Magnet status awarded after lengthy evaluation of nursing program
Pictured are members of the Magnet Task Force at the University of Texas Medical Branch at Galveston with Magnet appraisers from the American Nurses Credentialing Center. Front row, from left, are Kleanthe Caruso, Scott Woodby, Ruth Sathre, Charlotte Dison (ANCC team leader), Meredith Hartzog and Margaret Grue. In the back row are Ellarene Duis, Suzanne Couture, Gail Johnson (ANCC appraiser), Cindy Lyons (ANCC appraiser) and Lila Muzik.
UTMB nurses demonstrate professionalism to earn premier Magnet recognition
By John Koloen
MAY 10, 2005--The conference call April 19 lasted only about 10 minutes, but represented the culmination of four years of effort, 3,000 pages of documentation, and thousands of hours of labor by UTMB nurses and their colleagues. Members of the Magnet Task Force, Management Magnet Work Group, Nursing Cabinet, and nursing directors joined David Marshall, chief nursing officer and executive director, and Karen Sexton, chief executive officer and vice president, to hear the news. When all was signed, sealed and delivered, UTMB had reached a milestone of institutional professionalism by earning Magnet Recognition from the American Nurses Credentialing Center (ANCC).
Benefits of Magnet recognition cascade across hospital operations, affecting everyone from nurses to patients. According to ANCC, Magnet designation “serves to attract and retain quality employees. Magnet designation helps consumers locate health care organizations that have a proven level of excellence in nursing care.”
Only about 150 hospitals in the U.S. are designated as Magnet Hospitals. Ellarene Duis, project director Magnet Recognition/Shared Governance, said “The thing that got me really interested in Magnet was when we were working on a quality project having to do with patient falls or length of stay or patient safety or something like that then we would see something in the literature or in a conference presentation about Magnet standards dealing with the same issues.”
Duis said she’s been dealing with the issues of nurse retention and recruitment her entire career. The beauty of following the Magnet roadmap is, “In the course of putting in other improvements, we were able to make significant reductions in both vacancy and turnover in the four years that we worked on this,” she said. “Magnet gave us a structure. If we worked toward meeting the intent of the magnet standards, then we were dealing with our own improvement in a coordinated, comprehensive way, instead of just having all these scattered efforts going on trying to address the same things.”
After Chief Nursing Officer David Marshall agreed to pursue Magnet recognition in 2001, a task force made up of mostly nurse clinicians examined Magnet standards to determine where UTMB stood. “We started working on developing shared governance for nursing because we didn’t have in place a model that assured that nurses at the bedside had a voice in clinical decisions and things that affected their immediate work environment. That was probably our biggest effort.”
By February 2002, Nursing Service Councils were organized to focus on quality, workplace/environment, recruitment/retention, practice, education and research. The Nursing Cabinet started in June. By October, UTMB submitted the initial application for Magnet recognition to ANCC.
While Duis coordinated the Magnet process (the job became full-time in May 2003), members of the nursing councils focused on individual Magnet standards. Fourteen Forces of Magnetism guide institutions in their quest for Magnet recognition. These forces include such elements as quality of nursing leadership, organization structure, professional models of care and professional development.
In May 2004, UTMB submitted to ANCC its initial Magnet documentation and exhibits, totaling seven volumes covering 2,500 pages. By July, Duis was collaborating with others across Nursing Service and developing and compiling an additional 500 pages of documentation ANCC requested, which she submitted in August.
In order to disseminate information illustrating the principles of UTMB’s nursing bylaws and the Forces of Magnetism in a timely way, the Magnet Task Force and Management Magnet Work Group distributed fliers on these topics.
For each of 14 weeks between August and October, nurses throughout UTMB received a flier that focused on a single Force of Magnetism, and another flier focusing on one of the bylaws. An example is the Force 13 flier, which focused on Interdisciplinary Relationships. According to Force 13, “Interdisciplinary relationships are characterized as positive. A sense of mutual respect is exhibited among all disciplines.”
The Force 13 flier offered examples of how nurses in the Labor and Delivery/Birth Center demonstrate positive relationships with other professions. Susan Smith, member of the Best Practice Committee and the Nursing Products Review Committee, Nancy Johnson, co-chair of the Nurse Practice Council and member of the Nursing Cabinet, and Michelle Selvera, member of the Recruitment and Retention Council, developed the flier.
The narrative details the way in which labor and delivery nurses worked with pediatric physicians, pediatric nurse clinicians, social workers and clergy to assure the best care for patients who delivered premature infants or who suffered a fetal loss. The flier’s two solid pages of narrative makes clear what Force 13 involves and what it looks like when implemented.
Duis notes that 42 nursing units developed unit-specific examples of the 14 Forces of Magnetism. This occurred between Dec. 1, 2004, when the site visit schedule became known, and the actual three-day visit in February 2005 by Magnet Appraisers. This is where the process gets interesting, and it’s why all nursing staff had to have a working knowledge of the Forces of Magnetism.
During this period, “We did practice visits to all of the units,” Duis said. “We did two rounds of those. We had all the units practice their presentations.”
Two to three weeks before the site visit, the Magnet Appraiser team leader outlined what she expected to see during the unit visits. She expected a description of a unit initiative, demonstrations of how each unit implemented one or two of the Forces of Magnetism and a discussion about a patient case study or other patient care activity that the unit was proud of.
Magnet task force members held question and answer sessions for two months with evening and night staff because the ANCC appraisers had the option of visiting off-shifts.
During the actual site visit, the appraisers spoke with staff. “They asked us to identify all people in nursing who had birthdays on the ninth, 10th or 11th of any month of the year,” Duis said, totaling some 170–180 people. The appraisers then randomly selected people from that list. “If they worked the day shift, they were invited to the lunch meeting,” she said. “If they worked evenings, nights or the 7 p.m. shift, then they were invited to a meeting at 5:30.” The appraisers met with 80–90 staff.
“We had no idea exactly what they were going to ask them or who they were going to ask,” Duis said. “We tried to prepare all of those people, give them briefings and provide opportunities to ask any questions they might have about Magnet and how UTMB demonstrated the forces of magnetism.”
From the first day of the site visit, nursing staff felt confident about the outcome. “We were getting very positive feedback from the appraisers and we felt we were forming a really positive relationship with them,” Duis said. “The visits to the units and the unit stories were going really great. The appraisers were able to see the nursing excellence that we always knew our Nurse Clinicians and nursing staff provided every single day.”
The site visit concluded on the third day with closing remarks by the appraisers. They came into contact with more than 500 nurses and other members of the health care team during their visit. A group of nursing staff then cheered and applauded the appraisers and, as a final coda on what had become a very positive experience, serenaded them with “The Eyes of Texas.”
Surprisingly, the serenade ended up in the appraisers’ final report. “It was so unique and it had never happened to them before,” Duis said.