Eddie Beard, RN, MSN, CNAA

1
Why are there 57 Google search pages r/t
Magnet Designation?

• Eddie Beard, RN, MSN, CNAA
• April 10, 2008

2

Expand perspective on why attain Magnet
designation.
CHANGE THEORY
HISTORY
VALUE
CRITICISMS

• Understand the cost and benefits of attaining
  Magnet designation.

ADVICE
3
My experience

• 2 Magnet Applications as CNO
• 13 Times as Appraiser (since 2001)
• 10 of 12 progressed to site visits
• 3 of 10 were denied after site visit
• 1 application in review process
• 4 Times as Appeals Panel Member

18 APPLICATIONS
4
OUR TYPICAL VIEW OF HOW CHANGE HAPPENS
CHANGE
TIME
5
Rogers Diffusion of Innovation Theory

• Change is not an instantaneous act but an
  uncertainty reduction process and very much a
  social process.
• Elements
• Innovation
• Communicated over time
• Through a social system

6
Diffusion of Innovation Theory

• Individuals go through
• Information gathering (knowledge)
• Critical Analysis (persuasion)
• Decision to adopt or reject the idea (decision)
• Implementation
• Final judgment (confirmation)

Once adoption of an innovation reaches
approximately 20 to 30, a critical mass is
reached and adoption continues with or without
change agents efforts.
7
Adoption of an Innovation
8
S Curve of Change
9
Nursing History

• Medicine
• 243 Years

1779 -- Law 229 Years
Crimean War Florence Nightingale
1st Trained Nurse
1st Nurse Practice Act
1st College Based Nursing Courses
1st Autonomous Nsg School -- Yale
Diploma Education
ADN Education
BSN Education
Masters Education
10
Paternalism and Nursing

• Nurse/Doctor Game
• Usually those that get there first WIN!

11
9 Commission Seats are Role Specific

• CNO of a Magnet designated organization
• Staff nurse
• Advanced Practice Nurse
• Nurse Manager
• Representative from ANA Congress on Nursing
  Practice and Economics
• AONE Representative
• Representative from American Academy of Nursing
• A non-nurse consumer/public member
• Long-term care
• Originated study in the 80s

12
14 (39)
38 (107)
49 (139)
285 MAGNET FACILITIES 2 AUS/NZ
13
Program Growth
285 Applications in pipeline
14
Magnet is where

• Nursing delivers excellent patient outcomes
• Nurses have a high level of job satisfaction, and
• There is a low staff nurse turnover rate and
  appropriate grievance resolution
• Nursing involvement in data collection and
  decision making in patient care delivery
• ANCC

VALUE
15
Magnet Impact

• Other health care disciplines
• Physicians
• Pharmacists
• Support Personnel
• Magnet employee pin created due to requests from
  employees of Magnet facilities

16
Magnet Impact

• For the Health Care Consumer
• Reduced Patient Mortality (Aiken, 1994 Aiken,
  2002)
• Reduced Patient Morbidity (Aiken, 2002
  Needleman, 2002)
• Increased Patient Satisfaction (Aiken, 1996
  Bryan, et al, 1998)
• Decreased failure to rescue (Aiken, 2002)

17
Magnet Impact

• For the Nurse
• Lower nurse turnover (Kramer Schmalenberg,
  1988 Kramer, 1990)
• Lower nurse vacancy rates (Kramer Schmalenberg,
  1988 Kramer, 1990)
• Lower nurse burn-out rates (Aiken, 2000 Aiken,
  2002)
• Lower nurse emotional exhaustion (Aiken, 1997)
• Decreased needle stick injury (Aiken, 1997)
• Better nurse-physician relationships (Kramer
  Schmalenberg, 2003)
• Higher nurse satisfaction (Aiken, 2000 Aiken,
  2002 Bryan et al, 1998)
• Higher nurse to Patient ratio (Aiken (2000)

18
Magnet Impact

• Corporate/Financial
• Decreased length of Stay (Bryan et al, 1998
  Needleman, 2002)
• Decreased cost of nursing staff replacement
  (Advisory Board, 2000)
• Increased opportunity to market the institution-
• US News and World Report-100 Best
  Hospitals--Magnet part of criteria
• Favorable perception in Bond Market

19
Return on Investment

• Georgetown University Hospital
• 8 Million dollar cost avoidance-one fiscal year
• Increased recruitment success
• Less dependent on agency nurses
• James A. Haley VA Hospital
• Total Cost FY 95-03 l 144,413
• Total Benefit FY 9503 14,800,000
• Childrens Memorial Hospital
• Approx. cost 250,000
• Savings
  2,625,540

20
CRITICISMS
21
Magnet Process Outcomes
April 2008
Property of the Magnet Recognition Program - Used
by permission.
22
Appraisers

• 2008 250 Appraisers
• Approx. 30 Teams
• Recruiting heavily from service
• Appraisal teams larger and Site Visits shorter
  NOT!
• Appraisal teams are gaining competence
• The Big Dogs dont always make it
• Re-designations dont always make it
• Standards revisions may slow evolution of
  Appraisers

23
Unions

• California and Massachusetts Nurses Associations
  argue that the Magnet program is primarily a
  hospital promotion tool that resembles the Joint
  Commission in its seemingly incestuous relations
  with hospital management.

24
Magnet Horror Stories

• Little evidence that nurses at Magnet hospitals
  are really much better off than nurses
  elsewhere.
• A number of nurses are unhappy with the changes
  at their hospitals since the award of magnet
  status.
• Nurse who led the drive for magnet status was
  fired soon after the hospital received it.
• Hospitals revert to short staffing and exclude
  nurses from decision-making processes soon after
  receiving magnet.
• Some hospitals treat magnet status as mainly a
  promotional tool, and ANCC is not effectively
  monitoring compliance.

25
ADVICE
26
(No Transcript)
27
Global Issues in Nursing and Health Care
Structural Empowerment
Empirical Outcomes
Exemplary Professional Practice
Transformational Leadership
New Knowledge, Innovations, Improvements
28
Data
Policy
Culture
Goals Vision
29
Goals Vision
Culture
Programs/Initiatives
Application
30
Civil Rights Culture Change took 100 years
CULTURE IS Values, Norms, Climate,
Organizational Support, Peer Support

• Senior Leadership Support
• Support from the Infrastructure
• People Involvement
• Tim Porter OGrady, 2008

Nursing Culture Change How much longer
another 100 years?