Gen Guanci, MEd, RN-BC, CCRN
Creative Health Care Management
The beauty of using the pursuit of Magnet® designation as the framework for your cultural transformation is that it sets out clear parameters for all aspects of the transformation. The very pursuit of Magnet® designation will almost certainly bring your organization a myriad of improvements in nursing excellence, nurse satisfaction, and nurse retention.
Genesis of the Magnet Recognition Program®
Despite a serious nursing shortage in the 1980s, it came to light that several hospitals throughout the United States were still attracting and retaining nurses. With sponsorship from the American Nurses Association, a team of nurse researchers set out to determine what was occurring at those organizations that made each of them a “magnet” for nurses. Their findings pointed to excellence in administration and professional practice, as well as a consistent and visible commitment to professional development (McClure & Hinshaw, 2002).
Several years later, Marlene Kramer and her colleagues identified more of the conditions that were present in organizations that were successful in attracting and retaining nurses. This is a compiled a list of the “essentials of Magnetism”:
- Working with nurses who are clinically competent
- Good RN/MD relationships (collaborative/collegial)
- Nurse autonomy and accountability
- Control of nursing practice and the practice environment
- Supportive nurse manager/supervisor
- Support for education
- Adequate nurse staffing
- Emphasis on concern for patient (Kramer, 2003)
In short order, a few other commonalities were discovered. Hospitals that were able to attract and retain nurses showed the following outcomes:
- Lower morbidity and mortality rates
- Higher patient and nurse satisfaction
- Less nurse burnout
- Higher levels of professional nursing practice
Nurse leaders and researchers were closer than ever to defining what must be present in an organization in order for nurses to thrive.
In 1993, the American Nurses Credentialing Center (ANCC) established the Magnet Nursing Services Recognition Program for Excellence in Nursing to formally recognize organizations that demonstrated excellence in nursing practice. Since that time, more than 401 hospitals in the United States and abroad have gone on to receive or maintain Magnet® status. This number, however, continues to comprise less than 7 percent of the hospitals in the United States.
In 2002, the ANCC, “realizing it requires an initiative on the part of the whole organization and a change in its culture, chose another name—the Magnet Recognition Program®. This change confirmed what nurses already knew and valued… it takes the whole healthcare team to ensure good patient outcomes” (Guanci, 2005). Further program revisions were made in 2005 so that the designation review process focused on the 14 Forces of Magnetism. Then in 2008, ANCC unveiled the New Magnet Model, which consists of five components:
- Transformational Leadership
- Structural Empowerment
- Exemplary Professional Practice
- New Knowledge/Innovations and Improvements
- Empirical Outcomes
August 2013 saw the release of the 2014 Magnet Application Manual, which now offers specific instructions of the examples to submit, as well as an increased emphasis on concrete evidence. Fifty percent of the document submission must address the sustainable outcomes organizations have achieved.
What those who have designed the Magnet® designation program have given us is a set of tangible outcomes to which we can aspire. Taken together, the Magnet® components and their associated requirements help us to understand our destination, but they do far less to help us understand the route we need to take to get there. For this, an experienced guide is necessary. More than 30 percent of organizations fail on their first attempt at Magnet® designation. While it is quite likely that their organizations have benefited in some intangible ways from the process itself, pursuing Magnet® is costly, and failing to achieve designation means the measurable ROI on that investment is nonexistent.
There’s no doubt about it: the pursuit of Magnet® designation has a lot more in common with a marathon than it does with a sprint. Here are a few absolutely essential things to do before embarking on your Magnet® journey:
1: Conduct a Readiness Assessment
Some people refer to this as a gap assessment. Regardless of what you call it, it’s vital that you fully understand the point from where you’re starting, where you need to go and where your current challenges are. The wise organization has this assessment completed by an external, non-biased individual. If you do this, be sure the individual has many years of experience in a wide variety of organizations that have been successful in attaining Magnet® designation. When looking for an external consultant, your first question should be, “What’s your track record for helping organizations attain Magnet®?
2: Create your Budget
Your overall Magnet® journey budget will have elements that are dependent upon your readiness results. In addition, it will be a multi-year budget. Items you want to be sure to include are as follows:
- Initial education costs
- Application fees, including general application, as well as appraiser fees associated with document review and site visit
- External consultant journey support fees
- Human resources costs, such as those for a program manager and administrative assistant
- Monies needed to support the structures and processes needed for a successful Magnet® journey, such as councils, professional advancement program, and nursing research
Other budget considerations include printing or electronic document set-up costs, marketing costs (both before and after designation), celebration costs when you receive your designation, and costs to sustain your designation. If you don’t know these numbers, check with an experienced Magnet® consultant. It’s essential that your numbers are realistic.
