Domains. Components/Domains a meaningful set of related concepts or indicators

Quest for Nursing Excellence

Boston Medical Center

Quest for Nursing Excellence

Magnet Journey Quest for Nursing Excellence

Diane Hanley, MS, RN-BC, EJD Director, Nursing Education, Quality and Professional Practice

St. A’s Class of ‘79

What is Magnet?

American Nurses Credentialing Center (ANCC)

Certification

• Recognition for excellence in professional practice

• Performance driven recognition

• Measurement against very high standards

• Evidence-based framework

• Investment in nursing

The History of Magnet

• 1980’s – a significant nursing shortage.

• A handful of hospitals successfully weathered the shortage.

• 1983, a team of ANA researchers sought to discover what made them

special.

• 41 possessed superior attributes

• The research team identified “magnet” hospitals and the attributes

“forces of magnetism”

• Transformed to new Magnet Model

The Forces of Magnetism

• Quality of Nursing Leadership • Organizational Structure • Management Style • Personnel policies and programs • Professional Model of care • Quality of Care • Quality Improvement • Consultation and resources • Autonomy • Community • Nurses as teachers • Image of Nursing • Interdisciplinary relationships • Professional Development

Components/Domains – a meaningful set of related concepts or indicators

oTransformational Leadership

oStructural Empowerment - Resource Utilization

oExemplary Professional Practice - professionalism, autonomy and quality oNew Knowledge, Innovations and Improvements - Research

oEmpirical Quality Outcomes

Domains

Magnet Model

Why is it important?

• Improved work environment

• Magnet Hospitals have improved patient outcomes. • Magnet Hospitals lead and excel:



Infection rates



Mortality



Falls



Pressure ulcers • Work environment • Interdisciplinary collaboration • Greater external recognition • Enriched staff satisfaction and productivity • Competitive marketing advantages

QUEST FOR NURSING EXCELLENCE

But most importantly:

Magnet gives you a framework from which to;  talk about nursing practice

 celebrate the contributions of nursing  create tactics to improve patient care and

practice environment

Where are organizations in terms of Magnet?

Magnet

On the journey

Gap analysis

Not in the cards right now

8.8%

Magnet Program Growth

Approximately 8.8% of US

Hospitals have achieved

ANCC Magnet

Recognition.

8 organizations in

Massachusetts have

achieved designation.

Who’s next???

The Magnet Journey

Phase 1 – Gap Analysis and Application

Phase 2 – Submission of Written Documentation & review by Magnet Appraisers Phase 3 – Site Visit

Eligibility Requirements

• CNO: Masters prepared, and an active participant in the hospital’s governance and strategic planning and ultimately responsible for the standards of nursing practice throughout the organization

• 100% of nurse managers/leaders must have a degree in Nursing (BSN or MSN)

• ANA scope and standards for Nurse Administrators implemented throughout

• Must collect unit-level nurse sensitive data (NDNQI)

What are the attributes of a Magnet Hospital?

“Magnet is a prestigious and coveted international award given to organizations that demonstrate excellence in nursing practice and high quality patient care.”

In Magnet hospitals,

∙ nurses are empowered and accountable for their practice ∙ patients have better outcomes and are more satisfied ∙ professional advancement is encouraged and rewarded ∙ there is greater staff involvement in decision – making

QUEST FOR NURSING EXCELLENCE

Transformational Leadership

• Leadership

▫Quality of Nurse Leadership

▫Management Style

▫Strong visionary, well articulated philosophy • Communicates, develops others, strategic thinker • Patient and staff advocate

• Strategically positioned and influential • Quality Plan

• Evidence based practice • Shared decision making

Structural Empowerment

Resource Utilization and Development

Organizational Structure Personnel Policies Community Image of Nurses

Professional Engagement- shared governance

Professional Development

Teaching and Role Development

Commitment to Community Involvement

Recognition of Nursing

Exemplary Professional Practice

Professional Models of Care

Care Delivery Model

Quality of Care

ethics, patient safety, quality infrastructure, diversity

Quality Improvement

Consultation and Resources

Autonomy

Nurse as Teachers

Interdisciplinary Relationships

Culture of Safety

New Knowledge, Innovation & Improvements

▪Research, Innovations

▫Quality of Care

▫Research and EBP

▫Nurses role in IRB

▫Protection of patients

▫Quality Improvement

▫Outcomes

▫Quality of Care

Empirical Quality Outcomes

Patient Outcomes



Risk adjusted mortality rates



Healthcare acquired infections



Falls and injuries



Overall Patient Satisfaction



Patient satisfaction with nursing care, educational information, pain management



Patient perception of safety



Population specific outcomes

Empirical Quality Outcomes

Nurse Outcomes

Level of nurse engagement, nurse satisfaction

Perception of nurse autonomy

Turnover and vacancy rates

% direct care RNs and leaders with certifications

Educational preparation of nurses

Rates and types of staff injuries

Staff perception of safe culture and work environment

Staff perception of orientation and/or effectiveness of continuing education

Empirical Quality Outcomes

Organizational Outcomes

▪Efficiency and/or elimination of waste

▪CNO impact on system-level change

Consumer Outcomes

▪Impact of community outreach programs

▪Community health and welfare

Professional Practice Model

• Establishes a shared vision

• Demonstrates a partnership of leaders and clinical nurses • Designed, implemented and advanced over time. • Framework for ensuring…

• autonomy, accountability, and peer review • competence and ethical practice

• privacy, security, confidentiality, advocacy and diversity • Interprofessional collaboration and leadership • Quality care monitoring and process improvement

Professional Practice Model

• Explicit and observable set of values and philosophies • Practical methods for conducting work

•Leadership •Strategic Direction •Infrastructure and resources •Self reflective •Best practices •Respect and collaboration

Professional Practice Model

Every organization is unique, so…. No two professional practice models are the same.

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Professional Practice Model

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Practice Environment

• Nurse participation in hospital affairs • Nursing foundation for quality of care • Nurse manager ability, leadership, and support of nurses • Staffing and resource adequacy

• Collegial nurse-physician relations

Nurse Sensitive Outcomes

Rates

Non-Magnet Magnet

Falls CLABSI Assaults Injury Falls CAUTI

Magnet is Outcomes Focused!

That nurse satisfaction or engagement data, nursing-sensitive indicator data,

and patient satisfaction data, aggregated at the unit level outperform the mean,

median, or other benchmark statistic provided by the national database used

Magnet Themes Group Work

• Professional Practice Model

• Care Delivery Model- Synergy • Ethics, Research & IRB

• Nursing Quality Plan and NDNQI -- DATA

• Professional Development, PRP, Certification, Education Interdisciplinary relationships • Shared Governance – Shared Decision Making

• Evaluations and Peer Review

• New Graduate Transitions / Experienced Nurse • Patient and Family Education • Safe Patient Handling • Culture of Safety • Bedside Handoff • ED Handoff

Role of Nurse Educator

• 80 by 20

• Professional Certification • Learner Needs Assessment • Outcome of Professional

Development • Peer Review • Nursing Research • Utilizing trended data to

drive change • Professional Organization

membership • Preceptor and mentorship • Succession planning

• Patient Teaching expertise • New Graduate Nurse Transition • Opportunities for experienced nurses • Internal experts

• Evidence based practice

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Magnet Designation

It takes a village - Magnet Champions!

A designation for a hospital – we can’t do it alone!

Magnet is a Journey not a destination.

The playbook

And enjoy the ride!

“If you want to build a ship, don’t drum up the men to gather

wood, divide the work and give orders.

Instead, teach them to yearn for the vast and endless sea.”

Antoine de Saint-Exupery