Reaching Your Destination

Community hospitals can achieve ANCC Magnet status. Here’s how.

The loud cheers and long hugs that followed the phone call notifying us that Rush Oak Park Hospital had earned Magnet status were unforgettable and emotional. We had worked together for years on this process, and it had paid off!
Within hours, nursing colleagues at other community hospitals were asking: Was pursuing Magnet designation worth the effort? What did you learn that could help us? Should we pursue Magnet status?

We wrote this article to answer those questions.

1. Was pursing Magnet worth the effort?

Yes, if your organization is willing to trust in itself. Sophisticated nursing research and more readily available healthcare quality data helped quantify the obvious: Hospitals that have demonstrated nursing excellence provide the best care. Today’s consumers research where they should get their healthcare, and the American Nurses Credentialing Center’s (ANCC) Magnet designation provides confidence that the quality of care and patient satisfaction will be top notch.

But while quality, reputation and branding benefits make the “should we pursue Magnet?” question seemingly simple for large health systems, the substantial resource commitment is something that weighs upon smaller organizations as they make this decision.

A study by the Robert Wood Johnson Foundation’s Interdisciplinary Nursing Quality Research Initiative found that it takes an average of 4.25 years to attain Magnet status, at an average cost of $2,125,000 (see Jayawardhana J, et al. Is There a Business Case for Magnet Hospitals? Medical Care. 2014;52[5]:400-406). Hospitals eventually see a return on investment through decreased staff turnover and improved patient outcomes, but convincing leaders of a 200- or 300-bed hospital to invest $2 million requires high levels of confidence in your nursing staff, processes and leaders.

Rush Oak Park Hospital is a 176-bed hospital in suburban Chicago that is affiliated with Rush University Medical Center in Chicago, also a Magnet hospital.

2. What did you learn on your journey to Magnet status?

After news of our Magnet designation spread, peers from hospitals of similar size asked how we did it. What was our secret? Unfortunately, there are no secrets or short cuts. However, reflecting on what we learned between deciding to pursue Magnet and receiving that unforgettable telephone call revealed four key recommendations.

Set the CNO vision. The chief nursing officer (CNO) must be able to communicate how nurses drive quality care and operationalize excellence.

The Magnet process seeks to recognize organizations that respect each nurse and value their ideas and contributions. Shared governance and organizational structure must go beyond lip service and allow nursing in all roles and settings to have a voice-and the power to use it.

In preparing for the Magnet site visit and assembling the documents, it was especially important that the CNO express a consistent and memorable vision of nursing’s impact and importance in care. Whether she was presenting to the board of directors or interviewing a new recruit, Karen Mayer, PhDc, MHA, RN, NEA-BC, FACHE, our vice president of patient care services, was clear, direct and consistent: Inpatient and ambulatory bedside nurses are the experts at managing nursing care practices. It is simply a matter of empowering them to move forward, then getting out of their way!

Your size is your strength. The ability to initiate change is easier in a smaller setting. Martial arts experts often stress that smaller can be better in a fight. The ability to quickly react and stay nimble can prove more important than sheer size and strength. The agility and flexibility of community hospitals is such that one nurse’s idea or a small group’s brainstorming session can be tested. Here are two ways to initiate change:

1. Listen to early career nurses. Yes, those RNs who are just a few years out of nursing school are still learning, but they often are brimming with new ideas, knowledge of recent research and infectious energy. Ask them to share their ideas. Do not wait until they have more experience to let them run with those ideas. They are a generation who has been working in teams since preschool, and they know how to guide a team toward a desired goal.

2. Embrace a new care model. Smaller community hospitals have nurses working autonomously beside attending physicians. With nursing excellence, interprofessional collaboration is improved and newer models of care, improved transitions, and safety and patient experience can easily be piloted and hardwired through direct dialogue in a shared decision making process within the organization.

Documentation: Formalize the informal. Strong documentation of nursing processes is vital, even for the type of informal collaboration so important to small and mid-sized hospitals and nursing staffs.

While we knew to expect that the 78 sources of evidence required by the Magnet program would require extensive documentation, we also learned to document parts of the work day we hadn’t before. It is important to stay flexible to allow innovative ideas to flow from a chance meeting or impromptu discussion, yet those thoughts and ideas need to be captured. It is also necessary to have a mechanism for nurses to document and share the ideas and concerns with the CNO-even those that take place during rounding or hallway conversations. For us, these conversations now end with a request for the nurse to also send the information to the CNO by email to provide a verification of the interaction.

Seeking documentation of communication is a challenge, but by formalizing the informal, we were better able to capture and document the many things nurses do to improve the care environment, streamline care processes, identify potential problems, recognize team efforts, and acknowledge the excellence being achieved. Nursing doesn’t just happen at the bedside.

Extend excellence to the community. The commitment to excellent care shouldn’t end at discharge. A smaller community hospital often can leverage its value to its service area by deploying nurses for health screenings, providing nutrition education in food desert areas, and implementing programs that address chronic disease treatment and prevention.

Some of the most innovative, outside-the-box thinking for hospitals is actually “after-the-discharge” thinking. Nursing in particular is well positioned to propose creative solutions to keeping patients healthy. In our discussions with ANCC staff, they were especially interested in our efforts to reduce readmissions through a program that sends advanced practice nurses into partner long-term care settings to provide 24/7 on-call assistance for patients after discharge from the hospital. Patients at these settings were readmitting at a rate of approximately 45% prior to our APNs being deployed to these settings. They have now achieved a rate of < 9% and have sustained that for 3 years.

3. Should our hospital pursue the Magnet designation?

This was an expected question from peer nurses that gets an unexpected answer: No, your hospital should not pursue Magnet status. Your hospital should pursue nursing excellence for the sake of the best possible patient outcomes and care to the community. Doing so leads to the moment when you look at your results and see that you qualify for the Magnet certification.

So yes, achieving Magnet designation is worth the effort, but the effort is already completed, except for writing documents for submission. Magnet status is an important signpost to tell you and your organization that you have reached the destination: nursing excellence. Our Magnet-recognized nurses are prepared to lead healthcare solutions into the future, and we are ready and willing to continue innovating and leading in our patient and professional communities-not for Magnet designation, but because we are who we are: professional nurses.