Magnet Recognition and the Role of WOC Nurses

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1 WOCN Society Magnet Recognition and the Role of WOC Nurses Although many healthcare facilities are recognized by the American Nurses Credentialing Center (ANCC) Magnet Recognition Program, the program continues to be a source of questions common questions pertain to the program, eligibility, benefits, and the certification process. This paper will discuss the history of the program, outline the process to achieve Magnet designation, and highlight the unique contributions wound, ostomy, continence (WOC) nurses can make in this process. The WOCN Society, which shares the Magnet program s passion for patient care, supports the vital role of in the application process. This is evident is WOCN's mission statement, which expresses similar objectives to the Magnet Recognition Program: The WOCN Society is a professional nursing organization that supports its members by promoting educational, clinical, and research opportunities to advance the practice and guide the delivery of expert health care Magnet Recognition Program In 1993, the ANCC formally developed the Magnet Recognition Program to recognize healthcare organizations that promote nursing excellence and provide superior quality patient care. The objectives of the Magnet Recognition Program are to recognize nursing services that use the Scope and Standards for Nurse Administrators (ANA, 2004,) to build programs of nursing excellence for the delivery of nursing care to patients promote quality in a milieu that supports professional nursing practice provide a vehicle for the dissemination of successful nursing practices and strategies among healthcare organizations using the services of registered professional nurses promote positive patient outcomes (ANCC, 2002, 2004). Magnet designation has been in existence for more than a decade, providing consumers with a barometer to measure quality patient care and nursing excellence. The Magnet program acknowledges the dynamic and ever-changing nature of the healthcare system. Reviewers continually scrutinize the broad principles and challenges guiding nurses in the daily provision of patient care. The concepts that form the foundation and structure that define Magnet recognition have evolved as our healthcare system has expanded. Many of the core concepts that were recognized in Magnet-designated facilities 10 years ago, however, remain constant and serve as a foundation for nursing excellence and superior quality patient care today. With ever-more advanced technology, increasingly complex patient needs, and the evolution of more intricate treatments and medications, the practice of evidence-based medicine and nursing has become a highly significant factor in today s healthcare and Magnet designation. Evidence-based medicine provides a sound foundation on which to base clinical decisions and implement interventions. Financial resources in the healthcare industry are limited, and must be disbursed in a myriad of competing directions. Evidence-based practice helps clinicians focus on proven treatments, reducing healthcare costs, and easing patient pain and suffering. Evidencebased nursing empowers bedside nurses. With the patient as the focus, bedside nurses make clinical decisions regarding patient care, collaborate with physicians and other healthcare professionals, and receive support from additional resources provided by their administrations and nursing organizations. These are foundational concepts recognized in Magnet organizations. According to the ANCC and Magnet-designated organizations, in addition to reinforcing a professional environment, there are a number of other benefits of Magnet status: community recognition for the nursing care given by the organization improved patient care outcomes enhanced respect and acknowledgement of the nursing staff contributions to positive patient care outcomes competitive marketing advantages improved recruitment and retention of nurses, physicians, and other healthcare professionals reinforced positive collaborative relationships enriched nursing staff satisfaction and productivity. have embraced evidence-based practice and focus on quality to ensure that patients receive the specialized care they require. There is opportunity for to emerge as valuable assets to healthcare organizations as their organizations demonstrate how they meet Magnet standards. The knowledge, experience, and clinical application of that knowledge possessed by is an extremely valuable commodity that reflects the quality of a Magnet-designated organization. The Magnet program recognizes 14 Forces of Magnetism, elements that contribute to an organizational culture that permit patients to receive superior evidence-based care from nurses practicing in an advanced healthcare environment. Many of these forces come alive within WOC nursing practice. Recognizing Excellence in Nursing Service, published by ANCC, describes the 14 forces that healthcare facilities must achieve to attain Magnet recognition. Application Process Applying for Magnet recognition involves four basic stages preapplication consideration, application preparation, site evalution, and approval. To begin the process,

