1. Magnet Recognition Program Clinical Excellence in Action

2. Overview
Explain importance of a strong, supportive Professional Practice Model (PPM)
State role of Magnet Recognition Program as “evaluation” of PPM
Describe the five Magnet Model components
Provide illustrations of Magnet Model components

3. Professional Practice Model
Provides a comprehensive view of the components of professional practice and the contributions of all disciplines engaged in patient care. The model reflects an organizational commitment to teamwork in an effort to facilitate optimal patient care.
MGH Patient Care Services
Creates a practice setting that best supports professional nursing practice and allows nurses to practice to their full potential.
American Association of Colleges of Nursing, 2010

4. Massachusetts General Hospital Professional Practice Model
© MGH Patient Care Services 1996, 2006

5. Description of Magnet ®
Promotes quality in a milieu that supports professional practice
Identifies excellence in the delivery of nursing services to patients and families
Provides a mechanism for the dissemination of “best practices” in nursing services
Reflects the presence of both organizational, as well as nursing, excellence
Demonstrates criteria-based evidence of a professional practice environment
© American Nurses Credentialing Center

6. Benefits of Magnet Recognition
People 
Increased RN
retention and lower
nurse burnout
Decreased RN
vacancy rate
turnover rate
Cost 
Reduction in RN agency rates
Reduction in staff needle stick
rates
Improved operating margin
Improved bond rating
Marketing ROI – publication in lieu
of ads
Service
Increased patient
satisfaction
Quality 
Decreased mortality rates
Decreased pressure ulcers
Decreased ALOS
Decreased falls
Patient Safety
US News and World Report rating
© American Nurses Credentialing Center 6

7. Grounded in Research Magnet Standards of Professional Performance
The
Journey
Magnet
Quality of Leadership
Organizational Structure
Management Style
Personnel Policies & Procedures
Professional Models of Care
Quality of Care
Quality Improvement
Consultation & Resources
Autonomy
Community & the Hospital
Nurses as Teachers
Image of Nursing
Interdisciplinary Relationships
Professional Development
Standards of Practice for Nurse Administrators
Standards of Professional Performance
for Nurse Administrators
In 1993, the American Nurses Credentialing Center (ANCC), a subsidiary of the American Nurses Association, introduced a new Magnet Hospital certification process modeled after the 1980s study.
The program is based upon quality indicators and standards of nursing practice as defined in the American Nurses Association’s Scope & Standards for Nurse Administrators.
The Magnet designation process involves submission of written evidence addressing each of the Forces of Magnetism and an on-site review by Magnet appraisers.

8. Theoretical Underpinning
Structure
Outcome
Process
Donabedian, 1966; 1990
© American Nurses Credentialing Center
© 2008 American Nurses Credentialing Center. All Rights Reserved. 8

9. Structure + Process = Outcome
Outcomes
Plans
Roles
Resources
Equipment
Systems
Supports
Communication
Development
Recognition
Discipline
Education
Relationships
Productivity
Satisfaction
Accomplishments
Contributions
© American Nurses Credentialing Center

10. A New Model for ANCC’s Magnet Recognition Program ®
Structural
Empowerment
Exemplary
Professional
Practice
Transformational
Leadership
Empirical
Outcomes
New Knowledge
Innovations &
Improvement
© American Nurses Credentialing Center

11. Transformational Leadership
Leaders are:
Visionary
Inspiring
Strategic
Engaging
Respectful
Trusting
Demonstrated by nurse leaders at all levels

12. Transformational Leadership: Rationale
Need for dramatic change
To transform, not reform
Call for a new way of thinking
Leading people where they need to be
Transcending self-interests
Sharing vision and sense of belonging
Dealing with ambiguity

