is for a single hospital, only on a grander scale.
The Application Process After the initial commitment by the institution to achieve Magnet Recognition is made, an initial evaluation of the current nursing operations should be completed to determine the institution’s eligibility to apply. Table 2 provides a summary of eligibility criteria. The Magnet Recognition Program Instruction and Application Manual is invaluable in this process.6 This manual can be purchased online at www.ana.org. The next step in the preparation process is to identify a Magnet Project Director (MPD) and
MAGNET RECOGNITION PROGRAM
call for a work group. The selection of the project director should be based on the culture of the institution and the talents of its employees. The ideal candidate should have a talent for organization, be detail-oriented, have experience working on a large project, and preferably, be a clinical staff nurse. The work group will act as a steering committee and should consist of 6 to 8 people. Members should include someone from administration who can address budgetary issues, a clinical nurse specialist, and clinical staff nurses. It is not necessary to have representation from each specialty, but it is important that the members have pride in what they do, have a passion for nursing, believe in quality nursing care, and be able to commit adequate time to the project. This group will become your experts and the authors of your written documentation, which is a very time-consuming process. As such, the members should have a talent for detail, be assertive, and have good communication skills. Perianesthesia nurses exhibit all of these attributes and make wonderful additions to any Magnet workgroup. Perianesthesia nurses are in a unique position because they interact with numerous inpatient and outpatient units on a daily basis, and thus are very familiar with what is happening on the units. This interaction allows the perianesthesia nurse to encourage the various units to come forward with evidence that is needed for the written documentation for the Magnet application. An example of this: Table 2. Magnet Recognition Eligibility Requirements2,4,6 Nursing Service department exists within an existing health care organization One individual serving as the Nurse Administrator with a single governing body Scope and Standards for Nurse Administrators (ANA, 1996) implemented by the health care organization Free of any labor disputes for 5 years prior to application Participation in ANA’s National Database of Nursing Quality Indicators
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a patient is taken back to a Post Partum unit and the perianesthesia nurse hears conversation relating to a new government grant given to Women’s Health Services for parenting classes in the inner city. This provides an opportunity for that nurse to encourage the unit to submit the information to the work group for inclusion in the written documentation as a perfect example of community involvement and teaching. A link to the various inpatient and outpatient areas should also be created. A Magnet Champion from each area is one tactic that works well. This Champion should be an individual in the unit/area who will act as the link between the Magnet Steering Committee and the units/ areas. This individual must be willing to share information, be a resource for the Steering Committee, and be knowledgeable about the unit’s/ area’s activities. Once the project director is selected and the work team formed, the application process is essentially a 4-phase process. Phase I
Phase I is the completion of the application form that indicates your intent to apply. This form is a 1-page document indicating the anticipated date of submission of the written documentation along with a nonrefundable application fee of $2500.00. The institution can take up to 2 years to submit the written documentation once the intent to apply is submitted.2,4,7 Phase II
Phase II is the completion of the appraisal documentation showing evidence of how the nursing organization implements the Scope and Standards of Nurse Administrators and the nursing process.2 Working goals (Table 3) with deadlines should also be developed by the steering committee to keep the group focused on the outcome. The Standards are divided into Core Criteria and Measurement Criteria. Evidence supporting all of the Core Criteria must be in place for the
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Table 3. Steering Committee Goals Become familiar with the Standards Educate the nursing staff about Magnet and why the institution is applying Divide the Standards among the group Gather supporting documentation showing evidence of compliance with each Standard Evaluate the documentation for completeness Write the application document Attach supporting evidence
lence and proceed to the next phase of the process: the Site Visit.7 A gap analysis2 of the nursing structure should also be completed to identify where there might be deficiencies. The Magnet Recognition and Application Manual is invaluable in this process. The gap analysis is completed by the Steering Committee and should include:
● Evidence of growth and development of a professional nursing service