2 there are several items that the healthcare organization should consider (Urden & Monarch, 2002): Organizational commitment Do the vision and strategic plan for the organization and for nursing and patient care support Magnet forces? Does the current culture of the organization match Magnet tenets? Stakeholder commitment Do stakeholders (e.g., board, senior executive team, physician leadership, nursing leadership, nursing staff and all other clinical and nonclinical department leaders who work collaboratively with nursing) support the application? Project management and support Who (e.g., committee/work group, staff nurse champion) will coordinate the application process? Is there budgetary support? Initial timeline Is there time for implementation of desired practices and Magnet-culture development? This timeline is often dubbed the magnetic journey. Communication across the organization is key throughout the Magnet application. A communication plan that introduces the process and shares progress with all stakeholders is an essential way to maintain the motivation and momentum of all involved. Talking to and visiting with hospitals that have achieved Magnet recognition and other Magnet experts is extremely helpful during the application process. In addition, reading related articles, resources, materials, and attending presentations related to Magnet is helpful in understanding the process. After consideration of these factors, a gap analysis an in-depth assessment of how well the organization meets each of the standards as demonstrated in written documentation and actual practice must be conducted. The gap analysis is a time-consuming process that generates areas for improvement and a detailed action plan to ensure that both written evidence and actual practice are aligned with Magnet standards. Timeline The amount of work that an organization must undertake to meet Magnet standards defines the actual timeline for the process. Time must be allotted to meet the standards and submit the application and supporting documentation. The written documentation must be submitted within 2 years of application. The organization provides evidence according to the manual that is current at the date of application. Two quarterly reports, National Database for Nursing Quality Indicators (NDNQI), must be included with evidence submission. Reporting on two quarters of data reflects at least 1 year of data collection and benchmarking. This is an important consideration in determining the timeline. The two reports, when accompanied by documentation of how the information is being used to improve patient care, provide evidence that the organization has met required criteria. Application Many organizations appoint a project coordinator, an overall steering committee, and work groups to focus on each standard. It is important to include staff nurses and staff from other disciplines whenever possible. 2 Healthcare organizations interested in attaining Magnet recognition must submit a narrative summary documenting evidence of how the organization meets each of the Magnetic forces. An organizational profile and demographic information are also required. The written information must be submitted within 2 years of the initial application submission. Deadlines and various requirements are strict. Once ANCC receives the written documentation, two appraisers are assigned to the organization. Although they play a vital role in the process, the appraisers do not make the final decision regarding Magnet recognition status. The appraisers evaluate and score the materials indepedently and three possible outcomes result: If the score is within the range of excellence, a site visit will be scheduled. If the score is close to the range of excellence, but the appraisers require clarification on any items, queries are sent back to the organization, which has 30 business days to submit additional written clarifications. If the appraisers deem the additional provided information satisfactory and the score falls within the range of excellence, a site visit is scheduled. If, after review of the additional information provided, the appraisers determine a score that does not fall within the range of excellence, Magnet designation is denied, and feedback is provided to the institution. If the materials reviewed fail to score within the acceptable range, Magnet designation is denied. The organization is provided feedback and may reapply within 3 months with a substantially discounted application fee. Prior to the site visit, the document must be accessible to the public. Public comment generated during this time is shared and provides additional information for the appraisers. During the site visit the appraisers seek to validate, verify, and amplify compliance with the Forces of Magnetism. After the visit appraisers prepare individual reports based upon their review of the written documentation and observations recorded during their visit. These reports are merged into a blind consensus document that is submitted to the Commission on Magnet Recognition. During a blind appraisal, the Commission on Magnet Recognition determines the ultimate decision. There is no appeals process if an organization is denied. The applicant is provided with written and verbal feedback regarding the decision and may reapply at a future date, repeating the entire process. Magnet designation is awarded for 4 years. Monitoring via annual reports submitted by the organization occurs during the interim. At the end of the 4 years, the organization may apply for redesignation or the Magnet status will expire. To obtain redesignation, an organization must provide evidence that it still meets all the eligibility requirements through submission of documentation and a site visit.

