The American Nurses Credentialing Centers Magnet Recognition Program has become the standard of excellence to which hospitals across the country aspire. Its five components — transformational leadership; structural empowerment; exemplary professional practice; new knowledge, innovation and improvements; and empirical quality results — are geared toward providing a solid framework for nursing practice and research now and in the future. To get a better understanding of how the Magnet process has affected their nurses, we asked representatives of several local Magnet hospitals “Which of the components of Magnet do your nurses identify with most, and why?”
Tracey Boyd is a regional reporter. Janice Petrella Lynch, RN, MSN, is a regional nurse executive.
Maureen Altieri, RN, MS
Director, Professional Practice Good Samaritan Hospital Medical Center, West Islip, N.Y.
The one Magnet model component that our nurses identify with most is exemplary professional practice. This is evidenced by their focus on the pursuit of not only clinical excellence but also professional and academic excellence. Our nurses work within and among the disciplines to provide safe, effective and efficient high-quality care. As the true essence of a Magnet organization, this component promotes professional growth and development, which serves to enhance clinical outcomes related to nursing, patient and consumer outcomes, workforce outcomes and organizational outcomes. Good Samaritan Hospital Medical Centers nurses have assumed titled leadership roles, are seeking professional specialty certification, serve as active members and officers in professional organizations, and returned to school in pursuit of baccalaureate, masters and doctoral degrees. Our direct-care nurses are bedside leaders who participate in evidence-based practice initiatives and research projects that are essential elements in contributing to quality improvement, patient safety and a culture of excellence.
Ann Vanderberg, RN, MA, MBA, NEA-BC
Vice President, Nursing and Patient Services Hospital for Joint Diseases, New York, N.Y.
Structural empowerment is the component frequently identified by the staff that promotes their involvement in the Magnet designation journey. I frequently describe it as the foundation of all that we do. Our shared decision-making structure is a platform for creativity and innovation demonstrated though the professional practice model. Our nurses are generating outcomes in evidence-based practice, research, and quality while creating a culture of excellence where Magnet nurses can flourish. Since the beginning of our journey, nursing staff have championed the vision of nursing excellence. Through shared decision-making, nurses at every level are involved with decisions concerning patient care and professional practice. Giving nurses representation on hospital and interdisciplinary committees/councils provides nurses with an opportunity to participate in hospitalwide decisions. During the recent Magnet designation site visit, an appraiser asked staff nurse Keisha Ballentine, RN, BSN, CRRN, OCN, Why do you participate in these councils? She replied, Because it gives us a voice. It empowers us.
Susan B. Fowler, RN, PhD, CNRN, FAHA
Director, Magnet, Education, Quality and Research The New York Eye and Ear Infirmary, New York, N.Y.
Our nurses excel in the teaching and role development component. NYEE is primarily an ambulatory care center performing same-day surgeries and seeing patients in our clinics (ENT, eye and retina). Therefore, patient education is a big component of nursing care, preparing patients for discharge and/or self-care. Teachback is one strategy we use to validate patient and family understanding and application of knowledge. We are continually on a quest for the best educational resources for our clients. Because our patients may be seen in the clinic preoperatively then undergo surgery, be discharged home, and seen again in the clinic for follow-up, we try to make sure there is collaboration among the nurses on what teaching materials to use and tracking patient/family understanding of their surgical journey.
Ann Cella, RN, MA, MEd, NEA-BC
CNO St. Francis Hospital, Roslyn, N.Y.
Magnet designation has been described as a journey, an exploration of structure, process and leadership characteristics that define excellence in nursing care. Nurses at SFH integrate and demonstrate all the components of the Magnet model into their daily practice. The one component they identify with most, however, is exemplary professional practice. Using the SFH professional practice model, nurses assess, plan, implement and evaluate care in a variety of settings. Nurses at SFH are autonomous leaders, coordinating care with authority and using the best available evidence. Our nurses are leaders; they influence care decisions and become agents of change in a dynamic healthcare environment. This environment is supported by a culture of interdisciplinary collaboration in which professional nursing practice flourishes and succeeds in achieving extraordinary results. Visionary leadership guides and directs delivery of nursing care at St. Francis. This leadership has created an environment where the emphasis is on safe delivery of quality care.
