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Impact of Hospitals Obtaining Magnet Designation on Nurses and Patients

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Impact of Hospitals Obtaining Magnet Designation on Nurses and Patients

As hospitals and other health organizations compete to be the finest facility, one main focus is to create an environment that delivers excellent services and better patient outcomes (Drenkard, 2013). To achieve its goal, the American Nurses Credentialing Center (ANCC) has created designations recognizing hospitals for their outstanding nursing care delivery; Magnet Recognition Program (Joint Commission on Accreditation of Healthcare Organizations, 2014). Magnet recognition program creates tangible and visible link between nursing and overall hospital success (Cowen, Moorhead 2014). According to Swihart and Porter-O’Grady (2015), some consider it “the Nobel Prize of nursing excellence in professional practice environments” (p.79). However, only approximately 7% of health care organizations in the United States have achieved magnet status (ANCC, 2013). In her book, Nursing clinics of North America, Hill (2011) stated the designation ensures that a consistent level of practice and professionalism is demonstrated throughout magnet hospitals in the states and hospitals that are attaining magnet status shares the same characteristics of qualitative factors known as “Forces of Magnetism.” Forces of Magnetism was found during a study conducted in 1980’s by the American Academy of Nursing (AAN) to have better understanding of the cause of nursing shortage during that period. Despite high registered nurse turnover and vacancy rates that were affecting most health care organizations, yet a group of hospitals had low turnover and vacancy rates and had no trouble recruiting and retaining nurses. Among 163 organizations that were involved in the study, 41 organizations shared the same 14 characteristics that were found to attract and retain nurses in the midst of severe shortage (Current Issue in Nursing by perle). Forces of Magnetism is the key factors for the designation since the magnet-designated facility exemplify the specialized setting steered by a strong and optimistic leader who advocates and supports efficiency in the nursing practice (Jordan, 2011). It encompasses 14 characteristics hospitals must demonstrate the evidence of their achievement;

Quality of nursing leadership, management style, organizational structure, personnel policies and programs, community and the health organization, image of nursing, professional development, professional models of care, consultation and resources, autonomy, nurses as teachers, interdisciplinary relationships, quality improvement, quality of care (Potter, Perry, Stockert, & Hall, 2016, p.25).

Additionally, the commission on magnet introduced a new vision and a conceptual model that grouped the forces into five key components. These five components provide a framework to achieve excellence in nursing practice and serves as a road map for organizations seeking magnet designation. Thus, hospitals must follow in order to apply for a magnet status:

1. Transformational leadership

Nursing leaders at all levels of a magnet-designated facility must demonstrate advocacy and support on behalf of staff and patients to transform values, beliefs, and behaviors.

The Chief Nursing Officer (CNO) must be strategically positioned within the organization to effectively influence other executive stakeholders, including the board of directors. Nursing’s mission, vision, values, and strategic plan must align with the organization’s priorities to improve performance, wherever nursing is practiced. Mechanisms must be implemented for evidence-based practice to evolve and for innovation to flourish. As a result, nurses throughout the organization should perceive their voices are heard, their input is valued, and their practice is supported.

1. Structural empowerment

Nurses throughout magnet-designated facilities are involved in shared governance and decision-making structures and processes to establish standards of practice and address opportunities for improvement. Nurse leaders serve on decision-making bodies that address excellence in patient care and the safe, efficient, and effective operation of the organization. The flow of information and decision-making is multidirectional among profession nurses at the bedside, leadership, interprofessional teams, and the chief nursing officer. Nurses and nurse leaders develop strong partnerships with community organizations to improve patient outcomes and advance the health of the communities they serve. This is accomplished through the organization's strategic plan, structure, systems, policies, and programs.

1. Exemplary professional practice

Exemplary professional practice in magnet-designated facilitiy is evidenced by effective and efficient care services, interprofessional collaboration, and high-quality patient outcomes. Magnet nurses partner with patients, families, support systems, and interprofessional teams to positively impact patient care and outcomes. Interprofessional team members include but are not limited to personnel from medicine, pharmacy, nutrition, rehabilitation, social work, psychology, and other professions that collaborate to ensure a comprehensive plan of care. Collegial working relationships within and among the disciplines are valued and promoted by the organization’s leadership and its employees. The achievement of exemplary professional practice is grounded in a culture of safety, quality monitoring, and quality improvement. Nurses collaborate with other disciplines to ensure that care is comprehensive, coordinated, and monitored for effectiveness through the quality improvement model. Nurses at all levels analyze data and use national benchmarks to gain a comparative perspective about their performance and the care patients receive. Magnet organization data demonstrate outcome measures that generally outperform the benchmark statistic of the national database used in patient- and nurse-sensitive indicators.

