GNRS 5411 Program Evaluation: Educator Magnet Recognition The Assessment Process & The Impact upon Professional Nursing Practice Presented by: Jennifer Edeogu BSN, RN Yvette Heflin BSN, RN Katrina Hernandez BSN, RN Jacquelyn D. Svoboda RNC, MSN,WHNP In Partial Fulfillment Of the Requirements for the Course GNRS 5411 Program Evaluation: Educator Summer 2014

Magnet Recognition Objectives: At the conclusion of this Module, the audience will be able to: Describe the history of the Magnet recognition. Describe the criteria for the Magnet recognition. Understand the preparation for Magnet recognition. Describe the evaluation process for Magnet recognition. Describe the impact of Magnet recognition of the professional nursing practice. Describe the three phases of perioperative care. 2. Describe legal, ethical, physical, and psychological considerations in providing perioperative care. 3. Describe a comprehensive preoperative assessment to identify surgical risk factors. 4. Use the nursing process to develop an individualized plan of care for the surgical patient during each phase of the perioperative period. 5. Compare characteristics of acute pain and chronic (persistent) pain. 6. Describe the pathophysiology of pain. 7. Describe assessment of pain including pain measurement instruments. . 8. Describe pharmacologic and nonpharmacologic pain management interventions. 9. Use the nursing process to develop an individualized plan of care of patients with pain.

Magnet Recognition- Background History & Power of Magnet Recognition: 1981- began as a research study Committee established by American Academy of Nursing Nursing Shortage 41 of 150 hospitals were recognized as Magnet Based on recruitment and retention Resulted in recognition of 12 themes, Forces of Magnetism (Westendorf, 2007)

Magnet Recognition- Background History & Power of Magnet Recognition: 1993- American Nurses Association (ANA) through the American Nurses Credentialing Center established the Magnet Recognition Program (Sullivan & Johnston,2004) Objectives (Sullivan & Johnston,2004) 1. Recognize nursing services 2. Promote quality 3. Provide a means of successful nursing practices & strategies 4. Promote positive patient outcomes

Magnet Recognition- Forces of Magnetism 1. Quality of Nursing Leadership 2. Organizational Structure 3. Management Style 4. Personnel Policies and Programs 5. Professional Models of Care 6. Quality of Care 7. Quality Improvement 8. Consultation and Resources 9. Autonomy 10. Community and the Health Care Organization 11. Nurses as Teachers 12. Image of Nursing 13. Interdisciplinary Relationships 14. Professional Development

Magnet Recognition- Magnet Recognition Program Model Model classifies the 14 Forces of Magnetism into 5 Components Transformational Leadership ( Force 1 & 3) Structural Empowerment (Force 2, 4,10, 12 & 14) Exemplary Professional Practice (Force 5, 8, 9, 11 & 13) New Knowledge, Innovations & Improvements (Force 7) Empirical Outcomes (Force 6) The ANCC model for the Magnet Recognition Program® new model serves as a road map for organizations seeking Magnet recognition and provides a framework for nursing practice and research into the future. The model organizes 14 Forces of Magnetism into 5 Model Components, with a focus on outcome measurement and streamlined documentation. Vision for Magnet ANCC Magnet-recognized organizations will serve as the fount of knowledge and expertise for the delivery of nursing carely. Grounded in core Magnet principles, they will be 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 community.

Magnet Recognition- Eligibility for Application Organization’s governing body must have a chief nursing officer who has been in that position at least for 1 year Chief Nursing Officer must have a Master’s degree Key Features (must already be in place): Standards for the Nurse Administrators as identified by the American Nurses Association A confidential feedback system Data collected about the nurse-sensitive quality indicators Conformity to all state, local, and federal laws (Westerndorf, 20047)

Preparation and Assessment: Planning Structure and Process Chief Nursing Officer (CNO) Magnet Project Coordinator Nursing Directors and Managers Committees to address the Forces of Magnetism (Nursing staff and other staff members) Process Timing of application with other activities Coordinating team meetings Completing and submitting application Educating and communicating with staff (brochures, in-services, and posters) To achieve a successful Magnet journey, the CNO must gain support and commitment from the leadership team by holding a strategic planning meeting during the planning phase to discuss cultural transformation and what specific tasks needs to be accomplished to obtain and sustain Magnet status (Turkel, 2004).