3: Educate Yourself
When it comes to participating in a Magnet® journey, there is no such thing as too much education. I have seen four program revisions in the 15+ years I have been involved in Magnet®. This requires that I constantly refresh my knowledge. Education is available in a variety of methodologies. You can attend workshops and webinars, read the wide variety of articles available, or even join a learning community.
4: Educate Others
It’s obvious to most people that an organization embarking on a Magnet® journey must educate its nurses; however, your educational initiatives should go well beyond this group. Be sure to include all of the organization’s stakeholders, since the designation is for the entire organization. The best course of action is for the Magnet® program lead to see that all departments, leaders, executives, medical staff, and even the board of directors/trustees get educated about what it takes to achieve Magnet®. The wise program manager tailors the message to the audience and includes the “what’s in it for me” message.
Visiting other Magnet® organizations and networking with people who have been directly involved in a successful Magnet® journey are two extremely helpful things to do. If your organization is a community hospital, your biggest benefit would come from speaking to those from a similar community hospital as opposed to a large academic medical center. When you do your visit, whether in person or virtually, be sure to set up an opportunity for staff from your organization to speak to peers at the networking organizations. When staff members hear the Magnet® journey stories from peers, it really helps to unify the team around a common goal.
6: Create a Project Plan
Time flies while on the Magnet® journey. Deadlines that might seem a long way off have a way of rapidly sneaking up on you. The creation of a project plan or specific timeline is crucial. Be sure to include the following major milestones or journey phases:
- Getting ready/pre-submission phase
- Document creation and submission phase
- Document determination phase
- Site visit phase
- Status determination phase
Each of these phases has several components to them, so be very specific. The more detail you have, the higher the likelihood will be that you will not overlook something essential to your success.
7: Involve the Clinical/Direct Care Nurses
Successful Magnet® organizations involve staff at every opportunity. At site visit, staff will need to be able to speak to how they were involved in items, such as the development of the professional practice model, and how they are involved in decision-making. Whenever possible, always ask yourself, “Which clinical nurse should be involved in this?”
Lessons Learned through LOTS of Magnet® Journeys
I have learned several lessons from my work with both national and international Magnet®-aspiring and Magnet®-designated organizations. Here are my top 10 lessons learned:
Lesson 1: Critically analyze your data, as this will help you determine your best journey timeline.
Lesson 2: It is never too early to involve the clinical nurses.
Lesson 3: Spend time before application to ensure that strong structures and processes have become part of your organizational culture and will support your journey.
Lesson 4: Offer shared governance support for leaders, as well as clinical nurses.
Lesson 5: Do not wait until site visit time to engage the entire organization.
Lesson 6: Gather pre-data before you implement ANY new change, process, structure, etc., so you will be able to meet ANCC’s requirement to quantify your improvements and show your empirical outcomes.
Lesson 7: Engage with an expert; someone who can guide and coach you to maximize your success.
Lesson 8: When developing your document, pick your BEST example to showcase your organization and be sure to showcase all settings where nurses work.
Lesson 9: Do not hesitate to pause on the journey if indeed you know you are not meeting the requirements.
Lesson 10: Celebrate all your journey milestones including application submission, document submission and site visits—not just designation notification.
You may be asking yourself, at this point, “What is the best time to invite in a consultant partner for our Magnet® journey?” The fact is that it’s never too late or too soon to invite a consultant into the process. No matter where you are in the process, it is possible to maximize your potential for success, but I can tell you from experience that it’s a much easier road if you engage an expert guide and coach early on. The time you save in rework alone will pay for this support several times over.
More than half of today’s Magnet®-designated hospitals have chosen HealthStream as their trusted partner. HealthStream has a wide range of solutions to support your Magnet® journey, including advanced reporting, online education, assessments, and authoring.
Of special note is HealthStream’s new Nursing Excellence Survey, which helps organizations meet the latest application guidelines for Magnet Recognition® published by the American Nurses Credentialing Center (ANCC). The survey collects key data across the seven satisfaction categories to meet requirements for Exemplary Practice Evidence of Outcomes (EP3EO).
For a complete overview of HealthStream’s Magnet® readiness solutions, contact your HealthStream account executive today or visit www.healthstream.com/succeed-Magnet
MAGNET®, Magnet Recognition Program®, ANCC®, Magnet® and the Magnet Journey® are registered trademarks of the American Nurses Credentialing Center. The products and services of Creative Health Care Management are neither sponsored nor endorsed by ANCC.