More than four months after the American Nurses Credentialing Center did an extensive three-day Magnet site visit at The Christ Hospital in Cincinnati, an overflow crowd packed the hospital auditorium, eagerly awaiting news about the facility’s application for Magnet designation.
The staff felt the visit had gone extremely well. Their work included two years of meetings, data collection, education and process development geared toward raising and monitoring the hospital’s standards for nursing excellence as defined by the ANCC.
They were ready to celebrate success. Then came the news — Magnet designation had been denied.
"You could hear a pin drop, and then there were audible gasps of disbelief," said Sue Dickey, RN, MSN, the hospital’s director of nursing excellence and innovation. "I was shocked, absolutely shocked. You say you don’t take it personally, but you do."
The ANCC denied designation because nursing staff didn’t adequately articulate the nursing department’s model of care when interviewed during the site visit, Dickey said.
After an appeal was denied and the dust settled, the nursing staff went back to the drawing board. They created a task force that included 24 staff nurses from all of the hospital’s nursing councils as well as RNs who worked in other roles.
The Magnet committee task force polled hospital staff nurses about their thoughts on the professional practice model and reviewed nursing practice models at a slew of other facilities. Gradually, the team revised its nursing care model and created a visual representation to make it easier to understand and describe. The hospital received Magnet designation on its second attempt.
Bumps in the road
Magnet designation recognizes healthcare organizations for quality patient care, nursing excellence and innovations in professional nursing practice. Presently, there are 395 Magnet hospitals worldwide. The ANCC would not release information on the number of hospitals denied designation on first or later attempts.
Why do some hospitals struggle? Reasons vary from facility to facility, said Jan Moran, RN, BSN, MPA, assistant director of Magnet operations for the ANCC, but the problem often involves reporting rather than doing the wrong thing in actual practice.
"They sometimes have difficulty presenting what they’re doing in their documentation," she said. "Others fail to talk about nurses at all levels of the organization, or they don’t give enough examples of how they’re fulfilling the requirements."
To achieve success on their Magnet journey, Moran said, hospitals should use resources available from the ANCC. Nursing leaders and staff can attend Magnet conferences and workshops, call the ANCC for clarifications or hire ANCC Magnet consultants to do a "gap analysis," an evaluation of what their organization may be missing.
Need for evidence
Not fully documenting how nurses were involved at John Muir Medical Center, Concord, Calif., might have been what tripped up the 313-bed facility’s first Magnet application, said Donna Brackley, RN, MSN, MA, NEA-BC, senior vice president of patient care services and CNO.
"When we were turned down in 2007, they said that we didn’t have enough evidence of 'enculturation’ of our shared governance structure," she said. "The structure was there, but the evidence that it was fully embedded in the organization and that the nurses demonstrated autonomy was apparently lacking."
After being denied Magnet status, the nursing staff at John Muir-Concord took some time to evaluate whether they wanted to try again. "I was director of professional practice at the time, and we really wondered whether we wanted to continue on the journey," Brackley said. "We wanted clear support from the nursing staff, and we ended up taking several years to prepare ourselves for reapplying."
Rather than focusing solely on Magnet designation, the nursing leaders at John Muir-Concord called the process "our pursuit of nursing excellence," Brackley said. The process spurred a redesign of the hospital’s nursing leadership councils and a revision of its professional practice model to make it easier to fully understand and explain.
The second time around, the staff had full ownership of the application process, Brackley said. "The pride at the time of the [second] site visit was nothing I had ever seen in my career," she said. The hospital received Magnet designation on its second try.
Pat Steingall, RN, MS, NE-BC, CNO and vice president of patient care services at Hunterdon Medical Center in Flemington, N.J., said most people aren’t aware the medical center was denied designation in 1996 because it had no nursing research program at the time.
"We were a little gun-shy about reapplying, but lots of hospitals in the state were getting Magnet designation," Steingall said.
Donna A. Cole, RN, PhD, CNOR, NE-BC, Magnet writer at Hunterdon, said about 30% of acute care hospitals in New Jersey have Magnet status, compared with 7% of hospitals nationwide. To address the issue, the nursing department systematically built research practice into the organization, teaching nurses how to do literature reviews, conducting research within the facility, getting nursing staff involved by attending research symposia and doing research posters and presentations nationally.
The result? Hunterdon received Magnet recognition in 2008.
Demonstrating shared governance
Although it is a requirement for Magnet designation, shared governance can be challenging for some facilities to address, Brackley said. At John Muir-Concord, nurses are represented by a union that does not advocate for shared governance.
After becoming the first California hospital to receive Magnet designation in 1997, the University of California-Davis Medical Center in Sacramento was not redesignated in 2006. Magnet site reviewers were greeted by nurses picketing during a contract renegotiation, and the public demonstration of discontent probably didn’t convey a positive image of nursing to the surveyors, said Carol Robinson, RN, MS, MPA, NEA-BC, FAAN, chief patient care services officer at the medical center.
Losing designation was a difficult experience, Robinson said. "We had the designation, were redesignated, and then lost it — and the staff was really devastated, even tearful," she said.
Robinson said she told the staff they don’t need external validation and that not getting the Magnet designation didn’t change how they practiced nursing or what they accomplished every day. "Our quality indicators were good, we had no problem recruiting nurses and our reputation hadn’t suffered," she said.
But a little more than a year ago, the movement for Magnet designation resurfaced among the nursing staff. "We started keeping the data and hired a full-time coordinator [to spearhead] the Magnet process," Robinson said. In addition, the Gordon and Betty Moore Foundation contributed $200,000 to pay for a gap analysis and for ANCC consultants to assess the organization before next year’s formal review. The organization has filed its application, with documentation due in February. "I still remember the pain of losing the designation," Robinson said, "but now it feels like being reborn." •
The staff felt the visit had gone extremely well. Their work included two years of meetings, data collection, education and process development geared toward raising and monitoring the hospital’s standards for nursing excellence as defined by the ANCC.