Magnet application to progress to evaluation of the Measurement Criteria. In 2003, the terminology for the Core Criteria changed to “Organizational Overview” to improve understanding by the applicants. The Organizational Overview was compiled into one section that the Chief Nursing Officer addresses concerning the provision of a safe and healthful environment for the patient, family, and nursing staff.2,7 Evidence needs to be gathered and categorized according to each standard and substandard that it is supporting. A tool should be created to elicit that information from the various units/ areas. Each unit/area should have some project to contribute to the documentation. Quality improvement projects, new practices, awards, and/or grants that the units/areas have received are all examples of the type of evidence needed. The submission of these individual unit/area’s projects could be the responsibility of the Magnet Champions. Examples of projects that could be highlighted from the perianesthesia setting include family visitation in the PACU, interdisciplinary quality practice projects concerning physician signing of operative area, and Ambulatory/Surgical Nurse Liaison positions and their roles. Each Measurement Criteria must be addressed and evidence provided documenting compliance. Each criterion is scored according to a Likert (0-5) scale. The scores for each criterion are averaged and multiplied by the assigned weight of each standard. The sum of the scores must be greater than 800 to demonstrate excel-
● Evidence of the Nursing Process ● Evidence of compliance to the Scope and Standards for Nurse Administrators
● Evidence of compliance with regulatory agency requirements ● Evidence of nationally benchmarked nurse-sensitive quality indicators at the unit level. Any institution applying for Magnet Recognition must also address the nurse-sensitive quality indicators found in the National Database for Nursing Quality Indicators (NDNQI).8 Indicators currently included in this list are:
● Skill mix of RNs, LPNs/LVNs, and unlicensed staff
● Total nursing care hours provided per patient stay
● Maintenance of skin integrity (pressure ulcers)
● Patient injury rate (falls). Indicators currently under development include:
● Patient satisfaction with pain manage● ● ● ● ●
ment Patient satisfaction with educational information Patient satisfaction with overall care Patient satisfaction with nursing care Nosocomial infections Nursing staff satisfaction
Demographic information must also be supplied with the written documentation. Examples of the type of information required include
MAGNET RECOGNITION PROGRAM
the number of licensed beds, skill mix, number of certified staff, and degrees held. The documentation and demographic information is completed and sent to the Magnet Program Office along with the appraisal fee, which is based on the number of licensed beds.2,7 The documentation and demographic information, once submitted, is sent to two of the Magnet surveyors for evaluation and scoring. These individuals will also be the surveyors for the site visit. This part of the process can take 4 to 6 months.7 Phase III
While the written documentation is being evaluated, the next phase of the process is preparing for the site visit. Maintaining momentum and excitement during this waiting period is the next challenge for the steering committee to address. An agenda of events intended to increase staff awareness, excitement, and education needs to be planned. Activities can include a “Kick Off” meeting with the Magnet Champions to educate them about what Magnet means, the benefits to achieving this award, and what their role will be during the site visit. The meeting should be fun and informational and include a time for questions to be asked, answers found, and understanding achieved. The emphasis should be a positive fun event meant to counteract the preconceived negative notion of a surveyor’s visit. House-wide activities can include a question of the day highlighting the most common questions that the surveyors ask. A logo contest could also be held, and banners and posters with the logo created for display in key places. Develop a “Traveling Show” complete with food, posters exhibiting all of the projects submitted, pocket pamphlets with information, and a pep talk by a member of the steering committee. Reward your Magnet Champion by presenting them with something with the logo such as a shirt; and because all of the staff are important in this process, a magnet with the
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logo is an economical way of acknowledging their participation and importance in this process. Again, the idea is to make the experience fun and positive. Challenge each unit by asking, “What are you doing to improve patient care?” Each unit should be left with the same message: the preparation for this visit took place over the last 2 to 3 years; the appraisers are knowledgeable of the practice; they want to see if nursing walks the talk; and always remember that nursing deserves this award. This phase can also be used to educate the medical staff and other members of the health care team. Presentations at Medical Executive Committee and Quality councils are methods for reaching the physicians. Physicians’ goals are that their patients receive quality