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Magnet Status Accreditation and Quality of NursingSandra KolkFerris State UniversityAbstractQuality of nursing care demonstrates nursing excellence within an organization. Magnet Status ensures quality and patient safety and is considered the ultimate credential for nursing excellence. This paper outlines many of the factors related to quality nursing within a professional practice environment. Research related to Magnet and non-Magnet organizations is explored to consider various determinants of quality care. Theories related to Magnet Recognition and quality nursing are explained and incorporated into the Magnet Accreditation process. An assessment of the healthcare environment is explored, and recommendations related to QSEN competencies and ANA standards are defined. The conclusion of this paper is that quality patient care and nursing excellence can be demonstrated within non-Magnet organizations by following the framework of the Magnet Model. Also, it is concluded that Magnet Recognized organizations do provide nursing excellence as well as high quality and safety outcomes. Keywords: Magnet Status, professional practice environment, nursing excellence, quality outcomes Magnet Status Accreditation and Quality of NursingEvery nurse, as evidenced by standard 10 of the Professional Nursing Standards of Practice, should contribute to quality nursing practice (American Nurses Association, 2010). Magnet Recognition from the American Nurses Credentialing Center is considered the highest credential for quality nursing (American Nurses Credentialing Center, 2014). Guidelines set by the ANCC require hospitals to meet and maintain specific guidelines within their organization that demonstrate nursing excellence. The application and review process is extensive and involves years of preparation, a lengthy application, and a site visit from reviewers which includes interviews of staff and patients (Maryland Nurse, 2010). The ANCC has developed a Magnet Model that provides a framework to achieve excellence in nursing practice and serves as a roadmap for organizations seeking Magnet Recognition (American Nurses Credentialing Center, 2014).Although Magnet Recognition acknowledges nursing excellence within an organization, fewer than 9% of hospitals in the US have gone through the voluntary accreditation process (Stimpfel, Rosen, & McHugh, 2014). This statistic can lead to bias when comparing Magnet to non-Magnet hospitals. Therefore, the question is raised: do Magnet hospitals always provide better nursing care than non-Magnet hospitals? Research supports the high quality of care in Magnet institutions but does little to address the differences between quality in Magnet and non-Magnet hospitals. Considering the limited participation of American hospitals undergoing the Magnet accreditation process, it may be that non-Magnet organizations are capable of producing the same quality standards as Magnet organizations. Therefore, it is important for new graduate nurses to identify the characteristics within an organization that encompass Magnet Recognition when pursing nursing careers, rather than the title of Magnet Recognition alone. Identifying concepts within the Magnet model can provide an organization that does not have the resources, or is otherwise unable to begin the accreditation process, to strive for excellence in nursing practice.Theory BaseTheoretical concepts are used for the development of professional practice models and are a large driving force behind Magnet Recognition. As the ultimate credential for quality nursing, a Magnet recognized organization implements theory into professional nursing practice.Florence NightingaleTheory, based on the vision of Florence Nightingale, has led to the recognition of nursing as a specialized body of knowledge distinguishing nursing knowledge as separate from medical knowledge (Alligood, 2013). This vision has lead to the rapid development and evolution of theory in nursing practice. “The Magnet Recognition Program is an international recognition of excellence in nursing, and a key requirement for organizations is to describe and implement a professional practice model” (McCrae, 2011, pp. 223). Theoretical concepts are often used to guide the development of professional practice models within healthcare organizations. According to Alligood (2014), “understanding the development of nursing theory provides a perspective for understanding how theory relates to the discipline and profession of nursing” (pg. 2). Kurt LewinTheories outside of nursing are also incorporated into the foundation of standards for achieving Magnet Status. The components of the Magnet model identify the need for an organization striving for Magnet Status to restructure their professional practice environment to meet accreditation standards. Components include: transformational leadership, structural empowerment, exemplary professional practice, new knowledge, innovations and improvements, and empirical outcomes. Included within each of the components are criteria to demonstrate achievement of the Magnet Standards (American Nurses Credentialing Center, 2014). Kurt Lewin is a social psychologist that developed the Change Theory. The Change Theory consists of three parts: unfreezing, moving or changing, and refreezing. Organizations striving for