Conducting a Self-Assessment Online readiness tools from ANCC Organization Self-Assessment for Magnet Readiness (www.ana.org/ancc/magnet/orgready.pdf) Staff Nurse Self-Assessment to Determine Readiness to Pursue Magnet Recognition (www.ana.org/ancc/magnet/selfassess.pdf) Consider staff surveys and focus groups such as shared governance. Develop databases, sources of data and performance results Cost benefit assessment Consultants to assist with gap analysis and review documents Once a organization has identified readiness based on their self-assessment and staff nurse practice assessment, an initial one-page application along with application fee can be sent in. Once the application has been approved, the organization has 2 years (24 months) to submit completed application.

Making the grade: Essentials of Magnetism Working with other nurses who are clinically competent Good nurse-physician relationships and communication Nurse autonomy and accountability Supportive nurse managers Control over nursing practice and practice environment Support for education (in-service, tuition, continuing education, etc.) Adequate nurse staffing Concern for the patient is paramount Visibility of Chief Nurse Executive Staff nurse participation in hospital committees This is an assessment that Nursing Leadership team can take first to rate their hospital prior to applying for Magnet recognition. Each of these categories are graded 0-10. “1” meaning terrible and “10” meaning perfect. A total score of 90-100 means the hospital facility has identified exemplary practice in that area, and is ready to collect and provide documentation to meet the criterion for Magnet; A score of 80 means the hospital facility shows some weaknesses in an area but with staff input can move forward; A score of 70 means the hospital facility has potential but mild to moderate cultural transformation must occur prior to applying; A score below 70 means the hospital facility needs a MAJOR cultural transformation overhaul (Turkel, 2008).

Committees to address Magnet needs Quality Committee: involves collecting data for participation in the National Database of Nursing Quality Indicators (NDNQI). Forces of Magnetism committee: provide practice examples and collect supporting evidence from point of care on how Forces are integrated across nursing services and draft written documentation for submission to steering committee/Magnet project coordinator Education/Marketing committee: develops brochures, posters, and flyers to keep employees aware of projects, writes Magnet update articles for employees and nursing newsletters, educate all members of organization on Magnet, and prepares organization for site visit Steering committee: leads application process including document submission and site visit, assigns accountability expectations to other committees, evaluates progress, communicates with hospital leader and medical staff, and oversees all committees At least four committees should be established to complete the tasks associated with Magnet, having these committees in place will make it easy to identify practice exemplars that reflect the Forces of Magnetism, especially nursing autonomy and professional models of care (Turkel, M., 2004). Magnet status: Assessing, Pursuing, and Achieving Nursing Excellence. These committees will cover tasks or projects needed for both document and site-visit preparation.

Make-up of Committees Need to be interdisciplinary Should be 8-12 members Majority of members should be Registered Nurses Balance between detailed planners and creative thinkers Staff nurses can be serve as committee chairs or share role with member of the nursing leadership team Include nurse assistants, unit clerks, and LVN’s Magnet project coordinator should serve as resource Teamwork, patience, dedication, perseverance, and respect across the organization are integral to success. Making this an organizational journey rather than a nursing journey has proven successful (Turkel, 2004).

Key sub-committees/councils include: Nursing practice council to address evidence-based policies and procedures, infection, falls, and pressure ulcer rates (data must be collected at the unit level) nursing education council to address new employee orientation, professional development, ways to increase nursing certifications, and review required competencies for annual competency evaluation Nursing recruitment and retention council to revise/review staffing and scheduling policies, monitors RN turnover rates and organize recruitment job fairs and retention initiatives, and plan nursing recognition events Nursing leadership council to plan the budget for nursing resources, participates in the process of clinical ladders and peer/self evaluation, and review patient and nurse satisfaction surveys and recommend practice changes These different committees are needed to collect the data to show exemplary practices to meet the Forces of Magnetism. For every category that the organization says they are exemplary in, there must be evidence submitted such as narrative description including examples and testimonial statements and evidence which provides verification that what is stated in the narrative actually exists in the organization. Examples of acceptable evidence: copies of policies and procedures, meeting minutes, various types of correspondence, data, or rosters (Turkel, 2004).

