Karen Drenkard

The business case for Magnet.

The author describes the role of the chief nurse executive in delivering a business case for the Journey to Magnet Excellence™. Calculating a return on investment provides clear measurement of benefits of the credential and can be used to evaluate upfront resources that result in a longer-term gain. The range of cost savings that can possibly be achieved for a typical 500-bed hospital is presented. Although not every hospital will achieve the level of performance implied by the national assumptions, securing only a modicum of the potential level of cost improvement will ensure a multifold return on the investment required.

Effectiveness of a Clinical Ladder Program

A 5-hospital system shares results of the evaluation of a clinical ladder program. Improvements were noted in overall satisfaction with the program, nurse retention of those who participated in the program, and costs savings due to decreased turnover. The authors point out the importance of evaluating the effectiveness of advancement programs for nurses. The analysis of a clinical ladder program in relation to costs, financial impact, and benefits helps to justify the salary increments for the ladder programs. This article provides the nurse executive with appropriate justification and outcome data to effectively champion these programs.

Nursing exploration summer camp: improving the image of nursing.

Improving the image of nursing and finding ways to encourage young people to enter the nursing field are two areas that need attention from nurse executives. That concept was turned into reality with Inova Nursing Exploration Summer Camp 2001, a camp for seventh and eighth graders who are exploring their interest in nursing careers. The camp was a unique partnership among a county public school system, a local university, and an integrated healthcare system. The program, developed by the system nurses in consultation with middle school educators, introduced students to the nursing profession via demonstrations, site visits at multiple hospitals, role-playing, discussions, and a trip to the local nursing school to experience life as a nursing student. The authors discuss the planning, implementation, and outcome of this unique summer camp.

Clinical nurse leader: moving toward the future.

In an attempt to create solutions for the growing threat of the nursing shortage and shape the future of healthcare leadership and practice, the American Association of Colleges of Nursing (AACN) developed a working paper describing a new role, that of clinical nurse leader. Released in May 2003, the paper proposes the creation of a new role for professional nursing. Two AACN task forces (Task Force on Education and Regulation for Professional Nursing Practice 1 and 2) have been working since 2001 to search for answers to the concerns facing the discipline of nursing. Task Force 1, which worked on developing new educational models, determined that a new role was needed to differentiate scope of practice and create new licensure, rather than differentiate current entry levels of nursing. Task Force 2 began work in 2002 and focused on nurse competencies that would be needed in the future. It was this task force that created the role of the clinical nurse leader and published a draft of the white paper. AACN held a stakeholder reaction panel before the release of the white paper, to gather reactions and critical feedback from the practice arena. One of the authors participated in the reaction panel (Ms Drenkard) and provided input into the development of the role. The reaction panel included nurse executives from major systems across the country and provided the AACN leadership with some reality testing, comments, and suggestions for change. Based on the feedback, additional revisions were made to the working draft. In October 2003, the AACN invited academic and practice partners to participate in a meeting of “thoughtful, collaborative, dialogue” between nurse educators and practice partners about the education and practice of the nurse of the future, and to prepare an initial plan for implementation. More than 200 participants attended the meeting, furthering the white paper interpretation. The AACN’s next steps include academic/practice partnerships to pilot both the curriculum and the role set of the clinical nurse leader role. In January 2004, the AACN board of directors passed several policy motions to guide the work of the association to “assure the highest quality nursing workforce for our nation’s healthcare needs.” These motions are included in Figure 1. In June 2004, AACN will convene a conference between nurse educators and practice partners committed to advancing the clinical nurse leader initiative. At this meeting, educationpractice models and curriculum will be finalized, and an implementation timeline will be developed. AACN issued a request for proposals in April 2004 to identify education-practice partners interested in piloting a clinical nurse leader program.

Developing Nurse Leaders in Health Policy: An Education and Practice Partnership

This article describes the Washington Health Policy Institute and the Health Policy Leadership Program as a leadership and policy partnership to develop nursing leaders who will serve as mentors and role models to effectively lead through internal and external change. The leadership program helps future nurse leaders understand the policy-making process on many fronts—political, economic, social, technological, and international. The challenges facing this nation regarding health care access, quality, and cost are monumental. Only through well-educated and savvy nurse leaders who understand the political realities as well as the agenda-setting and policy formulation processes will health care change occur.

Interactive Care Model: A Framework for More Fully Engaging People in Their Healthcare.

Transformation of care delivery requires rethinking the relationship between the person and clinician. The model described provides a process to more fully engage patients in their care. Five encounters include assessing capacity for engagement, exchanging information and choices, planning, determining interventions, and evaluating the effectiveness of engagement interventions. Created by researchers and validated by experts, implications for practice, education, and policy are explored.

Transformational leadership: unleashing the potential.

