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The Pull is Strong


 

Magnet certification draws nurses to hospitals by documenting that these facilities are good places for them to work. But does magnet also suggest a positive environment for hospitalists and other physicians?

Ask Kathy Sparger, RN, MSN, chief nursing officer at South Miami Hospital in South Miami, Fla., who says her magnet facility perpetuates teamwork and collaboration in a way that creates a positive professional atmosphere for both nurses and physicians. She’s also emphatic that it enables high-quality care.

South Miami Nurses Kathleen Gori, RN, Melissa Korman, RN, and Zully Darby, RN, show off their magnet pride.

The mother of at least one patient likely agrees. Sparger tells the story of a baby born in the hospital with compromised circulation in his leg.

“When he was born, his leg was black,” she recalls. “We thought we would have to amputate.”

Devastated by the prospect of this decision, the physician-nurse team searched frantically for another solution. Then Sparger remembered an instance from years before when an elderly patient’s compromised circulation was resolved through the use of medicinal leeches. While the team had never heard of this procedure being used for an infant, they trusted Sparger and decided to follow her suggestion.

“We started therapy that night, and the baby went home with his leg intact,” she says, adding that she can recollect “hundreds of such scenarios” where the teamwork between physicians and nurses enabled positive outcomes. This is the essence of magnet, she notes: “Nurses know that their opinions are valued, so there is a better partnership with physicians.”

WHAT IS MAGNET?

Magnet certification is offered by the American Nurses Credentialing Center (ANCC) as a means of identifying hospitals that value nurses and provide optimal environments in which these professionals practice. According to ANCC, magnet designation is an important recognition of nurses’ work, the quality of a facility’s nursing program, and the importance of nurses to the entire organization’s success.

The concept of magnet dates back to the early 1980s. In 1981, the American Academy of Nurses developed the criteria for Magnet certification, which covered three broad areas:

  • Administration: Participatory and supportive management style; well-prepared, decentralized organizational structure; “adequate” nurse staffing; deployment of opportunities;
  • Professional practice: Professional practice models of care delivery; professional availability of specialist advice; emphasis on teaching staff responsibilities;
  • Professional development: Planned staff orientation; emphasized in-service/competency-based clinical ladders; management development.1
Because [hospitalists] spend so much time with nursing staff, the quality of nurses is especially important to hospitalists. Therefore, if we want to attract good hospitalists, we have to have good nurses. Because we have magnet status, we not only can say that we have a great nursing program; we can prove it.

—Allen Kaiser, MD

A 1983 Magnet Hospital study identified variables found in a “magnet-like” environment, although these evolved over the next decade into 14 key forces used to determine magnet status.2-4 These include quality of nursing leadership, organizational structure, management style, personnel policies and programs, professional models of care, quality of care, autonomy, and quality improvement.

Applying for magnet certification is an elaborate process that involves extensive and detailed documentation, site visits, and interviews. Staff participation includes nurses, administrators, and physicians—among others. The certification process can take a year or more, and facilities must recertify every four years.

Magnet-certified facilities are required to submit quality data for the ANCC to track. However, the agency states on its Web site that “independently sponsored research” has shown that magnet-certified facilities:

  • Consistently outperform nonmagnet organizations;
  • Deliver better patient outcomes;
  • Have shorter lengths of patient stays;
  • Enjoy increased nurse retention rates;
  • Report higher rates of nursing job satisfaction; and
  • Report higher patient satisfaction.5

To date more than 100 U.S. healthcare facilities have earned magnet certification, and the number is growing almost daily. In fact, Allen Kaiser, MD, chief of staff at Vanderbilt

University Hospital in Tennessee, wonders if the point will come where so many facilities are magnet-certified that that status will lose its significance. Or, perhaps, “people will wonder what is wrong if a facility isn’t certified,” he says.

(Left to right) Robert Diaz, RN, Angela Monteque, RN, Kathy Sparger, RN, Harriet Rudoff, and Pamela Pampe show off a quilt created by the staff at South Miami Hospital to communicate what magnet certification means to them. Rudoff was the quiltmaker to translated the design into fabric squares and produced the final quilt.

(Left to right) Robert Diaz, RN, Angela Monteque, RN, Kathy Sparger, RN, Harriet Rudoff, and Pamela Pampe show off a quilt created by the staff at South Miami Hospital to communicate what magnet certification means to them. Rudoff was the quiltmaker to translated the design into fabric squares and produced the final quilt.

HOSPITALISTS AND MAGNET

An academic hospitalist and Assistant Professor at Chicago’s Rush University Medical Center, Richard Abrams, MD, said that nursing-physician collaboration is key to a positive environment for hospitalist practice.

“To me, the strongest suit of the nurses I work with here is that they are collaborators,” he explains. “Everyone brings something—some unique skill set—to the table. This, along with our proclivity for collaboration and mutual trust—makes our facility successful.”

Magnet certification didn’t cause this collaborative atmosphere, Dr. Abrams is quick to stress. “Our facility was magnet before there was such a thing,” he explains. “Magnet status is nice, but nursing care was always fantastic here. Magnet just put a name to what we are and recognizes it nationally.”