care and attain positive patient outcomes. They understand that partnering with nursing is influential in attaining these goals. This author’s experience was that the Medical Staff supported nursing 100% in their endeavor to obtain Magnet Recognition. Many physicians asked for some way to show their support, so a button was designed by the Steering Committee and distributed just prior to the site visit. It was truly awesome to see physicians wearing their buttons as one walked through the hallways. Physicians were given the preliminary agenda and asked to be available in the units and to feel free to speak to the surveyors. Any member of the health care team could speak with the surveyors during the site visit to share both positive or negative comments. Meetings were set up with other disciplines as well, again to educate and to ask for their support. Acknowledging their importance to the overall care and comfort of the patient goes a long way with eliciting their support. Community comments should also be elicited during this time. The institution must proclaim their intent to obtain Magnet Recognition, providing information for the community to express their thoughts, pro or con, to the Magnet Program Office. Information and/or evidence of
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Table 4. Community Feedback Place written application on display in a public place that is accessible to staff, physicians, patients, and families Notification to staff, physicians, patients, and families inviting comments/feedback about the application; the Magnet Office provides a notification to post Identify 6 resources from your community, affiliations, patients, and/or families that would be willing to inform the appraisers about the institution’s relationship with the community
the activities outlined in Table 4 should also be submitted to the Magnet Program Office.2,7 Phase IV: The Site Visit
The site visit usually lasts 2 days per institution. The surveyors, having already reviewed the written documentation, arrive with a knowledge of the nursing culture that they are evaluating.2,7 Their goal is to see if nursing walks the talk exhibited in the written documentation and to clarify any questions. The surveyors and the institution agree on an agenda prior to the visit. The surveyors’ goal is to visit each unit. A typical survey starts the day with a meeting with the nursing leadership. This could include the CNO, Directors, Clinical Nurse Specialists, and clinical shared governance members.9,10 The meeting can be run as a question and answer session, explaining the institution’s heritage, culture, number of licensed beds, and the working relationship between nursing and other members of the health care team. The remainder of the agenda consists of the visits to the units, outpatient areas, and/or clinics that are under the nursing division umbrella. Someone needs to be assigned to greet the surveyor when they arrive on the floor, with the Magnet Champion being the logical choice. A predetermined area should be prepared for the interview. Physicians and/or other disciplines should also be readily available to talk with the surveyors. The surveyors tend to ask openended questions meant to elicit information from staff concerning quality improvement ac-
tivities, how the staff handles patient complaints, and how nursing interacts with the other disciplines. The surveyors always strive to portray a nonthreatening attitude designed to put the staff at ease. Once the visit is completed, the surveyors return home to compile their data, compare findings, write a report, and submit their recommendation to the Magnet Program Office. The time frame between the site visit and the official notification of Magnet Status Recognition is dependent on when the Magnet Commission meets. This group meets four times a year to review the information and recommendations of the surveyors whose site visits were completed prior to the meeting. The Commission on Magnet’s decision is the final phase in the process. The Commission on Magnet votes on whether an institution will receive Magnet Status. The Commission then sets up a predetermined time to call, notifying the institution of the final decision.2,7 It is truly exciting to hear that all of the hard work paid off and that your institution has been awarded a Magnet status.
Conclusion Often perianesthesia nurses live in their own world, feeling that the issues or concerns of other units are not their concern, and that the rules are different because they work in a specialty. Perianesthesia nurses, however, are usually independent thinkers and have good decision-making abilities and strong leadership qualities. These are characteristics that are invaluable to a Magnet work group. The perianesthesia nurse has the ability to view issues globally, without feeling ownership. They are also unique in that they have contact with most of the areas in the institution, thereby having the ability to reach out and create linkages with the various areas, absorbing a wealth of knowledge. The perianesthesia setting also lends itself to having time to donate to projects. Perianesthesia nurses need to challenge themselves by becoming involved in a hospital or regionwide project. It is an exhilarating experience.