Maureen Schneider, RN, MSN, PhD(c), MBA, NEA-BC, CPHQ, FACHE
Senior Vice President, Clinical Program Development, CNO Somerset Medical Center, Somerville, N.J.
RNs at Somerset identify the most personally with the shared governance structure. The structure is in place at both the unit and department levels and has empowered the nursing staff to govern themselves for their professional practice. Staff have embraced the council structure as they have experienced being change agents and making decisions to implement new processes and programs affecting their work environment and patient care. Councils at SMC have been in place for more than 10 years and have matured into a self-governance structure with six primary councils and a number of subcommittees for focusing on specific practice issues. The councils include education, process improvement, research, practice, professional development and informatics. Councils are all chaired by RNs with a nurse leader or advanced practice nurse as a facilitator for support of the chairperson. Each unit also has a council, including all levels of nursing personnel, and interdisciplinary team members to address unit-based issues.
Stephanie D. Conners, RN, BSN, MBA, NEA-BC
Senior Vice President, Nursing and CNO Robert Wood Johnson University Hospital, New Brunswick, N.J.
The most notable trait demonstrated by our Magnet nurses and interdisciplinary team members is their commitment to improving safety, service and quality outcomes for our patients and families. This highly developed team, striving for the fifth Magnet recognition in 2015, expertly uses each Magnet model component. The architecture and function of the Magnet model directs and advances nursing practice through the integration and inter-relationship between transformational leadership, structural empowerment, exemplary professional practice and new knowledge innovations and improvements. In turn, strong organizational structures and processes drive superior empirical outcomes. The Magnet component RWJ nurses most easily identified with is empirical outcomes. Our Magnet nurses critically appraise outcome measures, eagerly participate in research, and seek evidence-based solutions to improve safety, service and quality. RWJ nurses are empowered to lead teams, share in decision-making, and hold each other accountable in order to deliver exceptional personalized care. All of this is done with one unified purpose to improve the lives and quality outcomes of our patients, families and community at large.
Marianne J. Harkin, RN, BSN, MS, CNRN
Senior Director, Professional Practice and Obstetric Services NYU Langone Medical Center, New York, N.Y.
Our Magnet nurses identify most with exemplary professional practice. Interdisciplinary relationships are viewed as essential to providing our patients with the highest quality care. Nurses collaborate with other disciplines to ensure care is comprehensive, coordinated and monitored for effectiveness through the quality improvement model. Nurses assume leadership roles in interdisciplinary collaboration, and multiple departments within the hospital recognize that direct-care nurses consistently collaborate on day-to-day issues related to care of patients and families. Mutual respect is based on the premise that all members of the healthcare team make essential and meaningful contributions in the achievement of clinical outcomes. Interdisciplinary collaboration is evident with clear expectations and direction to all practicing nurses about the importance of partnerships with patients and families, and with other disciplines and professions to ensure a comprehensive plan of care.
Patricia S. Matos, RN, DNP
Magnet Program Director and Director of Nursing, Psychiatry The Mount Sinai Hospital, New York, N.Y.
The clinical nurses at Mount Sinai identify most with the Magnet component of exemplary professional practice. This component embodies the core of nursing practice care of the patient. The patient is the reason nurses become nurses. They are passionate about helping others. But passion alone is not enough to deliver high-quality care. There must be a framework and standards of practice that each nurse embraces and supports through his or her work. This component delineates, for instance, the Magnet requirements for a professional practice model, a care-delivery system, and structures and processes for quality care monitoring and improvement. Under the exemplary leadership of Carol Porter, RN, DNP, CNO and senior vice president of patient care services, Mount Sinai has adopted a variation of a relationship-centered model of nursing practice and is implementing it throughout our patient care services. Outcomes such as patient satisfaction will be examined. Within the model, there is a focus on direct and attentive communication between the nurse and the patient, family and interdisciplinary team. This, combined with the highly advanced technical systems in place here, provides patients with the most advanced technology in a setting of personalized care. Nurses participated in the development of this model, so it truly represents their philosophy and values.
Stephanie Goldberg, RN, MSN, NEA-BC
Senior Vice President, Patient Care Services and CNO Hospital for Special Surgery, New York, N.Y.