They were ready to celebrate success. Then came the news — Magnet designation had been denied.
"You could hear a pin drop, and then there were audible gasps of disbelief," said Sue Dickey, RN, MSN, the hospital’s director of nursing excellence and innovation. "I was shocked, absolutely shocked. You say you don’t take it personally, but you do."
The ANCC denied designation because nursing staff didn’t adequately articulate the nursing department’s model of care when interviewed during the site visit, Dickey said.
After an appeal was denied and the dust settled, the nursing staff went back to the drawing board. They created a task force that included 24 staff nurses from all of the hospital’s nursing councils as well as RNs who worked in other roles.
The Magnet committee task force polled hospital staff nurses about their thoughts on the professional practice model and reviewed nursing practice models at a slew of other facilities. Gradually, the team revised its nursing care model and created a visual representation to make it easier to understand and describe. The hospital received Magnet designation on its second attempt.
Bumps in the road
Magnet designation recognizes healthcare organizations for quality patient care, nursing excellence and innovations in professional nursing practice. Presently, there are 395 Magnet hospitals worldwide. The ANCC would not release information on the number of hospitals denied designation on first or later attempts.
Why do some hospitals struggle? Reasons vary from facility to facility, said Jan Moran, RN, BSN, MPA, assistant director of Magnet operations for the ANCC, but the problem often involves reporting rather than doing the wrong thing in actual practice.
"They sometimes have difficulty presenting what they’re doing in their documentation," she said. "Others fail to talk about nurses at all levels of the organization, or they don’t give enough examples of how they’re fulfilling the requirements."
To achieve success on their Magnet journey, Moran said, hospitals should use resources available from the ANCC. Nursing leaders and staff can attend Magnet conferences and workshops, call the ANCC for clarifications or hire ANCC Magnet consultants to do a "gap analysis," an evaluation of what their organization may be missing.
Need for evidence
Not fully documenting how nurses were involved at John Muir Medical Center, Concord, Calif., might have been what tripped up the 313-bed facility’s first Magnet application, said Donna Brackley, RN, MSN, MA, NEA-BC, senior vice president of patient care services and CNO.
"When we were turned down in 2007, they said that we didn’t have enough evidence of 'enculturation’ of our shared governance structure," she said. "The structure was there, but the evidence that it was fully embedded in the organization and that the nurses demonstrated autonomy was apparently lacking."
After being denied Magnet status, the nursing staff at John Muir-Concord took some time to evaluate whether they wanted to try again. "I was director of professional practice at the time, and we really wondered whether we wanted to continue on the journey," Brackley said. "We wanted clear support from the nursing staff, and we ended up taking several years to prepare ourselves for reapplying."
Rather than focusing solely on Magnet designation, the nursing leaders at John Muir-Concord called the process "our pursuit of nursing excellence," Brackley said. The process spurred a redesign of the hospital’s nursing leadership councils and a revision of its professional practice model to make it easier to fully understand and explain.
The second time around, the staff had full ownership of the application process, Brackley said. "The pride at the time of the [second] site visit was nothing I had ever seen in my career," she said. The hospital received Magnet designation on its second try.
Pat Steingall, RN, MS, NE-BC, CNO and vice president of patient care services at Hunterdon Medical Center in Flemington, N.J., said most people aren’t aware the medical center was denied designation in 1996 because it had no nursing research program at the time.
"We were a little gun-shy about reapplying, but lots of hospitals in the state were getting Magnet designation," Steingall said.
Donna A. Cole, RN, PhD, CNOR, NE-BC, Magnet writer at Hunterdon, said about 30% of acute care hospitals in New Jersey have Magnet status, compared with 7% of hospitals nationwide. To address the issue, the nursing department systematically built research practice into the organization, teaching nurses how to do literature reviews, conducting research within the facility, getting nursing staff involved by attending research symposia and doing research posters and presentations nationally.
The result? Hunterdon received Magnet recognition in 2008.
Demonstrating shared governance
Although it is a requirement for Magnet designation, shared governance can be challenging for some facilities to address, Brackley said. At John Muir-Concord, nurses are represented by a union that does not advocate for shared governance.
After becoming the first California hospital to receive Magnet designation in 1997, the University of California-Davis Medical Center in Sacramento was not redesignated in 2006. Magnet site reviewers were greeted by nurses picketing during a contract renegotiation, and the public demonstration of discontent probably didn’t convey a positive image of nursing to the surveyors, said Carol Robinson, RN, MS, MPA, NEA-BC, FAAN, chief patient care services officer at the medical center.
Losing designation was a difficult experience, Robinson said. "We had the designation, were redesignated, and then lost it — and the staff was really devastated, even tearful," she said.
Robinson said she told the staff they don’t need external validation and that not getting the Magnet designation didn’t change how they practiced nursing or what they accomplished every day. "Our quality indicators were good, we had no problem recruiting nurses and our reputation hadn’t suffered," she said.
But a little more than a year ago, the movement for Magnet designation resurfaced among the nursing staff. "We started keeping the data and hired a full-time coordinator [to spearhead] the Magnet process," Robinson said. In addition, the Gordon and Betty Moore Foundation contributed $200,000 to pay for a gap analysis and for ANCC consultants to assess the organization before next year’s formal review. The organization has filed its application, with documentation due in February. "I still remember the pain of losing the designation," Robinson said, "but now it feels like being reborn." •
Barbara Bronson Gray, RN, MN, is a freelance writer.Write to editor@nurse.com or post a comment below.