Magnet Recognition may use this theory to implement the standards of the Magnet Model. Recognizing where clinical processes can be improved, implementing evidence-based practice and research, and then finalizing new processes demonstrates the use of Kurt Lewins’ Change Theory. Assessment of the Healthcare EnvironmentThere are 410 hospitals worldwide that have Magnet Recognition, with 402 in the United States and 14 in Michigan. The first organization awarded Magnet Recognition by the ANCC was The University of Washington Medical Center in 1994 (American Nurses Credentialing Center, 2014). Research shows that Magnet facilities have increased nurse retention, increased job satisfaction, increased patient satisfaction, increased quality care, and decreased nurse burnout (Smith, 2014). Magnet Accreditation ProcessAccording to the American Nurses Credentialing Center (2010), the voluntary accreditation process for Magnet Recognition is both resource and time consuming. Eligibility for Magnet Recognition includes specific organizational and educational requirements. These requirements state that an eligible organization must be within a hospital organization, nurse leaders must hold master’s degrees, and 80% of nurses must be obtaining their Bachelor of Science in Nursing by 2020. Achieving Magnet Status often means restructuring of an organization’s professional practice environment to demonstrate competencies of the components within the Magnet Model. Restructuring can also mean change to create and sustain a culture of excellence in nursing practice (American Nurses Credentialing Center, 2014). Eligibility, structural change, and financial obligations present barriers to achieving Magnet Recognition.BarriersMany Magnet organizations are large academic teaching hospitals, located in urban areas. These organizations often have more resources to initiate the voluntary accreditation process, and therefore fewer barriers than smaller, rural organizations (Stimpfel, Rosen, & McHugh, 2014). Financial obligations, structural change, and educational requirements are some of the large-scale barriers to overcome when striving for Magnet Status. To address the impact on hospitals striving for Magnet Recognition, these barriers must be explored. Financial Components. The application for Magnet Accreditation will cost an eligible organization $5000 to submit to the ANCC. The application fee does not include the appraisal fee, which varies based on organizational size, but can cost up to $40,000 for a 400-bed hospital. Next is a documentation review fee, which will cost between $2,500 and $5,000 depending on the need for additional documentation by the ANCC. Before an organization can officially be recognized, appraisers present for site visits. Site visits can take up to four days and cost $1,850 per appraiser per day. The eligible organization is also responsible for any travel, lodging, and miscellaneous expenses that accrue (American Nurses Credentialing Center, 2014). Structural Change. Change can be intimidating for an organization and requires commitment, dedication, and flexibility from nursing staff, including nurse leaders. “Careful assessment of the nurse working environment is important before an organization can undergo innovation or change” (Wagner, 2014, p. 464). Organization wide acknowledgement and support are important to begin advancements towards nursing excellence (Wagner, 2014). Educational Requirements. As previously mentioned, educational requirements within the Magnet Model must be met for eligibility. According to the ANCC (2014), 80% of nurses within an organization must be obtaining their BSN by 2020. Continuing education requirements for nurses can present challenges including location of schools, time, effort, and financial obligations (Morganthaler, 2009). Older nurses have additional barriers to consider when continuing their education. Paper writing and computer skill requirements may add to the hesitancy for older nurses to return to school. In addition, it may be intimidating for nurses to become a novice again after being respected as a professional in their field for multiple years (Morganthaler, 2009). As mentioned previously, only 9% of American hospitals have undergone the accreditation process for Magnet Recognition (Stimpfel, et. al., 2014). Barriers such as eligibility, organizational change, and financial obligations may contribute to this statistic. Bias resulting from these barriers needs to be considered when comparing quality of care in Magnet versus non-Magnet hospitals.ImplicationsRegardless of the challenges presented for organizations striving for Magnet status, research shows that Magnet and Magnet-in-progress hospitals produce better quality of care than non-Magnet hospitals. The practice environment has shown to be one of the primary reasons correlating higher quality of care to Magnet organizations (Stimpfel, et. al., 2014). Considering the low percentage of hospitals with Magnet status, further research may discover comparable practice environments in selected non-Magnet hospitals. However, based on accumulated research, there appears to be a strong positive correlation between the practice environment of Magnet hospitals and increased quality of care (Stimpfel, et. al., 2014). Ultimately, the qualities within a Magnet organization attract and retain nurses (Lundmark, 