As the CNO of a three-time Magnet designated hospital, our primary goal is always better outcomes for our patients. The evidence-based approach found in a Magnet environment encourages compassionate care, research and professional education. The ultimate test of nursing success is how well our patients do. When nurses work at their highest potential and push themselves to provide the best, most professional nursing care possible, patients stay safe and make better recoveries. Our nurses are key players on the clinical team, and we are proud of our integral role in areas such as preventing UTIs, implementing a surgical safety checklist that has reduced our already low infection rate, implementing nursing-specific interventions to keep patients healthy during influenza season, and developing an interdisciplinary protocol that significantly reduced patient falls. Evidence of our success is our consistently high patient satisfaction scores.
Trish OKeefe, RN, MSN, NE-BC
CNO Morristown (N.J.) Medical Center
Our ANCC Magnet nurses at Morristown embrace the concept of empowerment daily. In caring for their patients in all types of settings, the nurses partner with medical staff and allied health to achieve the highest level of quality care. The nurses are empowered to be the patients advocate and voice when they cannot speak. Morristowns nurses also are accountable to practice at the full scope of their practice in designing policy throughout our shared governance framework organizationally and at the department level. This begins annually at our shared governance retreat to support the strategic goals of the organization and link to the practicing bedside nurses. MMC patient care and nursing goals are developed and implemented by our nursing staff and evaluated within the councilor structure. Examples of the empowerment structures include self-scheduling and staffing, specialty certification efforts, RN PACT Program (nursing recognition for patient care excellence), professional development and research efforts. Also, new areas of nursing empowerment include the new models of nursing care delivery, integrative healing arts and healing culture initiatives to enhance the patient and family experience driven by our bedside nurses. Our nurses also ensure as new nursing leadership transitions take place in nursing management that the key tenets of empowerment are embraced and facilitated by the new nursing leaders to ensure the culture of empowerment is sustained and supported.
Claudia Douglas, RN, MA, APNC
Manager, Clinical Practice and Nursing Research Hackensack (N.J.) University Medical Center
A Magnet-recognized organization since 1995, Hackensack UMC is on the journey to achieving its fourth redesignation. Inherent in the journey is the redesignation process, providing the operational gear through which organizations achieve, maintain and sustain this distinction of excellence. New knowledge, innovation and improvements in patient care and practice environment is the hallmark of Magnet recognition. Nursing knowledge is drawn from a multifaceted base and includes evidence that comes from science, experience and understanding. The main OR, led by Jennifer J. Pallotta, RN, BSN, CNOR, staff nurse, initiated an evidence-based project aimed at reducing hospital waste. Since initiating a recycling program, our preliminary results showed we increased our recycling in the OR to 34.1%. According to the American Nurses Association in 2010, healthy and safe care environments are sustained through multidisciplinary collaboration and nurses, the largest group of frontline healthcare professionals, are uniquely positioned advocates in creating, sustaining and applying evidence-based practice and research that improves health and maintains a safe healthy environment. Through our efforts, we are proud to have accomplished this goal.
Diane Applebaum, RN, DRPH, CIC
Administrative Director, Patient Care Services Hunterdon Medical Center Flemington, N.J.
HMC always has had a professional practice model but not a pictorial representation of it. Pat Steingall, RN, MS, vice president, patient care services, brought together nurses from all levels and roles to develop the PPM schematic. The team brainstormed about the true representation of HMC and the department of nursing. It became apparent a hot air balloon would be the central theme because it is a symbol of Hunterdon County. Nurses were invited to illustrate their vision of what the PPM should look like, including the nursing attributes that are important to us. The requirements were kept to a minimum to allow for creativity and innovation in the contest submissions. The entries depicted an oak tree balloon, a patchwork balloon, a computer-generated balloon, a hospital logo balloon, a nurses cap balloon, and a Florence Nightingale balloon. The Magnet steering committee was so impressed with all of the renditions that they incorporated them all in the final PPM, with the balloons depicting what we stand for and what is important to us: accountability, empowerment, advocacy, team building and autonomy. The balloons also signify nursing as always striving to go higher in reaching excellence.