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References 1. Lewis C, Matthews J: Magnet program designates exceptional nursing services. Available at: www.nursingworld.org/ajn/1998/dec/ qual/28.d.htm. Accessed June 2003 2. American Nurses Credentialing Center: Magnet. Available at: www.ana.org. Accessed June 2003 3. UC Davis Medical Center: News from UC Davis Medical Center. Available at: www.ucdmc.ucdavis.edu/magnet/. Accessed June 2003 4. Mayo Clinic: Department of Nursing. Available at: www. mayoclinic.org/nursing-rst/magnet.html. Accessed June 2003 5. Hackensack University Medical Center: Magnet Nursing. Available at: www.humed.com/nursinghwnat.html. Accessed June 2003 6. American Nurses Credentialing Center: Magnet information kit, application process. Available at: www.ana.org. Accessed June 2003
7. ANA, American Nurses Credentialing Center: Magnet, most frequently asked questions. Available at: www.ana.org. Accessed June 2003 8. Midwest Research Institute: National database of Nursing Quality Indicators. Available at: www2.mriresearch.org/ researchservices/healthsciences/ndnqi/ndnqi.asp. Accessed June 2003 9. George V: Developing staff nurse leadership behaviors and professional nursing practice autonomy [abstract]. Proceedings for the Fifth Annual International Conference on Advances in Management, 1998 10. George V: The role of the chief nurse executive in fostering excellence in the professional environment, in HaagHeitman B (ed): Clinical Practice Development Using Novice to Expert Theory. Gaithersburg, MD, Aspen Publishers, Inc., 1999, pp 229-239
Becoming a Magnet Hospital: The Role of the Perianesthesia Nurse Stephanie Kassulke, RN, ADN, CPAN
In today’s health care environment, nurses often feel that the care they are giving is below the level of quality that they would like to see. The Magnet Recognition Award is a nonbiased, positive acknowledgment of quality care and excellent patient outcomes. Nursing needs that third-party seal of approval. The purpose of this article is to educate the reader, to explore what becoming a Magnet hospital means to nursing, and to also encourage perianesthesia nurses to expand their involvement in such house-wide projects. © 2004 by American Society of PeriAnesthesia Nurses.
PERIANESTHESIA NURSES often live in their own world, feeling that the issues or concerns of other units are not their concern and that the rules are different because they work in a specialty. Perianesthesia nurses, however, are usually independent thinkers, have good decisionmaking abilities, and have strong leadership qualities. These are characteristics that are invaluable to a Magnet workgroup. The purpose of this article is to educate the reader about the process and meaning of the Magnet Recognition Process and to also encourage perianesthesia nurses to expand their involvement in such house-wide projects.
ing practice that resulted in excellent patient outcomes.1
History of the Magnet Recognition Award
The Magnet Recognition Program was built on the results of that 1982 survey. The baseline for the development of the Magnet program was the Standards for Organized Nursing Services and Responsibilities of Nurse Administrators Across all Settings.1,2 The American Nurses Association’s (ANA) Board of Directors approved the Magnet Recognition Program in 1990. The program is administered by the American Nurses Credentialing Center (ANCC) and has evolved over the years from recognizing nursing practice excellence in acute care settings to including long-term facilities and an international award.2
In 1982, the American Academy of Nursing Task Force on Nursing Practice conducted a survey to identify the variables in a nursing environment that attracted and retained quality nurses, whose care subsequently resulted in positive patient outcomes. Examples of the variables that were identified included nursing autonomy, personal and job satisfaction, and nurs-
Stephanie Kassulke is a staff nurse at Aurora Sinai Medical Center, Milwaukee, WI. Address correspondence to Stephanie Kassulke, RN, ADN, CPAN, Aurora Sinai Medical Center, 945 North 12th Street, Milwaukee, WI 53233; e-mail address: [email protected]. © 2004 by American Society of PeriAnesthesia Nurses. 1089-9472/04/1902-0004$30.00/0 doi:10.1016/j.jopan.2004.01.002
Journal of PeriAnesthesia Nursing, Vol 19, No 2 (April), 2004: pp 71-77
71
STEPHANIE KASSULKE
72
Table 1. Benefits of Obtaining Magnet Recognition2-5 Important recognition of nurse’s worth Improves patient quality outcomes Benefits nursing retention and recruitment Heightened consumer awareness Attracts high-quality physicians and specialists Validates a “Magnet Nursing Culture”
The first Magnet Recognition Award was presented in 1994 to the University of Washington Medical Center, Seattle, Washington. The first Magnet Recognition Award to a health care system was presented in January, 2001, to Aurora Health Care-Metro Region, Milwaukee, Wisconsin. Pernnine Acute Services NHS Trust: Pochdale Infirmary and Birsch Hall Hospital, Lancashire, England, achieved the first international award in March 2002. As of June 2003, 74 organizations had successfully obtained the Magnet Recognition Award.2
