MUSC nurses reach for ‘gold standard’ in hospital care
You may say I’m a dreamer, but I’m not the only one. MUSC Medical Center recently sent a letter of intent to the American Nurses Credentialing Center (ANCC) announcing the pursuit of Magnet Hospital status via the Magnet Professional Recognition Program. Dubbed “the gold standard” in hospital care, magnet hospitals constitute only one percent of all U.S. health care organizations. Currently, none exist in South Carolina. Needless to say it’s a rather selective designation, but Laurie Zone-Smith, R.N., Clinical Services Administration, doesn’t seemed worried. “We’ve spent the last two years really defining who we are as a professional nursing staff and who we want to be,” she said. “ I am confident that we have the ability to achieve magnet status. We have a strong nursing and administrative team and we provide excellent care here; I can think of no reason why we shouldn’t receive it.” The nursing profession is as vulnerable as ever, with nursing shortage projections reaching 30 percent by 2020, making now the time to pursue this “board certification” for the Medical Center. But as Zone-Smith will be the first to tell you, becoming a magnet hospital isn’t easy. “Everybody works on achieving magnet status,” said Jessica Stephenson, R.N., UMA. “It’s truly an evolutionary process that changes traditional roles and ideas about nursing. It’s not something that happens overnight, but everyone, including nursing, administration, physicians and ancillary staff must embrace it for a magnet hospital to work.” Stephenson, a 20-year nursing veteran, left a magnet hospital in Virginia eight years ago when she joined the MUSC family. “Before the hospital decided to go for magnet status, the nurses attempted to unionize because they were so disillusioned with the way things were going,” she said. “But once the forum was created for those down in the trenches, so to speak, to exercise their voice, people began moving forward. At some point you realize that working together for this process is taking a step that’s better for everyone involved.” Magnet hospitals exhibit core attributes that facilitate the idea that happy nurses make happy and healthy patients. Those attributes include an influential nurse executive, nursing viewed as a professional discipline, administrators value and support nurses, unit level decision making, good communication among nurses, physicians, administrators and the team as a whole, and nursing control over nursing practice. In short, magnet hospitals are the ultimate in coordinating excellent patient care because they allow those that interact the most with patients to help steer the hospital’s course. By integrating nursing into various levels of decision making, nursing staffs are able to move beyond traditional roles and add their intelligence, experience, and research potential to the organization’s pool of resources. “Magnet status is more than recognition for outstanding accomplishments,” Zone-Smith said. “Magnet hospitals reach new levels of collaboration and respect among team players. Magnet culture allows for positive and professional growth through opportunity and multi-level support. It’s like a mature, functional family; each individual must be recognized for what he or she can contribute but at the same time recognizing that the power of a group can accomplish more.” But as with any wind of change, there are some who would prefer to keep things the same, and batten down the hatches instead of braving the storm. “Going for magnet status isn’t without cost or risk,” Stephenson said. “But if you look at the organizations that have pursued it, they are better hospitals because of it. Magnet status establishes a middle ground where the best information from nurses and the best information from administrators meet to create the best outcomes for the organization. It is a big change, but look at the benefits down the road.” And those benefits are numerous. Magnet hospital data and research demonstrates positive changes for nurses and patients. Magnet nurses have seen decreased needlesticks, decreased turnover, decreased work-related injuries and illnesses, decreased fatigue and burnout, increased satisfaction with career and current employment, and increased ratings of quality of care. Magnet patients demonstrate decreased mortality, decreased failure-to-rescue rates, decreased shock and cardiac arrest, decreased pulmonary compromise after surgery, decreased infections, decreased falls, decreased medication administration errors, decreased unplanned hospital readmissions, decreased length of stay and decreased pressure ulcers. And like the knight on a white horse, magnet status may be the Medical Center’s savior from the increasing nursing shortage. “Magnet status will elevate MUSC where it should be,” Stephenson said. “When nurses are empowered to pursue a vision that is not just imposed upon them and each nurse is challenged to be the best he or she can be, you not only improve your current situation but you are able to bring in more of the best. In that situation, frankly, no one wants to leave.” Where do we go from here?
A year ago, this group of nurse managers and directors began educating every unit within the hospital on how the Medical Center would achieve magnet status. By focusing efforts on innovations and infrastructure supporting a healthy work environment, healthy nurses, and healthy patient outcomes, the group developed an ambitious plan including numerous media and video conferences, meeting with various interdisciplinary groups, initiatives to ensure continued motivation, speakers, and beginning the journey to magnet status with an honest assessment and GAP analysis. “We are continually monitoring and improving standards already in place like nurse autonomy, professionalism, interdisciplinary teamwork, and the relationship between nurses and physicians,” Zone-Smith said. “We also monitor nursing sensitive indicators like turnover, patient satisfaction, vacancy ratios, pressure ulcers, falls and nursing satisfaction on an annual basis.” In preparing for certification, the Nursing Alliance Shared Leadership Model was established by the Medical Center and the MUSC College of Nursing. Consisting of every nurse on the MUSC campus and Medical Center, the alliance created a Nursing Executive Council, much like the medicine executive committee that already existed for physicians. The council includes Marilyn Schaffner, chief nursing officer (CNO), Gail Stuart, College of Nursing (CON) dean, Rosemary Ellis, Quality director, and the tripartite leaders from PERL. Meaning Practice, Education, Research and Performance Improvement, and Leadership and Organizational Climate, each area of PERL consists of a staff nurse, nurse leader, and CON faculty member from the alliance committed to the performance improvement process. Prior to sending the letter of intent, the alliance approved visions, missions, and values for nursing in both the Medical Center and the CON. “We have the extreme benefit of having an excellent dean and a very strong and supportive CNO,” Zone-Smith said. “Hospitals that create not only an environment for excellent care but also for teaching are the ones that truly soar. We have incredible multi-level support for magnet status and I believe Marilyn has a lot to do with that; she really cares about the individual nurse and the Medical Center as a whole and makes it very easy for others to see that.” So, with the Medical Center geared and ready to go, now comes the hard part…waiting. Once the application is submitted in full, the commission may take up to two years to document and review it before deciding to conduct a site visit to the Medical Center. Similar to joint commission visits, appraisers will arrive in Charleston and make their assessment on whether or not to award magnet status. “From what I understand, they want to know an organization inside and out,” Zone-Smith said. “They will want to see it, taste it, hear it, and will talk to everyone from staff to the man on the street to get an overall feeling of an institution. “We are ready and eager to pursue an award that will recognize our nurses; they have all been through so much and magnet status is a wonderful way to show the nursing staff that they have the support of administration, physicians, and peers. We believe in them and their abilities and want them to be acknowledged and thanked for all that they do.” Catalyst Online is published weekly, updated as
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