Dr. Abrams encourages his residents to look for this quality at facilities with which they are considering employment. In fact, he even uses Rush’s magnet status as a selling point to attract hospitalists to his program.

“Sometimes they ask what that is and what it means,” he says. “You know the quality of the nursing staff at a magnet hospital. You know that there is a minimal level of quality you can expect.”

Dr. Abrams emphasizes the importance of trust between hospitalists and nurses. “If you can’t trust each other, it makes it so much harder to care for patients,” he says. “Our nurses spend much more time with patients than anyone else. I wouldn’t do anything without input from the nursing staff.

“We have a rule in the hospital. If a nurse thinks a patient needs to be transferred to intensive care, the patient is transferred,” continues Dr. Abrams. “We put this policy in place four to five years ago, and no one has ever questioned or disputed it.”

The biggest plus for nurses is that I’m on the floor eight or more hours a day. We have repeated interactions, and relationships develop more quickly. This probably breaks down some barriers that can exist between physicians and nurses.

—Richard Abrams, MD

PERFECT TOGETHER

Magnet status and hospitalists represent a good match. Just as magnet nursing status provides benefits for hospitalists, the presence of hospitalists helps create a positive environment for nurses.

“The biggest plus for nurses is that I’m on the floor eight or more hours a day. We have repeated interactions, and relationships develop more quickly,” notes Dr. Abrams. “This probably breaks down some barriers that can exist between physicians and nurses.”

When nurses have to whether to call an attending physician at 3 a.m., this often creates additional stress or worries for them. With hospitalists around, they almost always have a physician onsite. Even when the hospitalist isn’t right there, they know who to call and theyare likely to have a trusting relationship with this individual.

“I would feel bad if a nurse didn’t feel that she could pick up the phone and call me about any case,” says Dr. Abrams. “The more you work with people, the more trust you build.”

Magnet status is particularly important for hospitalists, explains Dr. Kaiser. “Because they spend so much time with nursing staff, the quality of nurses is especially important to hospitalists. Therefore, if we want to attract good hospitalists, we have to have good nurses. Because we have magnet status, we not only can say that we have a great nursing program; we can prove it.”

Sparger concurs. “Magnet validates a facility’s quality efforts and teamwork,” she says. “It makes you sit back and look at evidence-based practices for how you do things. You have to have evidence-based practices to write a policy. As hospitalists are more familiar and comfortable with hospital policies and procedures, this makes them the perfect match for magnet hospitals.”

At the same time when facilities put the hospitalist model together with magnet certification, the result is improved quality of life for both physicians and nurses.

While ANCC is still collecting data about magnet status and quality, Sparger and many individuals who work at magnet-certified facilities firmly believe that the characteristics that make they magnet also lead to reduced mortality and infections.

THE WORD SPREADS

If they don’t know about magnet certification already, hospitalists and other physicians likely will hear more about it in the near future.

“Magnet certification is a quality indicator at some level for hospitals,” says Dr. Abrams. “We will see a big push nationally for magnet at many more facilities.”

Nurses already see magnet status as an important sign that a hospital is a good place to work where quality care is high and nurses are respected. Increasingly, Dr. Abrams proposes, physicians will consider magnet status when choosing facilities at which to work. In fact this already is happening.

“I had one physicians say that he came here with confidence because he knew that we had a magnet staff,” says Beverly Hancock, MS, RN, education/quality and magnet project coordinator at Rush University Medical Center. “Also, I recently noticed on our Web site that several departments and programs mention our magnet status in their recruitment announcements.”

In fact, physicians themselves sometimes are the greatest advertisement for magnet hospitals. “If you talk to our physicians, they say that they tell everyone about the great nurses here,” says Hancock. “They say that they heard about it in their interviews and now they’re seeing it in person.”

At the same time, the word is spreading rapidly beyond practitioners. Just this year, U.S. News & World Report added magnet certification to its criteria for determining its annual list of the country’s best hospitals.

“There is no question that patients, insurers, and other healthcare groups will begin to place a lot of emphasis on magnet status as well,” concludes Dr. Abrams. TH

Contributor Joanne Kaldy is based in Maryland.

REFERENCES

  1. McClure M, Poulin M, Sovie M, Wandelt M. Magnet Hospitals: Attraction and Retention of Professional Nurses. American Academy of Nursing Task Force and Nursing Practice in Hospitals. Kansas City, MO: American Nurses Association 1983.
  2. Kramer M, Schmalenberg C. Magnet hospitals talk about the impact of DRGs on nursing care, part I. Nursing Management. 1987;18(9):38-42.
  3. Kramer M, Schmalenberg C. Magnet hospitals talk about the impact of DRGs on nursing car, part II. Nursing Management. 1987; 18(10):33-40.
  4. Kramer M, Schmalenberg C. Job satisfaction and retention. Insights for the ‘90s, part I. Nursing. 1991;3(3):50-55.
  5. American Nurses Credentialing Center Web site. www.nursingworld.org/ancc/magnet/consumer/benefits.html. Benefits of magnet. Last accessed 8/16/05.

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