Magnet Recognition- Program Evaluation The purpose of program evaluation is to improve program effectiveness and demonstrate accountability The more advanced a program is in its implementation, the more complex becomes the program evaluation Specific purposes of program evaluation are: To determine how various elements of the program interact and influence program effectiveness To determine the extent to which the mission, goals, and outcomes of the program are realized To determine whether the program has been implemented as planned To provide a rational for decision making that leads to improved program effectiveness To identify efficient use of resources that are needed to improve program quality

Magnet Recognition- Program Evaluation Approach to program evaluation can be theory-driven or a model based planning tool The Logic Model is a planning tool used by program mangers and evaluators to describe the effectiveness of their program The model describes logical linkages among program resources, activities, outputs, audiences, and short-, intermediate-, and long-term outcomes related to a specific problem or situation. Logic models are narrative or graphical depiction of processes in real life that communicates the underlying assumptions upon which an activity is expected to lead to a specific result Program evaluation is a systematic assessment of all components of a program through the application of evaluation approaches, techniques and knowledge in order to improve the planning, implementation, and effectiveness of programs.

Program Evaluation-The Logic Model Logic model process is a tool that has been used for more that 20 years by program managers and evaluators to describe the effectiveness of their programs

Magnet Recognition- Program Evaluation Magnet Recognized program evaluation is based on global issues in nursing and health care Program evaluation must begin by determining the appropriate mission, philosophy, program goals, and outcomes have been defined The Magnet Program advances 3 goals within health care organization Promote quality in a setting that supports professional practice Identify excellence in the delivery of nursing services to patients/residents Disseminate best practices in nursing services Program evaluations built solely around accreditation criteria may lack examination of some important elements or understanding of the relationship between elements that influences program success. Accrediting bodies exert considerable influence over nursing programs

Magnet Recognition- Impact on Professional Nursing practice & Relevance Purpose of Magnet recognition: to separate “true magnets from those that simply want to achieve the recognition” (Hughes, 2008). There are studies that have looked into the relationship of magnet features to patient outcomes Magnet Recognition creates a structure for an organizational environment conditions that “support and facilitate nursing excellence” (Hughes, 2008).

Magnet Recognition- Impact on Professional Nursing practice With the Magnet Recognition, hospitals are able to preserve a staff of well-qualified nurses which in turn results in higher quality of care for patients Studies show that nurses were more satisfied at Magnet facilities and burn out rates were decreased Having this recognition shows that these were good places for ALL employees to work as well as a better place for patients to receive care

Magnet Recognition- Conclusions In essence, improvements are still needed to research magnet features to better enhance requirements Philosophy of Magnet Status shows that nurses function at their peak when in a Magnet Status environment Magnet recognition shows “lower burnout, higher satisfaction, and fewer reports of intentions to leave” (Hughes, 2008).

References American Nurses Credentialing Center (2014). Magnet Recognition Program Model. Retrieved online at http://www.nursecredentialing.org/Magnet/ProgramOverview/New-Magnet-Model.aspx Billings, D. M., & Halstead, J. A. (2012). Teaching in nursing: A guide for faculty (4th ed.). St. Louis, MO: Elsevier Saunders. Hughes , RG (2008). Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Rockville, MD: Agency for Healthcare Research and Quality (US) Chapter 46. Retrieved online at http://www.ncbi.nlm.nih.gov/books/NBK2667/#ch46.r11 Turkel, M. C. (2004). HCPro's Guide to Assessing, Pursuing, and Achieving Excellence in theANCC Magnet Recognition Program. 1st edition. HCPro's, Inc.