1. New knowledge, innovations & improvements

Magnet-designated facilities integrate evidence-based practice and research into clinical and operational processes. Nurses are educated about evidence-based practice and research, enabling them to appropriately explore the safest and best practices for their patients and practice environment and to generate new knowledge. Innovations in patient care, nursing, and the practice environment are the hallmark of organizations receiving Magnet recognition. Establishing new ways of achieving high-quality, effective, and efficient care is the outcome of transformational leadership, empowering structures and processes, and exemplary professional practice in nursing.

1. Empirical outcomes

The empirical measurement of quality outcomes related to nursing leadership and clinical practice in magnet-designated facilities is imperative. Outcomes are categorized in terms of clinical outcomes related to nursing, workforce outcomes, patient and consumer outcomes, and organizational outcomes. These outcomes will represent the "report card" of a Magnet-recognized organization, and a simple way of demonstrating excellence.

On the other hand, earning a magnet status can be challenging and time consuming. Lorraine Mancuso, a nursing faculty at Hanover college, stated the process is a complex application procedure and extremely expensive (Lecture, Oct 13, 2016). It is not an easy task to obtain the status and hospitals must work hard to meet strict requirements as well as the commitment to the nursing practice (Hawke, 2013). In its website, Wentworth-Douglass hospital in Dover New Hampshire describes the process as a rigorous and lengthy that involved widespread participation from leadership and staff at all levels. The purpose of this paper is to compare the advantages of obtaining a magnet designation to the hospitals with the challenges faced when obtaining it to help decide if it is worth the struggle.

Discussion of Research

Points in Favor of obtaining Magnet Designation

Magnet designation is recognized to be the golden standard in nursing world and it is recognized for nursing excellence and delivers high quality of nursing care (“Magnet Status for Nursing Excellence,” 2016). The status yields a long list of advantages related to improved quality of care and nurse job satisfaction. For example, several studies have shown hospitalized patients with hip fractures were less likely to develop pressure ulcers in a magnet hospital with an average cost-savings of $43,180 per case. Evidence also points to a lower rate of patient falls in magnet hospitals. One study estimated the cost per hospitalization for patient falls at $33,894. Magnet hospitals have a reported 10.3% lower fall rate. The safety of nurses is also improved by magnet designation in hospitals. Studies conducted have indicated significant reduction in needle stick injuries due to magnet facilities that also cut cost per every incident. The magnet status also recorded lower muscular and skeletal injuries from risky occupations where injuries were frequent and blood exposures were common. Hospitals with the magnet status have proven to be a better working environment that nurses enjoy to be part of, which reduces the cases of nurse turnover since the services provided have a support from the system. They therefore retain their nurses and attract more in the case of recruitment (Elsevier, 2014). According to the Joint Commission on Accreditation of Healthcare Organizations (2014), there is less mortality rate in magnet hospitals due to higher nurse to patient rations (p. 23). For example, the incidence of pneumonia acquired in hospitals was associated to the nurse staffing level. A study revealed, “Adding just 30 minutes of RN staffing per patient daily, greatly reduced the incidence of pneumonia in patients following surgery” (Potter, Perry, Stockert, & Hall, 2016, p.25). The magnet program align with shared governance in that its standards require structural processes to be in place that allow nursing autonomy and decision making power in an organization (Karen Hill, 2011). Thus, “The most important thing to me as a staff nurse in a Magnet hospital is having input into and participating in decision-making related to my nursing practice” (Otero, 2016). Becoming magnet hospital also increases hospitals’ reputation, which in turn pays off long-term investment. Recent popular magazines and newspaper articles have recommended magnet designation as a factor consumer should support and consider in selecting a hospital. In addition, having the hospital’s listed the top 6% in the nation attracts health care professionals and consumers alike (Cowen, 2014). Last not least, the nursing shortage has generated solutions that impact recruitment and retention, such as a variety of bonus pay programs.