Linda Geisler, RN, MNED, NEA-BC, FACHE
Vice President, Patient Care Services CentraState Healthcare System, Freehold, N.J.
CentraState Medical Center has been actively involved in community education for decades. During our Magnet redesignation site visit, CentraState nurses took great pride in showing appraisers the award-winning student health awareness center, where RNs, dietitians and lifestyle specialists offer programs about substance awareness, family life, general health, character education and other topics to students, teachers, scouts and parents. A highlight of the center is TAM, a transparent anatomical mannequin. The organs and systems of TAMs body light up as she explains their function and importance for overall health. Magnet appraisers also toured the new Michelle and Jennifer Tobias Adventure to Health. This high-tech wonderland is one of a kind. Children learn at 19 interactive health education exhibits. They can observe germs through a giant microscope, watch themselves travel through the body on a computer monitor, see and feel what is inside a nose and learn the importance of taking care of their health. These are only two exemplary examples of the community education provided by nurses at CentraState. Community education on preventive healthcare measures, screenings and education about chronic illnesses, such as diabetes, heart disease and lung disease, will gain greater significance as the Affordable Care Act is enacted and healthcare costs are contained.
Sheryl Slonim, RN-BC, DNP, NEA-BC
Executive Vice President, Patient Care Services and CNO Holy Name Medical Center
The most extraordinary accomplishment Holy Name nurses, including myself, realized during the Magnet journey is that the nursing and organizational culture here is transformational in nature. Every day, Holy Name nurses demonstrate that they excel in their profession as they creatively address issues and overcome obstacles. They care for our patients, pursue innovation and seek opportunities for professional development with a sense of personal commitment and an indefatigable energy that, I believe, is atypical among many of our colleagues. Change and growth in any healthcare institution can occur only if its nurses are in tune with the strategy for that change. The legacy of the Sisters of St. Joseph of Peace lives on in each and every nurse at Holy Name who is empowered to affect and determine the way care is delivered at the bedside. That empowerment was realized during the Magnet journey and continues as we raise the bar for redesignation.
Linda Carroll, RN-BC, MSN
Director, Professional Practice Saint Peters University Hospital, New Brunswick, N.J.
The component our staff identified with most during our Magnet journey was exemplary professional practice and living our nursing professional practice model. In 2010, we received Magnet designation for the fourth time, and the appraisers were very impressed with our model and the fact the nursing staff truly live the model and apply it to their professional practice. The journey to our professional practice model began in 2004, when the nurse practice councils developed the original practice model. It incorporated the philosophies of Nightingales calling, Watsons caring and Leiningers culture as the framework that would hold together the patient, family and community. In 2008, our shared governance model evolved into the professional practice council. A subgroup further evaluated the practice model, with the approval of our completed model in 2009. The framework of a star was created, recognizing the continued importance of nursing leading the path to excellence and quality outcomes for our patients. Our modifications allowed us to reach out in collaboration and take the interdisciplinary lead; it is a symbol of our commitment to excellence as our journey continues. The points of the star connected with five philosophical components to solidify the framework into one, which is encased within the Magnet principles. In 2011, we created a pedestal upon which the star would rest. The foundation supports a culture of quality and patient safety on which the Magnet principles and our nursing philosophy are based.
Micki Patrick, RN, MSN
Director, Magnet and Nursing Organizational Effectiveness Raritan Bay Medical Center, Perth Amboy and Old Bridge, N.J.
Nurses at RBMC identify most with structural empowerment, specifically in the domain of professional development. They are supported at RBMC through generous tuition reimbursements for courses and national certification programs, and annually we have increased the amount we spend on higher education for them. More and more, RBMC nurses are interested in returning to school or obtaining national certifications. Peers study together, take classes together and encourage one other. Through our professional development council, special teams helped to focus and motivate staff to achieve their BSNs or MSNs. RBMC has a clinical ladder Professional Achievement Career Enhancement program that promotes nursing job satisfaction and recruitment and retention. Special recognition and monetary rewards are given to nurses who meet the eligibility criteria in three areas: leadership, professional practice, and education and professional development. In 2012, we already have surpassed our 2011 goal for the total number of RNs who participate in the PACE program. Our nurses are proud of their professional growth and accomplishments.
