Magnet recognition program gains stature in nursing community

Tips for the application process

As the eleventh hospital in the nation receives the Magnet Nursing Services Recognition from the American Nurses Credentialing Center, more than 80 hospitals are applying for the status that designates excellence in nursing service and nursing care, says Jennifer Matthews, PhD, RN, CS, director of accreditation and the Magnet program. And the program is attracting not only acute hospitals, but subacute facilities as well. Two months ago in Atlanta, more than 200 nurses met to find out what their facilities needed to do to earn the ANCC's highest seal of approval. (See list of Magnet hospitals, below.)

Matthews explains the history of the Magnet program, which began in the early '80s during nursing shortages. "The American Nurses Association and the American Academy of Nursing and a task force of nursing administrators designated 41 hospitals in the nation as `Magnet' facilities," she explains. "The purpose was to identify outstanding hospitals in which nurses had positive environments to practice as well as support of the highest level of administration."

The current Magnet program, which was revised in 1993 as a certification procedure, has these three objectives:

o recognize nursing services that support excellence in the quality of the care delivery;

o support positive environments in which nurses practice;

o recognize successful practices in various settings.

Yet the new program is more rigorous, requiring a thorough internal and external evaluation against these standards and criteria from the American Nurses Association's Scope and Standards for Nurse Administrators:

o management philosophy and practices of nursing services;

o adherence to standards for improving the quality of patient care;

o leadership of the chief nurse executive in supporting continued competence of nursing personnel;

o attending to the cultural and ethnic diversity of patients, their significant others and care providers;

o showing leadership in nursing research and integration of research findings into practice;

o participating in community service;

o adhering to standards that improve the quality of patient care;

o maintaining professional nursing practices and continued competence of nursing personnel;

o managing fiscal resources.

"These Magnet criteria are carefully scrutinized by the ANCC appraisers in the scoring process; the facility must achieve a minimum score overall for the Magnet criteria," says Matthews.

When the appraisers determine that the written evidence and documentation satisfy the magnet criteria, a two-day site appraisal is scheduled and conducted.

"This thorough site appraisal verifies, clarifies, and amplifies all information from the written documentation as well as on-site requirements," Matthews says.

Then, the evidence from both are presented to the commissioners of the Magnet program, who vote on whether a facility should be awarded the Magnet designation for its nursing service and nursing care, she says. Cost for the certification ranges from $1,500 to $9,000, depending on bed size.

Once a facility is deemed a Magnet institution, it must maintain its status for four years, Matthews adds.

The benefits of attaining the designation are worth it, says Getrude Rodgers, MSN, RN, former chief nurse executive at Inova Fairfax (VA) Hospital, one of the Magnet hospitals in both the early '80s and in the new program. (She now runs Rodgers and Associates, a health care consulting firm in Stuart, FL, that specializes in helping hospitals attain Magnet status. She recently served as consultant to Miami Baptist, the 11th hospital in the nation to receive the designation.)

"Magnet designation differs from JCAHO certification in that it only covers nursing services, and no funding sources are contingent upon completing the survey satisfactorily," she explains. "But there are several benefits to being designated a Magnet institution. Not only do you have proof to the public that you offer excellence in nursing, but you can also tell your administrators, physicians, and payers," she says. "And the most important benefit is that it instills tremendous pride in the nursing staff." (See story, p. 76, about the need for nurses to articulate their value.)

She also points out that ANCC studies have shown Magnet hospitals have experienced fewer shortages and less turnover of staff.

Surviving the survey

Although the application process is rigorous, it doesn't have to be overwhelming, maintains Rodgers. She offers five suggestions for making the Magnet process easier:

1. Don't reinvent the wheel.

"The Magnet program does require a lot of hard work and patience, but you don't have to start from scratch," she stresses. "If you think [the application] overwhelming, remember that you probably already have most of the information; you just don't call it by the same name."

The first thing she recommends is to conduct an assessment to find out how the structure of your nursing service and care compares to the Magnet criteria. "Check to see what committees you already have in place and what level of staff are on each one," she says. "You may have to redo some of the committees to make sure they are inclusive of all staff levels, but you don't have to create an entire new structure just to get the Magnet designation." She adds that the Magnet program is not prescriptive, nor are its surveyors punitive, but "they are looking for evidence of how your organization meets their standards."

For instance, instead of creating new committees to match the standards, a facility may use existing ones and create special task forces as needed. "Once you conduct the assessment of what policies you already have in place that support standards, you may even surprise yourself," she says. "Then, it becomes a matter of documenting it."

2. Involve staff nurses.

"Staff involvement is one of the most important things you can do in the Magnet process," says Rodgers. The focus of Magnet survey and review is to determine the level in which nurses are autonomous in clinical decision making. So, if you don't involve them, you are missing the point, and the entire process may end up as a paper chase."

For example, at Fairfax, Rodgers first presented the Magnet concept to the hospital's nursing practice congress and then put a staff nurse in charge of the standards. "Of course, there needs to be management oversight team, but you also should create a structure that encourages and includes staff in deliberations and discussions," she says.

3. Share and share alike.

After timelines are set up and responsibilities assigned, the next step is to coordinate as well as share the information. "In the final report, you want to make sure that several teams haven't cited the same initiative or example," she warns. "You also want to share the nursing administration portion of the application just as the staff level nurses share theirs." That mutuality creates a stronger connection among staffing levels, she says. "It leads to a better understanding and appreciation of how we each do our jobs. The staff learned more about the roles of chief executive nurse, and I learned more about their roles."

4. Get ready for site visit.

By the time the two-day site visit arrives, the lion's share of the work is completed. "In addition to a chart review, the surveyors will also spend a considerable portion of time in work areas with nursing staff," Rogers explains. "The purpose of the visit is to validate the documentation in the application by giving nurses the chance to articulate their practice."

She offers these examples of typical questions:

o How do you manage the care of a difficult patient?

o What is your interaction with patients' families?

o What type of teaching tools do you use?

o What kind of quality initiatives are you involved in?

"Essentially, they are listening for the type and quality of stories nurses tell about taking care their patients," she says. "They have a special ear out for a quality improvement story that saved money and improved outcomes."

At Miami Baptist, the latest hospital to attain Magnet status, Rodgers recommended nursing prepare storyboards and place them at strategic places so surveyors could see "evidence of work being done at every meeting," she says.

5. Tout your success.

Finally, when the coveted designation arrives, get the word out both inside and outside of your hospital. "Meet with the marketing department to devise a plan as to how to advertise this to your community," Rodgers recommends. Suggestions may include sending press releases to professional nursing organizations and local media and using the Magnet logo on all advertising, including your Web site.

"At Fairfax, we took out a one-page ad in The Washington Post during Nursing Week and listed all 1,700 nurses by name," Rodgers says. "In addition to explaining the Magnet designation to the community, we also took the opportunity to thank our nurses publicly. The value to the staff was tremendous."