Points in Opposition of Obtaining Magnet Designation

To apply for magnet designation, hospitals are expected to go through extensive procedures that required nurses to present proof of their ability cope with the rest of the national, state or regional in terms of levels achieved during application for the magnet standards. Data has to be gathered by the nurses and validated with the quality indicators set by the system of governance (Potter et al., 2016). The hospital is expected to go through this inspection period as a unit, therefore the conduct of each member of the institute is paramount to acquiring the system. The procedures may be lengthy and take about two years for confirmation of obtaining to be made hence; all the nurses are expected to be in line with the qualifications over this whole period. The patience level expected for the approval of this magnet standard from the idea development up to the system acquisition can be discouraging if the application is denied due to any fall out during the lengthy process (Marian, 2014). On top of the lengthy application process, the hospitals must reapply every four years to keep the designation status (“Magnet Status for Nursing Excellence”). Another dilemma is how it affects some nurses, particularly for those who do not have advanced degrees in term of where they fit in under magnet hospitals (Burnette, 2014). In 2011, the Institute of Medicine (IOM) announced a report recommending that the proportion of nurses with baccalaureate degrees will be increased to 80% by 2020. It is believed that a more educated nursing workforce would be better equipped to meet the demands of an evolving health care system, and this need could be met by increasing the percentage of nurses with a BSN. An increase in the proportion of nurses with a BSN also would create a workforce poised to achieve higher levels of education at the master’s and doctoral levels, required for nurses to serve as primary care providers, nurse researchers, and nurse faculty— positions currently in great demand across the profession and within the health care system (2011). However, is that mean some nurses who don’t have advanced degrees will have no jobs available in hospitals? Margarette added.

Effects on Nursing Practice

By analyzing the benefit versus the difficult procedure of obtaining magnet designation in healthcare organizations, the student nurse believes obtaining the designation is worth the effort. Hospitals exist to improve the quality of human life and if there is a way to improve the means of providing the care to patients, no cost can be too high to pay for the returns received. The improvements gained overshadow the struggles. The desired outcome overrules the difficulties experienced, and they seem minute once the struggles are over and the fruits of the efforts start being enjoyed. The student nurse believes that Registered Nurses (RN) is vital members of the health care team. Their clinical knowledge, skills, and engagement are essential to the promotion and health maintenance of society. Thus, they must work in an environment where they can grow and flourish. That is the environment where positive attitudes are enforced, nurses’ inputs are valued, management is supportive, high nurse patient ration exists, constructive communications between nurses and physicians as well as a structural empowerment for all the nursing staff to participate in their professional practice: to implement new knowledge and innovations (Finkelman & Kenner, 2014). The environment that supports exemplary professional nursing practice and that can be found in magnet-designated facility (Cowen, 2014). In her article, Swanson also explains that forces of magnetism greatly have a positive impact on patients’ outcomes because the nurses in such an environment are satisfied, involved, and advanced (Swanson, 2011). Satisfied nurses evidently leading to fewer complications, fewer adverse events, shorter lengths of stay, and most importantly, lower mortality rates (Zittel, Moss, & O’Sullivan, 2016).

Conclusion

When comparing if it is worth obtaining magnet designation, the benefits of having it quite drastically outweigh when hospitals do not have the designation. The magnet program objective is to promote quality in the work setting that supports excellence nursing practice through the application of evidenced-based leadership, management, and clinical practices. It requires transformation, and the level of thinking in the organization must change to whole systems thinking in order to change the level of practice (Cowen, 2014). The magnet designation program recognizes health care organizations that operate by utilizing the forces of magnetism, resulting in quality patient care, nursing excellence, and innovations in professional nursing practice. It identifies excellence in delivering nursing services and these facilities disseminate best practice in nursing services and live by nursing ethics (Potter et al., 2016). According to Perle, benefits of achieving magnet status are high patient and family satisfaction, exemplary professional practice with improved clinical outcomes, strong collaborative relationships, and high staff satisfaction leading to improved recruitment and retention of nurses and other employees (2014). Although staff satisfaction in unique to each individual, the factors known to contribute to job satisfaction such as practice environment, relationship with leadership, mentoring and commitment, parallel with the concepts of the magnet model, the framework for the magnet designation program. All in all, magnet hospitals are most likely the desirable facility that patients will seek (Joint Commission on Accreditation of Healthcare Organizations, 2014). It sets the expectation for continuous learning because excellence is a journey that has no finish line (Cowen, 2014). Understanding the disadvantages; costly, time consuming, need dedication from employees throughout the process are the reasons why some facilitates opt-out of obtaining the status. However, nurses in magnet facilities have better positive attitudes towards work and this advantage is felt by the patients and the hospital who are equally satisfied by the outcomes of the magnet status.