Benefits of Magnet Recognition Many clinical staff nurses will ask, “Why are we doing this?” The rationale is that the Magnet Recognition Award is the Good Housekeeping Seal of Approval for nursing practice. This stamp of approval gives the nursing division of a hospital national recognition for the quality of care that they deliver and the resulting excellent patient outcomes. The community is becoming more educated concerning their health care issues via the Internet and partnering with the physician in decision making regarding their health care. The changing health care environment is promoting competition between health care systems in their acquisition of insurance contracts, qualified physicians, and the retention of qualified nurses.3-5 The ANA is educating the community on what the Magnet Recognition Award represents while encouraging the public to seek the health care systems whose nursing division has obtained this coveted award. The Magnet award helps facilities to effectively compete. Other benefits of obtaining Magnet recognition are noted in Table 1.
Applying for Magnet Recognition: System Versus Single Hospital Approach The nursing division decision-making body should determine whether to apply for the Magnet Recognition Award as a single institution or as a system. This decision can be made by the administrative body or by the nursing shared governance structure, depending on the institution’s culture. The culture and heritage of each institution need to be evaluated for their strengths and weaknesses, which will contribute to the application. Further evaluation needs to include whether the institution is rural, urban, or community based. As a system, evidence needs to be based on what is common throughout all hospitals and/or clinics. Care management initiatives, protocols, shared policy and procedures, and standards are used as a basis for evidence documentation. The process remains the same whether the application is as a single institution or system. The difference lies in the need to show evidence for multiple sites versus one. The major concern about applying as a system is that if one site fails in any part of the process, then the whole system fails to achieve Magnet status. The process of collecting evidence, evaluating, and completing the written documentation is the same for a system as it is for a single hospital, only on a grander scale.
The Application Process After the initial commitment by the institution to achieve Magnet Recognition is made, an initial evaluation of the current nursing operations should be completed to determine the institution’s eligibility to apply. Table 2 provides a summary of eligibility criteria. The Magnet Recognition Program Instruction and Application Manual is invaluable in this process.6 This manual can be purchased online at www.ana.org. The next step in the preparation process is to identify a Magnet Project Director (MPD) and
MAGNET RECOGNITION PROGRAM
call for a work group. The selection of the project director should be based on the culture of the institution and the talents of its employees. The ideal candidate should have a talent for organization, be detail-oriented, have experience working on a large project, and preferably, be a clinical staff nurse. The work group will act as a steering committee and should consist of 6 to 8 people. Members should include someone from administration who can address budgetary issues, a clinical nurse specialist, and clinical staff nurses. It is not necessary to have representation from each specialty, but it is important that the members have pride in what they do, have a passion for nursing, believe in quality nursing care, and be able to commit adequate time to the project. This group will become your experts and the authors of your written documentation, which is a very time-consuming process. As such, the members should have a talent for detail, be assertive, and have good communication skills. Perianesthesia nurses exhibit all of these attributes and make wonderful additions to any Magnet workgroup. Perianesthesia nurses are in a unique position because they interact with numerous inpatient and outpatient units on a daily basis, and thus are very familiar with what is happening on the units. This interaction allows the perianesthesia nurse to encourage the various units to come forward with evidence that is needed for the written documentation for the Magnet application. An example of this: Table 2. Magnet Recognition Eligibility Requirements2,4,6 Nursing Service department exists within an existing health care organization One individual serving as the Nurse Administrator with a single governing body Scope and Standards for Nurse Administrators (ANA, 1996) implemented by the health care organization Free of any labor disputes for 5 years prior to application Participation in ANA’s National Database of Nursing Quality Indicators