2008). New graduate nurses can be confident when pursuing a career at a Magnet organization that the components within the magnet model are implemented, and the professional practice environment upholds the standards to deliver high quality nursing. However, due to the rapidly evolving healthcare field, an awarded organization has to be looked at every four years. Earning Magnet recognition is not a lifetime achievement unless the organization is successful in keeping up with the evolving criteria of the ANCC (American Nurses Credentialing Center, 2014). Studies report a positive correlation between Magnet Recognition and higher reports of patient satisfaction with care (Smith, 2014). Quality of care is determined by many different factors and few studies have addressed what is meant by quality outside of patient satisfaction scores. As mentioned earlier, many Magnet organizations are large, urban organizations. Patient satisfaction of large organizations may not be comparable to those of smaller organizations for reasons outside of lower quality care. Quality of CarePatient satisfaction with care is based on many different components. According to a study done by Smith (2014), there is statistical evidence that Magnet and Magnet-in-progress hospitals provide higher quality than non-Magnet hospitals. Communication among nurses, pain control, recovery time, medication explanation, and likelihood to recommend were factors analyzed in this study. The key component is that even the Magnet-in-progress hospitals reported higher patient satisfaction with care, therefore it is not necessarily the Magnet logo that implies quality care, but the environments that mirror the ANCC standards for quality care. Professional Practice Environment. The primary focus of the Magnet Model is to set a framework for organizations to restructure their professional practice environment and deliver excellent nursing care (American Nurses Credentialing Center). When organizations use the Magnet Model, they can be capable of producing a professional practice environment without the financial obligation of achieving Magnet recognition. “An organization can draw from the Magnet principles to develop a quality practice environment by having a visible and accessible chief nurse, including nurses in decision making throughout the organization, supporting nursing practice, and engaging in interdisciplinary patient care” (Stimpfel, et. al., p. 6).New Graduate Implications. Due to the educational requirements of Magnet Status, many student nurses are pursing a bachelor of science in nursing. “New graduate BSN prepared nurses are prized for their skills in critical thinking, leadership, case management, and health promotion” (American Association of Colleges of Nursing, 2015). The skill set of a BSN prepared nurse has been linked to increased patient safety and delivery of quality care. Quality care is a large driving force behind the standards of Magnet Recognition. Educational achievement of a BSN will positively impact the professional practice environment of an organization regardless of the Magnet logo (Stimpfel, et. al., 2014). Recommendations and CompetenciesRegardless of Magnet Status, quality and safety can be improved by incorporating strategies that improve the professional practice environment. Hospitals should focus on areas of nursing practice that are enhanced with Magnet Status such as nurse retention and job satisfaction, patient satisfaction, and quality of care. QSEN Institute provides guidelines for quality and safety education in nursing. Patient-centered care, teamwork and collaboration, evidence-based practice, and quality improvements are QSEN principles that are also driving forces behind Magnet Status. Patient-Centered CareAs previously mentioned, implementing a professional practice model is a key requirement for organizations working towards excellence in nursing. Patient centered care is the foundation of many professional practice models implementing nursing theory. According to QSEN (2014), to provide patient-centered care is to “recognize the patient as the source of control and full partner in providing compassionate and coordinated care based on respect for patient’s preferences, values, and needs.” Teamwork and CollaborationStructural empowerment and transformational leadership components of the Magnet Model incorporate teamwork and collaboration to set standards for Magnet Status. Transformational leadership encompasses advocacy on behalf of staff and patients. Nurse leaders must demonstrate advocacy for support of the nursing unit and organizational goals. The structural empowerment component is met by demonstrating involvement in shared governance among nursing staff (American Nurses Credentialing Center, 2014). QSEN standards for teamwork and collaboration state that “an organization must function effectively within nursing and inter-professional teams, fostering open communication, mutual respect, and shared decision-making to achieve quality patient care” (QSEN, 2014). Evidence-Based PracticeNew knowledge, innovations, and improvements incorporate evidence-based practice into the Magnet standards. “An organization needs to incorporate evidence-based practice and research into clinical and operational processes” (American Nurses Credentialing Center, 2014). Protocols within a Magnet organization are