Building a Magnetic Environment

International Global Centre for Nursing Executives Building a Magnetic Environment Executive Guidance and Support Marguerite B. Lucea, PhD, MPH, RN Senior Consultant LuceaM@advisory.com

2 Rising Interest in Magnet Recognition Programme Recent Publications Highlighting Need for Magnet Recognition Programme in the UK March 2015 Shape of Caring: A Review of the Future Education and Training of Registered Nurses and Care Assistants HHE should establish an expert group to examine the potential and implications of developing and implementing Magnet principles to improve education of the workforce and patient outcomes July 2015 The Magnet Recognition Programme: A discussion of its development, success and challenges for adoption in the UK Nursing has come a very long way in recent decades and now boasts a refined skill-set covering clinical excellence with strong patient interface and relationshipcentred care. Magnet s role has been to encourage care providers to recognise and embrace this vital contribution supporting nurses as partners in the formulation and delivery of care. Source: Lord Willis of Knaresborough, Shape of Caring: A Review of the Future Education and Training of Registered Nurses and Care Assistants, Health Education England, March 2015; available at: http://hee.nhs.uk/wp-content/blogs.dir/321/files/2015/03/2348-shape-ofcaring-review-final.pdf; Royal College of Nursing, The Magnet Recognition Programme: A discussion of its development, success and challenges for adoption in the UK, RCN Policy and International Department, July 2015, available at: http://www.rcn.org.uk/ data/assets/pdf_file/0011/634790/9.15-the-magnet-recognition-programme_a-discussion-of-its-development,- success-and-challenges-for-adoption-in-the-uk.pdf; Advisory Board interviews and analysis.

3 Staffing Crisis is Behind This Rising Interest Present Day Staffing Crisis in the UK The Guardian, 2015 Nursing chief: Nurse shortages are life-threatening Daily Record, 2014 NHS jobs SOS: Patient care at risk as health boards fail to fill consultant, midwife & nurse positions Past Staffing Crisis in the US New York Times, 2002 Shortage of Nurses Hurts Patient Care, Study Finds Reader s Digest, 2003 Condition Critical: With nurses leaving in droves, a stay at the hospital gets scarier every day 83% Percentage of UK organisations reporting qualified nursing workforce shortages in 2014 survey 1 125,000 Estimated shortage of full-time hospital registered nurses in the United States in 2002 1) Percentage based on NHS service providers surveyed by NHS Employers; n=109 organisations. Source: Grady D, Shortage of Nurses Hurts Patient Care, Study Finds, New York Times, 30 May 2002; Pekkanen J, Condition: Critical; With nurses leaving in droves, a stay at the hospital gets scarier every day, Reader s Digest, September 2003; Mulholland H, Nursing chief: Nurse shortages are life-threatening, The Guardian; 2015; Aitken V, NHS jobs SOS: Patient care at risk as health boards fail to fill consultant, midwife & nurse positions, Daily Record; Keenan P, Kennedy JF, The Nursing Shortage: Causes, Consequences, Proposed Solutions, The Commonwealth Fund, April 2003; NHS Employers, NHS Qualified Nurse Supply and Demand Survey Findings, May 2014; Advisory Board interviews and analysis.

4 Attracting, Retaining Nursing Staff Among Shortages History of Magnet Recognition Program 1983 Hospitals look to learn what draws nurses to certain organisations with impending nursing shortage. AAN 1 Task Force study identified work environment characteristics known as Forces of Magnetism 2000 Dramatic nursing workforce shortages projected in US. Hospitals actively seek to create magnetic environments. Magnet expands internationally 2013 Magnet status still rare with fewer than 7% of all registered hospitals in the US holding ANCC Magnet Recognition status 1990 Magnet Hospital Recognition Program for Excellence in Nursing Services established 2008 New conceptual model introduced, grouping 14 Forces of Magnetism into five key components Role Models of Nursing Care Magnet hospitals are international models for nursing care. Other hospitals look to Magnet organizations for ways to improve patient results, reduce hospital stays, and attract and keep the most qualified nursing staff. American Nurses Credentialing Center 1) The American Academy of Nursing. 2) American Nurses Association. http://www.nursecredentialing.org/magnet/international/magnetprogo verview/magnetprogfaq.html

5 Magnet Model for Excellence in Nursing Practice Five Components of the Magnet Model Structural Empowerment Transformational Leadership Empirical Outcomes Exemplary Professional Practice New Knowledge, Innovations, & Improvements Source: American Nurses Credentialing Center, ANCC Magnet Recognition Program, http://www.nursecredentialing.org/magnet.aspx; Advisory Board interviews analysis.