73
a patient is taken back to a Post Partum unit and the perianesthesia nurse hears conversation relating to a new government grant given to Women’s Health Services for parenting classes in the inner city. This provides an opportunity for that nurse to encourage the unit to submit the information to the work group for inclusion in the written documentation as a perfect example of community involvement and teaching. A link to the various inpatient and outpatient areas should also be created. A Magnet Champion from each area is one tactic that works well. This Champion should be an individual in the unit/area who will act as the link between the Magnet Steering Committee and the units/ areas. This individual must be willing to share information, be a resource for the Steering Committee, and be knowledgeable about the unit’s/ area’s activities. Once the project director is selected and the work team formed, the application process is essentially a 4-phase process. Phase I
Phase I is the completion of the application form that indicates your intent to apply. This form is a 1-page document indicating the anticipated date of submission of the written documentation along with a nonrefundable application fee of $2500.00. The institution can take up to 2 years to submit the written documentation once the intent to apply is submitted.2,4,7 Phase II
Phase II is the completion of the appraisal documentation showing evidence of how the nursing organization implements the Scope and Standards of Nurse Administrators and the nursing process.2 Working goals (Table 3) with deadlines should also be developed by the steering committee to keep the group focused on the outcome. The Standards are divided into Core Criteria and Measurement Criteria. Evidence supporting all of the Core Criteria must be in place for the
STEPHANIE KASSULKE
74
Table 3. Steering Committee Goals Become familiar with the Standards Educate the nursing staff about Magnet and why the institution is applying Divide the Standards among the group Gather supporting documentation showing evidence of compliance with each Standard Evaluate the documentation for completeness Write the application document Attach supporting evidence
lence and proceed to the next phase of the process: the Site Visit.7 A gap analysis2 of the nursing structure should also be completed to identify where there might be deficiencies. The Magnet Recognition and Application Manual is invaluable in this process. The gap analysis is completed by the Steering Committee and should include:
● Evidence of growth and development of a professional nursing service
Magnet application to progress to evaluation of the Measurement Criteria. In 2003, the terminology for the Core Criteria changed to “Organizational Overview” to improve understanding by the applicants. The Organizational Overview was compiled into one section that the Chief Nursing Officer addresses concerning the provision of a safe and healthful environment for the patient, family, and nursing staff.2,7 Evidence needs to be gathered and categorized according to each standard and substandard that it is supporting. A tool should be created to elicit that information from the various units/ areas. Each unit/area should have some project to contribute to the documentation. Quality improvement projects, new practices, awards, and/or grants that the units/areas have received are all examples of the type of evidence needed. The submission of these individual unit/area’s projects could be the responsibility of the Magnet Champions. Examples of projects that could be highlighted from the perianesthesia setting include family visitation in the PACU, interdisciplinary quality practice projects concerning physician signing of operative area, and Ambulatory/Surgical Nurse Liaison positions and their roles. Each Measurement Criteria must be addressed and evidence provided documenting compliance. Each criterion is scored according to a Likert (0-5) scale. The scores for each criterion are averaged and multiplied by the assigned weight of each standard. The sum of the scores must be greater than 800 to demonstrate excel-
● Evidence of the Nursing Process ● Evidence of compliance to the Scope and Standards for Nurse Administrators
● Evidence of compliance with regulatory agency requirements ● Evidence of nationally benchmarked nurse-sensitive quality indicators at the unit level. Any institution applying for Magnet Recognition must also address the nurse-sensitive quality indicators found in the National Database for Nursing Quality Indicators (NDNQI).8 Indicators currently included in this list are:
● Skill mix of RNs, LPNs/LVNs, and unlicensed staff
● Total nursing care hours provided per patient stay
● Maintenance of skin integrity (pressure ulcers)
● Patient injury rate (falls). Indicators currently under development include:
