Download Contemporary Hospital-based Nursing Practice

Models of good practice for
promoting staff autonomy:
The Magnet Recognition Program
Karen B. Haller, PhD, RN
Vice President for Nursing & Patient Care Services
The Johns Hopkins Hospital
Baltimore, Maryland, USA
[email protected]
Objectives
● Review Magnet Program’s goals.
● Relate to HPH strategies.
● Discuss implementation.
Magnet designation is
the highest level of
recognition given to
health care organizations
that provide the services
of professional registered
nurses.
- American Nurses Credentialing Center
(ANCC)
Magnet Recognition Program
Goals
1. Promote quality in a milieu that
supports professional practice.
2. Identify excellence in the
delivery of nursing services.
3. Provide for the dissemination of
“best practices” in nursing.
Hospitals can use the
Magnet Program
● To assess and improve their
processes for achieving quality
outcomes.
● To acknowledge nursing staff for
contributions to positive care
outcomes.
● To achieve greater recognition
within the community for nursing.
Origins of the Magnet Program
1981 – American Nurses Association
commissions a study of hospitals
that maintained competent nursing
workforces during a time of shortage.
1983 – Researchers (McClure
et al., 1983) publish
characteristics of model
hospitals and coin the
term “Magnet hospitals.”
Creation of Magnet Award
1990 – Accreditation program began
through the ANCC.
1994 – University of Washington
Medical Center, Seattle, received
the first award.
2000 – Rochdale Trust, U.K., became
the first nonU.S. healthcare
organization to receive a Magnet
award.
Magnet hospitals
must meet stringent
qualitative and
quantitative
AMERICAN NURSES
standards that
CREDENTIALING CENTER
define the
ANCC MAGNET RECOGNITION
highest level
of nursing practice
and patient care.
M
Forces of Magnetism
1. Quality of Nursing Leadership
(visionary, knowledgeable, staff advocacy)
2. Organizational Structure
(flat, decentralized, unit-based decision-making)
3. Management Style
(participatory, valuing staff nurse input)
4. Personnel Policies and Programs
(employee-friendly)
5. Professional Model of Care
(staff nurses given authority and accountability)
Forces of Magnetism
6. Quality of Care
(an organizational priority)
7. Quality Improvement
(educational, with staff nurses)
8. Consultation and Resources
(availability of expertise, adequate staffing)
9. Autonomy
(within scope of Nurse Practice Act)
10. Community and the Hospital
(hospital as corporate citizen)
Forces of Magnetism
11. Nurses as Teachers
(of peers as well as patients and families)
12. Image of Nursing
(RN is integral member of team)
13. Interdisciplinary Relationships
(mutual respect, collegial RNs - MDs)
14. Professional Development
(education, competency)
Six Principal Health Promotion
Strategies for Staff
Quality development Strategic
positioning
Staff as
persons
STA-1: Enabling staff for
healthy living at the
workplace
STA-5: Enabling staff
for lifestyle
development
Staff in their
professional
roles
STA-2: Enabling staff for
healthy working in the
hospital
STA-4: Enabling staff
for management of
work related health
problems
Hospital /
community
setting
STA-3: Developing the
hospital into a health
supportive setting for staff
Pelikan et al., 2003
Italian National Conference on HPH
Torino, Italy, November 2003
STA-6: Developing
the community into a
health supportive
setting for specific
needs of staff
Health
Promoting
Hospitals
Technically
supported by:
WHO
Collaborating
Centre for
Health
Promotion in
Hospitals
and Health
Care
At the
Ludwig
Boltzmann
Institute for
the
Sociology of
Health and
Medicine
at the Institute
for Sociology,
University of
Vienna
Sponsored by
Federal
Ministry for
Health and
Women
Co-ordinated by:
World
Health
Organization
European Office for
Integrated Health Care
Services, Barcelona
Magnet research shows…
 Improved recruitment  Fewer needlesticks
 Improved retention
 Lower mortality rate
 Less agency usage
(CMI-adjusted Medicare
mortality rate)
 More control of
 Lower diseasepractice environment
specific mortality rate
 Greater autonomy
 Better relationships
with physicians
 Higher patient
satisfaction
 Decrease in falls
Summary of the Research
Job
Study
Kramer &
Schmalenberg
(1991, 2002, 2003)
Nurse- Autonomy Education
Patient
Satisfaction Patient
and
Levels of Patient
& Burnout Ratios Empowerment Nurses Outcomes Satisfaction
+
+
Aiken, Smith, & Lake
(1994)
+
Aiken, Sloane, & Lake
(1997)
+
Aiken, Sloane, Lake,
Sochalski, & Weber
(1999)
+
Aiken, Havens, &
Sloane (2000)
+
Upenieks (2003)
+
+ indicates the study variables.
+
+
+
+
Lower Medicare Mortality
Among a Set of Hospitals
Known for Good Nursing Care
 4.6% lower mortality rate
 0.9 to 9.4 fewer deaths per 1,000
(95% confidence interval)
Aiken, Smith, & Lake, 1994
“ – a greater proportion of nursing
service personnel being registered
nurses–is not the sole explanation
for their lower mortality. This
finding reinforces our belief that
the mortality effect derives from
the greater status, autonomy, and
control afforded in the Magnet
hospitals ...”
Aiken, Smith, & Lake, 1994, p. 783
“ The practical importance of
our findings is influenced by
the extent to which the
organizational characteristics
of Magnet hospitals can be
replicated elsewhere.”
Aiken, Smith, & Lake, 1994, p. 783
Relationship between
the practice of nursing and
the mortality rates in hospitals
 Aiken et al., 2002
 Blegen, Goode, & Reed, 1998
 Czaplinski & Diers, 1998
 Kovner & Gergen, 1998
 Mitchell & Shortell, 1997
Hospital Organization, Nurse
Staffing, and Patient Outcomes
Hospital organization
Nurse patient ratios /
nursing skill mix
Nurse autonomy
Nurse control
Nurse intraorganizational
status
Patient
outcome
Surveillance / early
detection of complications
Nurse-physician relations
Rapid institutional response
Medical staff organization
and qualifications
Aiken, 1999
Implementing the
Magnet approach
Structure
Process
Outcom
Characteristics of Effective Nursing
 Organizational structure
 Quality of nursing leadership
 Personnel policies and programs
 Professional models of care
 Levels of autonomy
Source: ANCC (www.ana.org)
 Organizational structure
1. Chief Nursing Officer is at the
executive level.
2. Decentralized departmental
structures allow strong nursing
involvement in the committee
structure across departments.
3. Equal attention is given to the
quality of staff and the quantity
of staff.
 Quality of nursing leadership
1. Leaders are knowledgeable
and strong risk-takers who
convey a sense of advocacy
and support for the staff.
2. The nursing directors and
managers are pivotal to the
success of the organization.
 Personnel policies and programs
1. Salaries and benefits are
competitive.
2. Shift rotation is minimized.
3. Significant administrative and
clinical promotions reward
expertise with both title and
salary changes.
 Professional models of care
1. The model of care gives the nurse
the responsibility and related
authority for patient care.
2. Nurses are accountable for their own
practice and are coordinators of care.
3. Nursing management is responsible
for developing an environment where
care can flourish.
4. Nurses are involved in the
development, implementation, and
evaluation of nursing care.
 Level of autonomy
1. Nurses exercise independent
judgment.
2. Autonomy is viewed as selfdetermination.
3. Interdisciplinary decisionmaking is essential.
Conclusion
● The Magnet Program provides
a good framework for granting
high levels of staff autonomy
(empowerment).
● http://www.nursingworld.org/
ancc/magnet.html