One of the most powerful Sources of Evidence of the Magnet Recognition Program is TL 10EO: Transformational Leadership 10VExpected Outcome. To meet the expectation for this standard, Magnet organizations must describe and demonstrate changes in the work environment and patient care based on input from direct care nurses. This single requirement packs a punch and aptly represents what Magnet is all about. Early research from McClure et al found evidence of this important aspect in every one of the original 41 reputational Magnet hospitals. What does it mean in today’s healthcare environment and how can the formal leaderVthe chief nurse executive (CNE)Vbring it to life? A review of the literature on leadership reveals a turning point when Burns explored what made transformational leaders different from ‘‘Great Man’’ leaders. The Great Man theory posited that leaders were born and only men with great intellect, persuasive powers, and keen decision-making ability could lead the masses. Burns determined that true transformation could only occur when there was a relationship between leader and followers. An effective leader didn’t hold all of the power and authority, but rather created an environment that brought leaders and followers together to solve problems, create new ways of doing work, and manage change together. Highly effective leaders have highly effective teams and strong group culture. The leader does not have to be in charge of everything, but he or she must communicate the shared vision, encourage intellectual stimulation, consider individuals, and motivate the team to be innovative and take measured risks to improve. Fast forward to today’s healthcare environment, Tim Porter O’Grady, DM, EdD, ScD(h), FAAN, shares a powerful image of leaders ‘‘setting the table’’ for a space where shared dialogue and shared problem solving can occur. Aligned with this perspective, as a CNE, I often felt that my key job was to call the meeting and bring people together (and make sure I found a way to pay for lunch). Once the right people were in the room, and the task was set before the team, those who actually did the workVthat is, the clinical nursesVwere the best ones to redesign, quality improve, innovate, and implement the changes that were needed to make patient care better. In many Magnet organizations around the country, CNEs have created cultures of transformational leadership. Excellent examples abound of formal shared governance structures and highly effective councils, committees, and congresses. As I visit these Magnet hospitals, I have witnessed something moreVa spirit of transformation at the cellular level that manifests

Strategy as solution: developing a nursing strategic plan.

This month, the Executive Director of the American Nurses Credentialing Center provides a look at the importance of having a nursing strategic plan especially when working to create a research agenda.

The Magnet Imperative

The Magnet Recognition Program® was developed by the American Nurses Credentialing Center (ANCC) more than 20 years ago to recognize healthcare organizations that demonstrate nursing excellence. From its origins (l) as a recruitment and retention strategy in the 1980s, it has grown to epitomize much more: outstanding patient care in a safe, high-quality environment; development, dissemination, and enculturation of exceptional nursing practices and strategies; a supportive, innovative workplace with empowered nurses; and, most significantly, superior clinical outcomes. In 2000, Aiken et al (2) evaluated Magnet®recognized hospitals and revealed some impressive data. These facilities had more nurses with BSN status, lower burnout rates, higher job satisfaction, and better quality and safety as evidenced by a decrease in patient mortality. Magnet hospitals also provide consumers with the ultimate benchmark to measure expected quality of care. In its annual showcase of “America’s Best Hospitals,” US News & World Report indicates those that are Nurse Magnet facilities, a designation that boosts overall ranking. Last year, 7 of the top 10 hospitals on its exclusive Honor Roll were Magnet recognized. Evidence continues to grow that achieving Magnet status leads to improved patient and nursing outcomes. ANCC is pleased to partner with the Journal of Nursing Administration to present the highlights of recent and historical research from some of the nation’s most distinguished independent investigators. This research focuses on Magnet status related to clinical outcomes, such as patient infection rates and mortality, and nurse outcomes, such as occupational health incidents. The body of research also compares recruitment and retention rates, nurse career development, the work environment, and nurse-sensitive indicators at Magnet and non-Magnet facilities. (4–8) As you will see, the findings show strong evidence that, in all of these areas, Magnet hospitals continue to lead and excel. Since it began 20 years ago, the ANCC’s Magnet Recognition Program has experienced geometric growth, expanding from the 41 reputable hospitals cited by the American Academy of Nursing (l) in 1983 to 335 Magnetrecognized facilities in mid-2009. As it has grown, the program has evolved to reflect changes in healthcare delivery and nursing practice. In 2007, with input from a broad range of stakeholders, the Commission on Magnet Recognition developed a new Magnet Model (http://www.nursecredentialing. org/Magnet/ProgramOverview.aspx), featuring greater emphasis on evaluating outcomes. Evidence-based practice, innovation, evolving technology, and patient partnership also are stressed. To reduce redundancy and streamline documentation, the Forces of Magnetism were configured into 5 components, and the required Sources of Evidence were reduced from 164 to 88 requirements. Beginning in October of this year, the new Magnet standards will be required for all applicants. After the introduction of the new model, the Commission unveiled its new vision: Magnet organizations will serve as the fount of knowledge and expertise for the delivery of nursing care globally. They will be solidly grounded in core Magnet principles, flexible, and constantly striving for discovery and innovation. They will lead the reformation of health care; the discipline of nursing; and care of the patient, family, and the community. This new vision is especially relevant during our country’s current economic downturn. nna39-7s_20077.qxp 7/8/09 9:26 AM Page S1

Patient and Family Engagement Summit: Needed Changes in Clinical Practice.

Patient and family engagement is a strategy to enhance healthcare outcomes through strong clinician-patient partnerships. A new care delivery process, in which the patient is the driver of the healthcare team, is required to achieve optimal health. A summit partially funded by a seed grant from the Robert Wood Johnson Executive Nurse Fellow Alumni Foundation was held with interprofessional colleagues and patient representatives to identify needed clinical competencies and future practice changes. Recommended shifts in the care delivery process included a focus on patient strengths, including the patient as a valued team member, doing care “with me” and not “to me,” and considering all entities or providers including the patient, as equal partners.