● Patient satisfaction with pain manage● ● ● ● ●
ment Patient satisfaction with educational information Patient satisfaction with overall care Patient satisfaction with nursing care Nosocomial infections Nursing staff satisfaction
Demographic information must also be supplied with the written documentation. Examples of the type of information required include
MAGNET RECOGNITION PROGRAM
the number of licensed beds, skill mix, number of certified staff, and degrees held. The documentation and demographic information is completed and sent to the Magnet Program Office along with the appraisal fee, which is based on the number of licensed beds.2,7 The documentation and demographic information, once submitted, is sent to two of the Magnet surveyors for evaluation and scoring. These individuals will also be the surveyors for the site visit. This part of the process can take 4 to 6 months.7 Phase III
While the written documentation is being evaluated, the next phase of the process is preparing for the site visit. Maintaining momentum and excitement during this waiting period is the next challenge for the steering committee to address. An agenda of events intended to increase staff awareness, excitement, and education needs to be planned. Activities can include a “Kick Off” meeting with the Magnet Champions to educate them about what Magnet means, the benefits to achieving this award, and what their role will be during the site visit. The meeting should be fun and informational and include a time for questions to be asked, answers found, and understanding achieved. The emphasis should be a positive fun event meant to counteract the preconceived negative notion of a surveyor’s visit. House-wide activities can include a question of the day highlighting the most common questions that the surveyors ask. A logo contest could also be held, and banners and posters with the logo created for display in key places. Develop a “Traveling Show” complete with food, posters exhibiting all of the projects submitted, pocket pamphlets with information, and a pep talk by a member of the steering committee. Reward your Magnet Champion by presenting them with something with the logo such as a shirt; and because all of the staff are important in this process, a magnet with the
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logo is an economical way of acknowledging their participation and importance in this process. Again, the idea is to make the experience fun and positive. Challenge each unit by asking, “What are you doing to improve patient care?” Each unit should be left with the same message: the preparation for this visit took place over the last 2 to 3 years; the appraisers are knowledgeable of the practice; they want to see if nursing walks the talk; and always remember that nursing deserves this award. This phase can also be used to educate the medical staff and other members of the health care team. Presentations at Medical Executive Committee and Quality councils are methods for reaching the physicians. Physicians’ goals are that their patients receive quality care and attain positive patient outcomes. They understand that partnering with nursing is influential in attaining these goals. This author’s experience was that the Medical Staff supported nursing 100% in their endeavor to obtain Magnet Recognition. Many physicians asked for some way to show their support, so a button was designed by the Steering Committee and distributed just prior to the site visit. It was truly awesome to see physicians wearing their buttons as one walked through the hallways. Physicians were given the preliminary agenda and asked to be available in the units and to feel free to speak to the surveyors. Any member of the health care team could speak with the surveyors during the site visit to share both positive or negative comments. Meetings were set up with other disciplines as well, again to educate and to ask for their support. Acknowledging their importance to the overall care and comfort of the patient goes a long way with eliciting their support. Community comments should also be elicited during this time. The institution must proclaim their intent to obtain Magnet Recognition, providing information for the community to express their thoughts, pro or con, to the Magnet Program Office. Information and/or evidence of
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Table 4. Community Feedback Place written application on display in a public place that is accessible to staff, physicians, patients, and families Notification to staff, physicians, patients, and families inviting comments/feedback about the application; the Magnet Office provides a notification to post Identify 6 resources from your community, affiliations, patients, and/or families that would be willing to inform the appraisers about the institution’s relationship with the community
the activities outlined in Table 4 should also be submitted to the Magnet Program Office.2,7 Phase IV: The Site Visit
