The Power of the Magnet Hospital Credential Excellence in Nursing.ppt

thepowerofthemagnethospitalcredential excellenceinnursing colleenj goode rn phd faan cnaavicepresidentpatientservicesandchiefnursingofficeruniversityofcoloradohospitaldenver colorado usacolleen goode uch edu healthcarecongresshamburg germanynovember2 2007 overview briefhistoryofmagnethospitalsmagnetstandards methodsforachievementresearchrelatedtomagnethospitalsmagnetprize evidence basedpractice historyofinitialmagnethospitals 1980 americanacademyofnursesstudyidentifiesfactorsassociatedwithattractionandretentionofnursesdataonvacancyratesgathered survey dataonworkenvironment interviews 1983 studypublished hospitalscalled magnethospitals becausetheycouldattractandretainnurses41hospitalsdesignatedasmagnet history continued qualityofnursingleadershiporganizationalstructurepersonnelpolicies proceduresnursesasteachersimageofnursingcollegialnurse physicianrelationshipmanagementstyle qualityofcareautonomyqualityimprovementconsultation resourcescommunityinvolvementprofessionaldevelopmentprofessionalmodelsofcare fourteenforcesofmagnetismidentifiedinmagnetstudyandpublishedin1983 historyofcurrentmagnethospitalprogram 1990 americannursesassociationboardofdirectorsapprovedanewmagnethospitalrecognitionprogram1991 americannursescredentialingcenter branchofana assignedprogramoversight ancc commissiononmagnetrecognition standardsdevelopedappraiserselectionandtraining1994 pilotproject study with5hospitalsusingnewstandards1994 universityofwashington seattle washington firstmagnethospital2007 251designatedmagnetfacilitiesin44statesand1inaustralia standards baseduponthe americannursesassociation ana scopeandstandardsfornurseadministrators purchasefromana purchasethemagnetservicesrecognitionprograminstructionsandapplicationprocessbookfromtheamericannursecredentialingcenterconductinternalreviewtodeterminereadinessidentifystrengths weaknessesdeterminewherenotmeetingstandardsimplementcorrections standards continued manualtellswhatarethecomponentsofeachofthe14forcesandwhataresourcesofevidenceyoumustprovideexamplestandard qualityofnursingleadershipcomponent thechiefnursingofficerisaccuratelyperceivedbyallemployeesasrepresentingnursingatthehighestlevelofthegoverningbodytotheenvironmentinwhichnursingispracticed sourceofevidence giveexamplesfromseveralnursingunitsofadvocacybythecnoonbehalfofstaffforftes systems equipment personnelsupport etc internalprocessforsuccess magnetsteeringcommitteemagnetdirector coordinatorcnoinvolvement memberofsteeringcommitteesteeringcommitteememberswritehowstandardsmetandgatherevidencetodemonstratebringwrite upofhowstandardsmetandevidencetosteeringcommitteeforfurtherreview submissionofmaterials notebooksthatincludewrite upofhowhospitalmetstandardanddocumentsthatprovidesupportingevidence magnetprogramappraisers reviewwrittenmaterials asksforadditionalmaterials ifnecessaryscoresdocumentsaccordingtoestablishedprocessifpass schedulesasitevisitof2to3appraisersappraiserteamspends3to5daysathospital validatingwhatwassubmittedappraisersscorevisitandsubmittothecommissiononmagnetrecognitionthecommissionreviewsreportsandratesachievementofmagnetstatusmagnetofficenotifiestheapplicantofoutcome magnethospitalresearch instrumentsdevelopedtomeasureworkenvironmentsurveyinstrument nursingworkindex nwi bydr kramerbaseduponherresearchonmagnethospitals 1989 nwiinstrumentrevisedbyaiken patrician 2000 developmentofpracticeenvironmentscaleofthenursingworkindexbylake 2002 essentialsofmagnetismtooldevelopedbykramer schmalenberg 2004 researchrelatedtomagnethospitals firststudybyaiken lake etal 1997 20urbanhospitals10haddedicatedaidsunitsand10didnot3ofthecomparisonhospitalsweremagnet2medicalunitsanddedicatedaidsunits whenpresent werestudied studied1 205patientrecordsandinterviewed594patientsregardingsatisfactionwithcarenursesurveyusingrevisednursingworkindex aiken 1997 study continued outcomesbothmagnethospitalsanddedicatedaidsunitshad greaterautonomybetternurse physicianrelationshipsnursesinmagnethospitalshadlowerlevelsofemotionalexhaustion aiken sloane 1977 andlowerlevelofneedle stickinjuries aiken sloane klocenski 1997 patientsatisfactionhighestinmagnethospitals studyofmortalityrates matched39magnethospitalswith195controlhospitalsmagnethospitalshad7 7 mortalityrate 9feverdeathsper1 000dischargesthancontrolhospitals aiken smith lake 1994 magnetresearchbyfrederick 2003 relationshipofmagnethospitalandnursejobsatisfaction