Paving and Resurfacing the Road to Magnet: The Perspective and Wisdom of Magnet-Designated Coordinators -- Part I

Alison P. Smith

Disclosures

Nurs Econ. 2006;24(2):112-115. 

In This Article

As promised in the November/December 2005 issue of Nursing Economic$, a series of interviews were conducted with representatives from ANCC Magnet®-recognized organizations to elicit their perspective and wisdom regarding the achievement and maintenance of their Magnet status. Across the initial seven organizations surveyed, the number of profound similarities and creative differences were remarkable. While each interviewee conveyed a reverent and deep professional commitment to the principles of the ongoing journey, each reported an array of unique variables within or around their institutions and has called upon myriads for clever approaches to draw out their Magnet characteristics.

Each interview explored approaches to securing leadership support for pursuing Magnet status, project organization and financial requirements, particularly challenging standards, cautions for avoiding pitfalls, and communication strategies. Figure 1 outlines the themes that emerged from the interviews and will be addressed in this and subsequent Roundtables. In this issue, aspects of culture and relationships will be explored with respect to the prevailing culture in Magnet facilities, the importance of administrative involvement, and key collaboration with physicians and other clinical disciplines.

Pre-Existing Conditions

The question "How and why did you decide or secure support to pursue Magnet recognition?" was posed as one of the first questions to the Magnet Coordinators during each interview. Interestingly, no one really answered that question directly. In most cases, this "decision" was not an historic moment and no one conveyed a sense of B.C. and A.D., or in industry terms, "Before Magnet" and "After Magnet." Rather, each, in her own way, described her organization as one having a long history and culture of Magnet behaviors. The sentiment of most responses revolved around remarks like "we have been Magnet-like for longer than there have been terms for it or a process to recognize it."

Regardless of pre-existing culture and structure, all respondents viewed the Magnet standards as a guide for any organization, regardless of intent to apply for formal recognition. Many organizations have consciously decided not to apply for Magnet recognition due to the fees and/or burdens of visit preparation. All of the coordinators agreed that the benefits of the journey are worth the effort regardless of your intent to submit an application. Beverly Hancock, MS, RN of Rush University Medical Center in Chicago, IL, added, "if only the standards are used as a mechanism for nurses' voices to be heard, it is a huge step forward for an organization."

Preparing and applying for Magnet recognition for many was an exercise, albeit monumental, in packaging and organization, not a journey to create the culture and standard compliance from scratch. In many instances, the hallmark structures like shared governance models and clinical ladders have existed in these institutions for years. For example, Barbara J. Hannon, MSN, RN, of University of Iowa Hospitals and Clinics in Iowa City, IA, reported the existence of their shared governance system since 1975, a cultural and infrastructure element older than many of their staff nurses. Patti Rackstein, BSN, RN, BC, of Morton Plant Mease Health Care in Dunedin, FL, as well as others cited a long-standing "quality culture" often stemming from forward thinking members of the C-suite. Like recruitment and retention, she described their Magnet journey as a "chicken and egg" phenomenon.

Although many cultural and structural characteristics predisposed many institutions to the decision to apply for Magnet, each described areas for improvement as revealed by their initial gap analysis. These areas included predictable aspects of documentation, more standardized language for the staff to verbalize their practice in response to a surveyor, and more uniform performance across all units and divisions of patient care. Many coordinators like Kathy Szumanski, MSN, RN, CNA-BC, of Advocate Lutheran General Hospital in Park Ridge, IL, stressed that this endeavor is "not to be taken lightly" and that the process is "not for the faint of heart." Coordinators often cite the initial challenge of the demographics sheet and tome of documentation as overwhelming. Specific strategies for navigating these logistical efforts will be discussed in Part II of this Leadership Roundtable series. In an effort to describe the level of difficulty involved, the coordinators were clear that Magnet preparation was not even comparable to JCAHO survey preparation. Preparing for a Magnet visit is not akin to a quick clean up before company arrives. Surveyors will feel the mess that is swept under the carpet or shoved in the closet.

Rackstein described their decision to apply for Magnet recognition as a conscious decision made in the face of staffing shortages, increasing competition, and declining reimbursement. With recognition for the health of their existing excellence, they hoped to distinguish themselves in the marketplace with a true measure of quality.

Each coordinator also demonstrated a hearty appreciation for the continuous challenge of maintaining their Magnet qualities. This effort requires sustaining the existing forces that resulted in their initial recognition, but moreover, continuing to reach beyond their existing level of performance to higher levels. "As more hospitals gain Magnet recognition, it actually makes it more difficult to sustain the recognition as the bar is continually raised," noted Rackstein. She said this momentum is beneficial to the integrity of Magnet and actually helps to sustain its meaning — a constant pursuit of improvement and excellence.

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