3 Forces of Magnetism and WOC Nurses The 14 Forces of Magnetism and the role of outlined here can be helpful to an organization that is applying for Magnet recognition: Force 1: Quality of Nursing Leadership Nurses are knowledgeable risk takers who bring a strong sense of advocacy and support for both patients and staff. Nurses are empowered to be leaders at the bedside, seeking optimal outcomes for their patients. support RNs by developing guidelines for assessment/ standards of care and implementation and evaluation of nursing skills encourage and mentor staff in the accessibility and application of guidelines develop and implement competency testing participate in their organization s leadership council and appropriate committees. Force 2: Organizational Structure The nursing department is productive, responsive to change within the healthcare environment; there is strong nursing representation on organizational committees to ensure shared decision making. participate in applying their organization s policy and procedure committees, clinical practice committees, patient safety, and patient teaching lead wound/skin team and mentor staff-level RNs participate in unit practice councils to monitor and study clinical practices and make decisions based on evidence. Force 3: Management Style The focus is on leadership that endorses participation and encourages open communication among all levels of nurses within an organization. Nurse leaders must be visible, accessible, and committed to communicating with their staff. are often independent practitioners, collaborating with nurse managers, clinical nurse specialists, staff, and physicians to cover issues that directly and indirectly affect nursing care communicate openly and regularly with nurse leaders regarding standards of care, practice guidelines, patient safety, and issues influencing optimal patient care. Force 4: Personnel Policies and Programs Addresses a safe, healthy work environment; opportunity for professional growth and advancement; support of professional nursing practice to ensure the delivery of quality care; competitive salaries and benefits; and staff involvement in policy development and performance appraisal. identify individual RNs to participate on wound/skin teams lead educational seminars and programs 3 often participate on clinical ladder committees and other programs encouraging advanced levels of nursing practice are in a position to mentor other staff (e.g., precepting) often function within the nursing professional development department, fostering nursing education. Force 5: Professional Models of Care Reflects a nurse s responsibility and accountability for providing patient care across the continuum. Promotes the professionalism of RNs; incorporates evidence-based practice; upholds state nursing practice acts and regulations and meets professional standards. Reviews staffing systems to provide skilled care and resources that meet patient needs. regularly work with patients across the continuum: preoperatively for education and stoma siting, in hospitals during perioperative periods for patient teaching and postoperatively in consultation for follow-up after discharge collaborate regularly across the continuum: acute, longterm, subacute, and home care to deliver seamless care and teaching to the patients regularly practice evidence-based medicine, as well as promote research to further develop evidence-based patient care utilize the latest technological advances in their practice regarding WOC care. Force 6: Quality of Care Examines quality as the driving mechanism for nursing and for a nursing organization. Nurses must be involved in establishing, monitoring, and evaluating standards of care and patient care policies at all organizational levels to ensure patient safety. Patient care policies and organizational policies are founded upon the Patients Bill of Rights. The application of ethical principles in nursing practice is supported through incorporation of the ANA Code of Ethics for Nurses and the ANA Bill of Rights for Registered Nurses. Nurses at all levels of an organization are strongly encouraged to be involved with both evidence-based practice activities and nursing research. conduct regular prevalence and incidence studies to benchmark their organization to national standards ensure that nursing practice standards are current with regard to WOC care within their organization are often involved with new product trials and research to validate standards of practice and care guidelines are in a position to disseminate and share information with staff RNs, generating interest in research and participation in journal clubs. Force 7: Quality Improvement Addresses the participation of staff nurses in the quality improvement process by monitoring, evaluating, and implementing changes through evidence-based quality initiatives, thus improving the coordination and care delivery across the healthcare delivery system.

4 often conduct chart audits to monitor adherence to standards of care and compliance with clinical practice, sharing information with staff, along with working with staff to make improvements are active members of quality improvement (QI) committees, and may assist staff with QI efforts at both the unit and organizational-wide levels usually participate in new staff orientation and mandatory yearly inservice education and competency validation regarding WOC policies and procedures. Force 8: Consultation and Resources Knowledgeable experts, particularly advanced practice nurses, are available as resources to develop and support professional nursing practice. Relationships with educational institutions for consultation and building collaboration within the professional nursing community are encouraged. Nurse involvement in professional organizations and among peers in the community is strongly encouraged. participate on nursing research committees often link to nursing colleges have an advanced specialty of nursing practice available to staff for mentoring and guidance are highly regarded as resources for WOC care within the medical and nursing arenas and the community at large may be members of the nursing staff or are available to organizations on a consultative basis often conduct educational programs for nursing schools and other institutions are often active in their communities and participate