nursesemployedatmagnethospitalscomparedtonon magnetmagnethospitalnursesexperiencedhigherlevelsofempowermentandjobsatisfactionelementsaccountingfordifferencesaccessibilityofmagnetnurseleaderssupportofnursedecision makinggreaterworkempowerment structuresandresources internationalstudybyaiken usednwi r 700hospitalsin5countries usa canada england scotland germany 43 000nursessurveyedineachcountry asizeableminorityofhospitals 20 rankedhighontraitscommontomagnethospitalsintheusasuggestshospitalsinothercountriescouldqualifyformagnetstatus aiken sochalski 1997 1999 magnetstatus registerednurseviewsoftheworkenvironment randomsampleof3 500rns uslicensednursescomparedmagnet onjourneyandnon magnetmagnetorganizationsweremorelikelynottoseetheshortageasaproblemmagnetsmorelikelytoreportovertimeasstrictlyvoluntaryandnotrequired45 ofnursesinmagnethospitals andthoseinprocesstobecomemagnet believedemphasisonpatientcareasastrongpriorityintheorganization while26 ofthoseinnon magnetstronglyagreed magnetstatus registerednurseviewsoftheworkenvironment cont d opportunitiesforprofessionaldevelopmentanddecision makingratedhigherbyorganizationsinprocessofmagnetstatusmagnetsratedrelationshipbetweennursesthehighestmagnetandin processorganizationsweresignificantlymorelikelytoobserveincreasedeffortsforrecruitingandretention ulrich buerhaus donelan etal 2007 kramer schmalenberg 2002 8essentialsoftheworkenvironment interviewed289staffnursesin14magnethospitalswhatareessentialelementsoftheworkenvironmenttodeliveryqualitycare rankorder workingwithclinicallycompetentnursesgoodnurse physicianrelationshipandcommunicationnurseautonomyandaccountabilitysupportnursemanager supervisorcontrolovernursingpracticesupportforeducationadequatenursestaffingculturewhereconcernforthepatientisparamount furtherevidenceonthemagnetrecognitionprogram schwartz 2005 sampleof470rns 173frommagnethospitals 297fromnon magnet direct careprovidersrandominvitations 6hospitalsagreedtoparticipate 3magnet 3non magnetoutcomesmagnethospitalssignificantlyhigherlevelsofoveralljobsatisfaction mccloskey muellersatisfactionscale 1990 magnetnurses morelikelytoremainincurrentposition intenttostay anticipatedturnoverscale 1982 interrelationshipoforganizationalcharacteristicsofmagnethospitals nursingleadershipandnursingjobsatisfaction upenieks 2003 comparedconveniencesampleofclinicalnursesfromtwomagnethospitalsandtwocomparisonnon magnethospitals sampledallmedical surgicalnursesnwirquestionnaire aiken patrician 20020 conditionsofworkeffectivenessquestionnaire laschinger wong 1999 outcomesnursesatmagnethospitalshave higherlevelofempowermentandjobsatisfactiongreateraccesstonurseleadersgreatersupportofdecision makingbynurseleadersgreateraccesstoresources informationandopportunities magnetprizefortheuniversityofcoloradohospitalawardedin2004 evidence basedpracticeproject managementofalcoholwithdrawal protocoladopteduseofclinicalinstitutewithdrawalassessment ciwa alcoholscaleinter raterreliabilityr 80andconstructvaliditysymptomtriggeredtherapypatientsmonitoredusinganassessmentscaleandmedicatedonlywhensymptomscrossathresholdofseverity evidence basedpracticeproject managementofalcoholwithdrawal resultsofstudy evidence basedpracticeproject painmanagement developmentofpainperformanceimprovementteamwith5subcommitteespainassessmentpoliciesandproceduresstaffeducationpatienteducationpainoutcomeswaronpainconferencedevelopmentofpainchampionsofchangeprogramwildascaletomeasurepain evidence basedpracticeproject painmanagement painreassessmentscores skinchampionsofchangepressureulcerpreventionprotocoltherapeuticsurfacesserveasadjunctstocareandarenotreplacementsforfrequentrepositioning nursingstandardofcareofpreventionofpressureulcersandskinbreakdown allpatients turnpatientevery2hoursandprn1 4hob45oifpatienthasriskforpulmonarycomplications increaseturningfrequency moisturizeskindailyandprn1 4controlmoisture determineandtreatcauseofmoisture applymoisturebarriercreamsasneeded1 2nutritionalconsultifalbumin 3 4g dland orpre albumin 20mg dl1 2maximizeuseofturningsheetsandslideboardstomovepatient 1 2cwocnrnconsult amiekirkwoodrncwocn ifstageiii ivorunstageablepressureulcerpresent bariatricpatients 300lbs bradenscore 13useauchbariatricbed bradenscore 13kcibariatricbed braden 9kcibariairreferences ratliff c r etal 2003 guidelineforpreventionandmanagementofpressureulcers woundostomyandcontinencenursessociety lakeavenue glenviewil u s departmentof