constantly changing to keep up with evidence-based practice in order to meet the constantly evolving standards of quality nursing practice. QSEN standards for evidence-based practice state “an organization will integrate best current evidence with clinical expertise and patient/family preferences and values for delivery of optimal health care” (QSEN, 2014).Quality ImprovementEmpirical outcomes are used as the report card of Magnet Status. Measurement of quality outcomes related to nursing leadership and clinical practice is critical for demonstration of Magnet standards (American Nurses Credentialing Center, 2014). Quality encompasses all of the QSEN principles, however quality improvement specifically is defined as “the use of data to monitor the outcomes of care processes and use improvement methods to design and test changes to continuously improve the quality and safety of health care systems” (QSEN, 2014). Quality outcomes are the largest indicator of nursing excellence and the driving force behind Magnet Status. Nursing StandardsThe American Nurses Association has set standards for nursing care. These standards can be incorporated into Magnet Status to create an environment of nursing excellence. Standard eight: Education. “The registered nurse attains knowledge and competence that reflects current nursing practice” (ANA, 2014, p. 49) Educational requirements of the Magnet Model ensure knowledge and competence of nursing staff within a Magnet Recognized organization. Standard nine: Evidence-based practice. “The registered nurse integrates evidence and research findings into practice” (ANA, 2010, p. 51) Utilizing evidence-based practice and incorporating research into clinical processes ensures quality outcomes keep up with the evolving health care system, thus ensuring the quality standards within a professional practice environment. Standard 12: Leadership. “The registered nurse demonstrates leadership in the professional practice setting and profession” (ANA, 2010, p. 55) Transformational leadership ensures that an organization involves nurses in decision-making and leadership roles within an organization. Standard 14: Professional Practice Evaluation. “The registered nurse evaluates his or her own nursing practice in relation to professional practice standards and guidelines, relevant statuses, rules, and regulations” (ANA, 2010, p. 59) Exemplary professional practice is demonstrated by providing details that support a culture of safety and quality. Nursing excellence within a professional practice environment includes accountability for ensuring best practice and quality outcomes.ConclusionNursing excellence can be found in both Magnet and non-Magnet hospitals (Smith, 2014). The Magnet Model, QSEN competencies, and ANA standards are all frameworks for quality nursing care. Magnet organizations are proven to have competencies that provide nursing excellence and are required to meet standards to demonstrate high quality nursing (American Nurses Credentialing Center, 2014). Many factors contribute to reasons an organization does not have Magnet Recognition, including size, finances, and time intensive requirements (Stimpfel, et. al., 2014). New graduate nurses should strive to consider the qualities within an organization that demonstrate excellence, while also understanding the significance and value placed on an organization that has earned Magnet Recognition. ReferencesAlligood, M. (2014). Nursing Theorists and Their Work (8th ed., pp 1-11). St. Louis, MO: Elsevier.American Association of Colleges of Nursing [AACN]. (2015). The impact of education onnursing practice. Retrieved from aacn.nche.edu/media-relations/fact-sheets/impact-of-educationAmerican Nurses Association [ANA].(2010). Nursing: Scope and Standards of Practice (2nd ed.). Silver Spring, MD: .ANCC Magnet Recognition Program. (2014). Retrieved from , V. (2009). Magnet environments for professional nursing practice. Patient Safety and Quality: An Evidence-Based handbook for Nurses. Rockville, MD. Retrieved from: , N. (2012). Wither nursing models? The value of nursing theory in the context of evidence based practice and multidisciplinary health care. Journal of AdvancedNursing, 68(1), 222-229.McLaughlin, A. & Fetzer, S.J. (2015). The perceived value of certification by Magnet and non-Magnet nurses. The Journal of Nursing Administration, 45(4), 194-199.Morgenthaler, M. (2009). Too old for school? Barriers nurses can overcome when returning to school. AORN Journal, 89(2), 335-345.Pre-Licensure KSAS. (2014). QSEN Institute. Retrieved from , L. (2013). Management and Leadership for Nurse Administrators (6th ed.) Boston:Jones and Bartlett Publishers.Smith, S. (2014). Magnet hospitals: higher rates of patient satisfaction. Policies, Politics, & Nursing Practice, 15(1), 30-41.Stimpfel, A., Rosen, J., & McHugh, M. (2014). Understand the role of the professional practice environment on quality of care in Magnet and non-Magnet hospitals. Journal of Nursing Administration, 44(1), 10-16.Unknown Author. (2010). University of Maryland Medical Center achieves Magnet status: Designation signifies highest level of nursing excellence. The Maryland Nurse (11)1. 1-4.Wagner, C., (2004). Is your nursing staff ready for Magnet hospital status? Journal of Nursing Administration, 34(10), 463-468 ................
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