6 Five Components of the Magnet Model The Five Components of the Magnet Programme Model Transformational Leadership Structural Empowerment Exemplary Professional Practice New Knowledge, Innovations, Improvements Empirical Outcomes Nursing leaders at all levels of a Magnet recognised organisation must demonstrate advocacy and support on behalf of staff and patients to transform values, beliefs, and behaviors. Nurses throughout Magnet -recognised organisations are involved in shared governance and decision making structures and processes to establish standards of practice and address opportunities for improvement. Exemplary professional practice in Magnet -recognised organisations is evidenced by effective and efficient care services, interprofessional collaboration, and high-quality patient outcomes. Magnet -recognised organisations integrate evidencebased practice and research into clinical and operational processes. The empirical measurement of quality outcomes related to nursing leadership and clinical practice in Magnet recognised organisations is imperative. Source: Magnet Model, American Nurses Credentialing Center, http://www.nursecredentialing.org/magnet/programoverview/newmagnet-model; Advisory Board interviews and analysis.

7 Applying for Magnet Designation Overview of Magnet Application Process 1 2 3 Get Started Magnet is open to public, private and charitably-funded healthcare organisations Application process requires appraisal fee calculated according to number of beds within institution Confirm Credentials Written documentation proving educational background of nursing staff, compliance with national regulations, etc Data collection tables and forms available on secure application portal to confirm credentials in all components Site visits scheduled to audit these submissions Maintain Status Upon receiving accreditation, organisations move into monitoring and evaluation phase Annual evaluations take place each of the four years the award is valid in order to maintain status Award must be renewed or it will lapse Journey Towards Magnet Designation Source: Royal College of Nursing, The Magnet Recognition Programme: A discussion of its development, success and challenges for adoption in the UK, RCN Policy and International Department, July 2015, available at: http://www.rcn.org.uk/ data/assets/pdf_file/0011/634790/9.15-the-magnet- Recognition-Programme_A-discussion-of-its-development,-success-and-challenges-for-adoption-in-the-UK.pdf; Magnet Program Overview, American Nurses Credentialing Center, available at: http://www.nursecredentialing.org/magnet/programoverview; Advisory Board interviews and analysis.

8 Impact of Hospitals with Magnetic Environments Example Outcomes From Magnet Hospitals Estimated Vacancy Rates 1 14% 8.1-16.0% US National Average Lower odds of mortality for patients treated at Magnet -designated hospitals 2 3.6% Magnet -Designated Hospitals 1.5M Estimated cost savings possibly achieved through improvements in Magnet -designated hospitals 3 Direct Impact on Outcomes Staffing alone does not ensure better patient outcomes...it is a healthy work environment fostered by a Magnet journey that has been proven to improve patient outcomes. The Magnet journey has helped raise the level of RN 4 professionalism in every organisation I ve worked with. Gen Guanci, Med, RN-BC, CCRN, Consultant at Creative Health Care Managerment 1) Vacancy rate in Magnet-designated hospitals across the United States as of October 2009 is 3.64%, with reported national vacancy averages in 2007 at 8.1% to 16%, depending on the specialty and the region of the country. 2) While controlling for nursing factors as well as hospital and patient differences. 3) The range of cost savings that can be possibly achieved for a typical 500-bed hospital is estimated between $2,308,350 and $2,323,350 (US dollars). Cost estimate based on the literature of improvements in Magnet hospitals and using the data assumptions of a typical 500-bed hospital, to determine cost opportunities and a potential return on investment for a hospital. 4) Registered nurse. Source: McHugh M, et al., Lower Mortality in Magnet Hospitals, Med Care, 51, no.5 (2013): 382-388; Drenkard K, The Business Case for Magnet, Journal of Nursing Adiministration, 40, no.6 (2010): 263-271; Guanci G, Why Magnet Designation is Worth It, Creative Health Care Management, available at: http://www.chcm.com/wpcontent/uploads/2014/07/is%20magnet%20designation%20worth%20it%20redo%2020 14%2005%2015.pdf; Advisory Board interviews and analysis.