The site visit usually lasts 2 days per institution. The surveyors, having already reviewed the written documentation, arrive with a knowledge of the nursing culture that they are evaluating.2,7 Their goal is to see if nursing walks the talk exhibited in the written documentation and to clarify any questions. The surveyors and the institution agree on an agenda prior to the visit. The surveyors’ goal is to visit each unit. A typical survey starts the day with a meeting with the nursing leadership. This could include the CNO, Directors, Clinical Nurse Specialists, and clinical shared governance members.9,10 The meeting can be run as a question and answer session, explaining the institution’s heritage, culture, number of licensed beds, and the working relationship between nursing and other members of the health care team. The remainder of the agenda consists of the visits to the units, outpatient areas, and/or clinics that are under the nursing division umbrella. Someone needs to be assigned to greet the surveyor when they arrive on the floor, with the Magnet Champion being the logical choice. A predetermined area should be prepared for the interview. Physicians and/or other disciplines should also be readily available to talk with the surveyors. The surveyors tend to ask openended questions meant to elicit information from staff concerning quality improvement ac-
tivities, how the staff handles patient complaints, and how nursing interacts with the other disciplines. The surveyors always strive to portray a nonthreatening attitude designed to put the staff at ease. Once the visit is completed, the surveyors return home to compile their data, compare findings, write a report, and submit their recommendation to the Magnet Program Office. The time frame between the site visit and the official notification of Magnet Status Recognition is dependent on when the Magnet Commission meets. This group meets four times a year to review the information and recommendations of the surveyors whose site visits were completed prior to the meeting. The Commission on Magnet’s decision is the final phase in the process. The Commission on Magnet votes on whether an institution will receive Magnet Status. The Commission then sets up a predetermined time to call, notifying the institution of the final decision.2,7 It is truly exciting to hear that all of the hard work paid off and that your institution has been awarded a Magnet status.
Conclusion Often perianesthesia nurses live in their own world, feeling that the issues or concerns of other units are not their concern, and that the rules are different because they work in a specialty. Perianesthesia nurses, however, are usually independent thinkers and have good decision-making abilities and strong leadership qualities. These are characteristics that are invaluable to a Magnet work group. The perianesthesia nurse has the ability to view issues globally, without feeling ownership. They are also unique in that they have contact with most of the areas in the institution, thereby having the ability to reach out and create linkages with the various areas, absorbing a wealth of knowledge. The perianesthesia setting also lends itself to having time to donate to projects. Perianesthesia nurses need to challenge themselves by becoming involved in a hospital or regionwide project. It is an exhilarating experience.
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References 1. Lewis C, Matthews J: Magnet program designates exceptional nursing services. Available at: www.nursingworld.org/ajn/1998/dec/ qual/28.d.htm. Accessed June 2003 2. American Nurses Credentialing Center: Magnet. Available at: www.ana.org. Accessed June 2003 3. UC Davis Medical Center: News from UC Davis Medical Center. Available at: www.ucdmc.ucdavis.edu/magnet/. Accessed June 2003 4. Mayo Clinic: Department of Nursing. Available at: www. mayoclinic.org/nursing-rst/magnet.html. Accessed June 2003 5. Hackensack University Medical Center: Magnet Nursing. Available at: www.humed.com/nursinghwnat.html. Accessed June 2003 6. American Nurses Credentialing Center: Magnet information kit, application process. Available at: www.ana.org. Accessed June 2003
7. ANA, American Nurses Credentialing Center: Magnet, most frequently asked questions. Available at: www.ana.org. Accessed June 2003 8. Midwest Research Institute: National database of Nursing Quality Indicators. Available at: www2.mriresearch.org/ researchservices/healthsciences/ndnqi/ndnqi.asp. Accessed June 2003 9. George V: Developing staff nurse leadership behaviors and professional nursing practice autonomy [abstract]. Proceedings for the Fifth Annual International Conference on Advances in Management, 1998 10. George V: The role of the chief nurse executive in fostering excellence in the professional environment, in HaagHeitman B (ed): Clinical Practice Development Using Novice to Expert Theory. Gaithersburg, MD, Aspen Publishers, Inc., 1999, pp 229-239