Ruth Harrell, RN, BSN, MS, MN-BC
Relationship-based Care Manager; Nurse Manager, High Risk OB; and Magnet Content Writer St. Josephs Regional Medical Center, Paterson, N.J.
During our third Magnet redesignation journey, the nursing department at St. Josephs passionately identified with the professional practice model and care delivery system as its guiding light. Our professional practice model is a true representation of professional nursing care and practice at St. Josephs and is deeply rooted in the mission, vision and values of the organization, which is to render quality healthcare in northern New Jersey with a special concern for the poor and underserved. We designed and developed a professional practice model schematic, which served as our visual framework of nursing practice and depicts how nurses at St. Josephs practice, collaborate, communicate and develop professionally. It elucidates the nurses responsibility, authority and accountability for clinical decision-making and the outcomes of nursing practice. Our passion for nursing is operationalized through Jean Watsons caring theory and relationship-based care, which are the components of our professional practice model and care delivery system, and serves as the common thread throughout our Magnet journey.
Leigh Anne McMahon, RN, MSN, MHA, NEA-BC
Vice President, Nursing and CNO White Plains (N.Y.) Hospital
We received our Magnet designation in April, and our journey began about five years ago. The most rewarding part of the journey was to bring a voice to WPHs nurses. Introducing shared decision-making and developing our professional practice model were the first steps of our journey. A very tall nursing division was flattened by empowering nurses at all levels to work together to achieve successful patient outcomes, advance the profession of nursing and improve the work environment. We formed our first councils: the professional nurse practice council; professional development; and quality and informatics. It was very exciting to watch our nurses develop into Magnet nurses. Empowering nurses requires an organizational commitment to shift power to the caregivers. Once the decision is made to support shared decision-making, the nurse leadership team must live and breathe this structure. Our shared decision-making grew rapidly. We now have a very robust structure with more than 12 councils and very active unit councils, which include infection control liaisons, finance, night council, education, patient education, medication management and others, representing all the processes involved with nursing care or the professional nurse. Each council takes its domain very seriously. Our shared decision-making structure has transformed our nurses and the hospital. The value of Magnet designation has delivered a strong message to all of us that the power of nursing is critical to the success of healthcare.
Ann Marie Leichman, RN, MSN, NEA-BC
Vice President, Patient Care Services and CNO The Valley Hospital, Ridgewood, N.J.
As a Magnet organization going for our third designation, we pride ourselves on effectively measuring our performance on producing positive patient outcomes and having an environment rich in nursing research and evidence-based clinical practice. As our Magnet journey evolves into an unfaltering pursuit of excellence, we have found we need to be more diligent in measuring interventions or outcomes before beginning a change. Magnet requires facilities to show pre-data as part of the measurement for improvement. I and many of the nurses at my organization involved in performance improvement were surprised to find we sometimes implemented change without completely measuring our current state. This valuable lesson has helped us reframe our thinking. Now, nurses implementing changes in clinical practice have learned to answer the simple question, Where are we now? before a change. Pre-and-post data lead them back to knowing whether they made a difference in their patients lives.
Maggie Adler, RN-BC, MSN, WCC
Associate Director, Quality and Standards Hudson Valley Hospital Center, Cortlandt Manor, N.Y.
The Magnet component that resonated with us was exemplary professional practice, and the role of the nurse in relationship to patients, families, interdisciplinary colleagues and the community was the core of our facilitys Magnet application. The nurse as knowledge worker reflects how staff nurses apply new knowledge in practice, demonstrating what nurses engaged in practice can achieve. Five exemplars were cited by the Magnet surveyors at our redesignation site visit. The first two, peer mediation and peer review, were cited as cutting-edge programs that emphasize a focus on open and honest communication in a structured and supportive environment. Peer review for nursing had begun to change the professional culture, and the surveyors acknowledged our facilitywide approach to risk assessment and error management. A third exemplar was a nurse-led interdisciplinary anticoagulation management program, which exceeded Magnet expectations. Our Leadership Development Institute and a staff nurse-driven breast-feeding community support group, developed as we pursue baby-friendly status, involved use of internal experts. We are proud of our professional, accountable, compassionate staff nurses who live out their Magnet-ness every single day.