in educational programs (e.g., American Cancer Society and the Crohn s and Colitis Foundation) and as a resource to outpatients in the community. Force 9: Autonomy Fosters the nurses ability to practice autonomous nursing care built upon clinical competence, professional expertise, and a knowledge base that supports evidencebased practice. Nursing standards, policies, and procedures should provide a structural framework to guide the multidisciplinary approach to patient care management and practice. are encouraged by the WOCN Society to be certified in their specialty, demonstrating competence and the ability to practice autonomously generate a deep respect within the institutions in which they are employed for their clinical competence, knowledge, and skill disseminate current standards of care and practice guidelines within their organizations to enable staff RNs who practice at the bedside to have an evidence base on which to make clinical decisions autonomously regarding patient care. Force 10: Community and the Healthcare Organization Supports the establishment of partnerships and collaboration with healthcare organizations and community groups. These collaborative partnerships will enhance the health of the community and improve outcomes for clients. are leaders and active participants in their local patient organizations (e.g., Youth Rally and Young Adult Ostomy Programs) often become involved as parish nurses, offering programs on incontinence, prevention of skin breakdown, and other topics are involved in healthcare policy development and reform at both the state and federal levels that affect patients and themselves, both as private citizens and professionals. Force 11: Nurses as Teachers Nurses are educators who incorporate teaching into all aspects of their practice. Nurses provide patient and family education while administering direct patient care. They help to facilitate the smooth transition during orientation and become mentors to recently graduated nurses and to peers. The educational needs of patients, staff, specialty nursing organizations, affiliate academic programs, and the community at large rely on the nurse to act as an educator. constantly conduct patient education for ostomy care, wound care, prevention of skin breakdown, and continence preservation are educators for nursing staff, physicians, and ancillary staff during orientation and ongoing as a resource conduct educational programs for community, home care organizations, and in other settings as requested and appropriate. Force 12: Image of Nursing Nurses are essential in the day-to-day operations of a healthcare organization. Nurses are integral in providing quality patient care and influencing decision making, strategic planning, organizational success, and patient satisfaction. are often certified and highly respected professionals in their organizations. Force 13: Interdisciplinary Relationships Advocates participation among nurses at all levels of an organization. Supports the premise that mutual respect is crucial for collaborative relationships. These relationships must include multidisciplinary membership and provide for interdisciplinary decision making to ensure vital contributions in achieving quality clinical outcomes. collaborate with other healthcare disciplines are usually highly regarded by physicians and other disciplines and are valued for their contributions to patient care. 4

5 Force 14: Professional Development Addresses the personal and professional growth and development of nursing staff. Learning is a lifelong process. It must be fostered and encouraged within the healthcare organization. Professional development can assume many forms (e.g., orientation, in-service education, continuing education, and professional certification) as well as the development of clinical competence and leadership capabilities. often receive educational support and support for certification and other professional development from their facilties are encouraged and supported by the WOCN Society. contribute to the professional development of the nursing staff are involved within their state affiliations and in their regions and by participating on national councils and committees. Conclusion This paper outlines the history and steps to earn Magnet Recognition Program designation. As healthcare organizations apply to achieve this distinction, can be a great asset. practice evidence-based nursing care, and their daily practices embrace many of the 14 Forces of Magnetism. can help document evidence that highlights how their roles are a vital part of the way their organizations achieve superior nursing care and illustrate the existence of the 14 Forces of Magnetism. References American Nurses Association. (2004). Scope and standards for nurse administrators (2nd ed.). Washington, DC: Author. American Nurses Credentialing Center (2002) Magnet Recognition Program application manual. Silver Spring, MD: Author. American Nurses Credentialing Center. (2005) Magnet Recognition Program application manual. Silver Spring, MD: Author. Urden, L. D., & Monarch, K. (2002). In M. L. McClure & A. S. Hinshaw (Eds.), Magnet hospitals revisited: Attraction and retention of professional nurses (pp ). Washington DC: American Nurses Publishing. Suggested Reading American Nurses Credentialing Center. Magnet Program Recognizing excellence in nursing services. Last retrieved on June 22, 2005, from Bliss-Holtz, J., Scherer, E., & Winter, N. (2004). An invitation to magnet accreditation. Nursing Management, 35(9), Cullen, B. (2002). Wound, Ostomy, and Continence Nurses Contribution: JCAHO and Magnet Status. Proceedings from the Wound, Ostomy, and Continence Nurses Society (WOCN) 34th Annual Conference, Las Vegas, Nevada. Kramer, M., & Schmalenbergm, C. (1988a). Magnet hospitals, part 1: Institutions of excellence. Journal of Nursing Administration, 18(1), (1988b). Magnet hospitals, part 2: Institutions of excellence. Journal of Nursing Administration, 18(2), (1990). Magnet hospitals: Excellence revisited. Journal of Nursing Administration, 20(9), Taylor, N. (2004). Magnetic pull Does your facility have what it takes to attain magnet recognition? Nursing Management, 35(9), Wound, Ostomy, Continence Nurses Society Web site Eileen McCann, RN CWOCN, Ann Navage, APRN CWOCN, Susan Schardt, RN CWCN CWS Commerce Parkway Suite C Mt. Laurel, NJ /