9 Learning From Magnet Hospitals Around the World Magnet Designated Facilities Canada (1 facility) Lebanon (1 facility) Australia (3 facilities) 80% Percentage of Magnet -designated facilities with Advisory Board memberships USA (~400 facilities) Saudi Arabia (2 facilities) Source: Find a Magnet Hospital, American Nurses Credentialing Center, http://www.nursecredentialing.org/findamagnethospital.aspx; Advisory Board interviews and analysis.

10 Magnet recognition is not a checklist of achievements, but rather an enculturation of values, standards, vision, commitment, and pride. It is important to remember that each organization is different and is at a different place in their development at any one time. S.Pinkerton, The Magnet view: pursuing ANCC Magnet recognition as a system or individual organisation. Source: Pinkerton S, The Magnet view: pursuing ANCC Magnet recognition as a system or individual organisation, Nursing Economics, 26, no. 5 (2008): 323-324; Advisory Board interviews and analysis.

11 More Than Teaching to the Test Executive Guidance and Lessons Learned Pearls of Wisdom From Executives That Have Achieved Magnet Designation Magnet Requires Long-Term Organisational Commitment Attaining and sustaining Magnet designation is about the journey, not the destination Continuous effort must be devoted to instilling the values behind Magnet principles Key Stakeholders Must Be Involved Along the Way It is imperative that staff are informed, engaged during initial stages Staff at all levels should be involved in project planning and preparation to ensure they are aware of upcoming changes Success Relies on a Cultural Shift The journey will require a shift in mindset, common language, and mutual goals This cultural shift is necessary in order for continuous improvement to be effective and sustainable Careful Planning, Preparation are Essential Spend time before application to ensure your organisation s readiness, and strong structures, processes are in place to support your journey Educate yourself and key stakeholders about the process; utilise networking opportunities Source: Guanci G, Magnet Designation: Why it Matters and What You Need to Know, Creative Health Care Management, available at: http://a1265.actonsoftware.com/acton/fs/blocks/showlandingpage/a/1265/p/p- 0212/t/page/fm/0?sid=MBHiikkbU; Broom C, Tilbury MS, Magnet status: a journey, not a destination., Journal of Nursing Care Quality, 22, no. 2 (2007): 113-118; Advisory Board interviews and analysis.

12 How We Can Help You on Your Journey Key Ways the Global Centre Can Help Organisations Create a Magnetic Environment Getting Staff on Board Educate, Enfranchise Staff Motivating, Inspiring Staff Communicating Changes, Expectations Encouraging Shared Ownership of Goals Prepare the Organisation Identify Improvement Opportunities Pinpointing Key Metrics Identifying Best Practices Implementing Practices Sustain the Momentum Reevaluate, Adapt Practice Hardwiring Best Practice Measuring Performance Adapting, Evolving Practice Source: Advisory Board interviews and analysis.

13 Support in Achieving Structural Empowerment Global Centre Resources, Tools for Implementing Shared Governance Structural Empowerment Motivating, Inspiring Staff Communicating Changes, Expectations Encouraging Shared Ownership of Goals Pinpointing Key Metrics Identifying Best Practices Implementing Practices Hardwiring Best Practice Measuring Performance Adapting, Evolving Practice Customisable Shared Governance Enfranchisement Presentation Member-Led Webconferences Decision-Making Needs Assessment Decisional Involvement Scale International Case Studies Shared Governance Impact Assessment Suggested Performance Metrics Library of Additional Resources Source: Advisory Board interviews and analysis.

14 Magnet Framework, Key Global Centre Resources Five Components of Magnet and Key Global Centre Resources Transformational Leadership Tools for Building a Best-in-Class Communication Strategy The Manager s Problem-Solving Toolkit Structural Empowerment Tools for Implementing Shared Governance Member-Led Webconferences Exemplary Professional Practice Elevating the Patient Experience Toolkit Safeguarding Against Nursing Never Events New Knowledge, Innovations, & Improvements Tools to Foster Meaningful Staff Input Tools for Encouraging Individualised Career Planning Empirical Outcomes Ready-to-Use Diagnostics Practice Impact Assessments Source: Advisory Board interviews and analysis.

15 Global Centre s Dynamic Magnet Crosswalk Snapshot of the Global Centre s Dynamic Magnet Crosswalk Tool Filter resources by Magnet component or sub-component Title and description provide quick summary of each resource Hyperlink will take you directly to the tool, best practice, webconference, or service on our website To use our Dynamic Magnet Crosswalk to find all Global Centre resources aligned to ANCC's Magnet programme, visit: www.advisory.com/international/gcne Source: Advisory Board interviews and analysis.

16 Questions & Answers