13. Transformational Leadership
Examples:
Excellence Every Day philosophy
Quality and safety strategy to guide the outcome
Adequate resources to support nursing practice
Creating a culture of safety
Clear strategic direction
Nursing strategic plan and quality plan aligned with Hospital’s mission and strategic plan
Fiscal support for nursing education, conference attendance, certification and research
Award & Recognition Programs
Robust communication structure ( , website, newsletters)
Advocate for support for innovative programs
New Graduate Residency Program
Innovation Units
Short-stay unit
Force 2 focuses on a organizational dynamics that supports proactive decision-making & responsiveness to change.
Nurses are in decision-making roles throughout the organization. Key forums include:
Patient Care Services Executive Committee (PCSEC) – comprised of the Directors of each of the PCS departments and the Associate Chief Nurses. Charges of the committee include evaluation & adoption of policies relating to patient care, education for nursing & health professions, and/or other matters affecting the optimal operation of PCS.
Combined Leadership – provides an opportunity for nursing leadership & triad teams to discuss & review departmental and/or hospital-wide initiatives, policies & procedures that will be implemented on the patient care units.
Unit-based staff meetings – provide an opportunity for the Nursing Director & staff to discuss issues that have a direct impact on the day-to-day operations of the unit.
The Institute for Patient Care is the new interdisciplinary structure within Patient Care Services that provides a “think and do tank” for work to unite multiple organizational efforts designed to advance high quality, cost-effective, safe care. The Institute is comprised of the following Centers: The Norman Knight Center for Clinical & Professional Development, The Yvonne L. Munn Center for Nursing Research, The Blum Patient & Family Learning Center and The Center for Innovations in Care Delivery.
The Collaborative Governance model is the core mechanism within the Professional Practice Model used to support nursing practice by bringing decision-making to the bedside. The seven committees are: Diversity, Ethics in Clinical Practice, Nursing Practice, Nursing Research, Patient Education, Quality & Staff Nurse Advisory.
The unit-based leadership triad is comprised of the Nursing Director, Clinical Nurse Specialist and Operations Coordinator. Together, they oversee the clinical operations of the unit and supporting unit-based decision-making.

14. Structural Empowerment
Transformational leaders
create structures that ensure access to:
Information
Resources
Support
And opportunity to take
advantage of them

15. Structure Empowerment: Rationale
The mission, vision and values of the organization
“come to life” in the structure.
The structure needs to acknowledge, value,
support, and develop strong professional practice.

16. Structural Empowerment
Examples:
Organizational structure (flat organizational chart)
Interdisciplinary collaborative governance communication & decision-making structure
Clinical Recognition Program – promotes advancement at the bedside
Institute for Patient Care
Norman Knight Center for Clinical & Professional Development
Yvonne L. Munn Center for Nursing Research
Eleanor & Maxwell Blum Patient & Family Learning Center
Center for Innovations in Care Delivery
Force 2 focuses on a organizational dynamics that supports proactive decision-making & responsiveness to change.
Nurses are in decision-making roles throughout the organization. Key forums include:
Patient Care Services Executive Committee (PCSEC) – comprised of the Directors of each of the PCS departments and the Associate Chief Nurses. Charges of the committee include evaluation & adoption of policies relating to patient care, education for nursing & health professions, and/or other matters affecting the optimal operation of PCS.
Combined Leadership – provides an opportunity for nursing leadership & triad teams to discuss & review departmental and/or hospital-wide initiatives, policies & procedures that will be implemented on the patient care units.
Unit-based staff meetings – provide an opportunity for the Nursing Director & staff to discuss issues that have a direct impact on the day-to-day operations of the unit.
The Institute for Patient Care is the new interdisciplinary structure within Patient Care Services that provides a “think and do tank” for work to unite multiple organizational efforts designed to advance high quality, cost-effective, safe care. The Institute is comprised of the following Centers: The Norman Knight Center for Clinical & Professional Development, The Yvonne L. Munn Center for Nursing Research, The Blum Patient & Family Learning Center and The Center for Innovations in Care Delivery.
The Collaborative Governance model is the core mechanism within the Professional Practice Model used to support nursing practice by bringing decision-making to the bedside. The seven committees are: Diversity, Ethics in Clinical Practice, Nursing Practice, Nursing Research, Patient Education, Quality & Staff Nurse Advisory.
The unit-based leadership triad is comprised of the Nursing Director, Clinical Nurse Specialist and Operations Coordinator. Together, they oversee the clinical operations of the unit and supporting unit-based decision-making.

17. Exemplary Professional Practice
• A professional practice model depicts a nursing philosophy and links it an organization’s mission.
• The model frames and directs nursing practice according to legal and ethical professional standards.
• Nurses are accountable for safe, ethical, evidence- based care.

18. Exemplary Professional Practice: Rationale
Nursing practice in Magnet organizations actualizes ideals and believes of the profession.
A professional practice model depicts a nursing philosophy and links it to the organization’s mission.
The professional practice model frames and directs nursing practice according to legal and ethical professional standards.
Nurses are accountable for safe, ethical and evidence-based care.

19. Exemplary Professional Practice
Examples:
Care Delivery Model: Interdisciplinary, Patient- and Family-Focused Relationship-Based Care
Autonomous practice
Provide educational programs and coaching to develop nurses’ critical independent thinking skills
Nurses as teachers
Nurses are preceptors, mentors, instructors (for nurses, students, patients, families and the community)
Rounds:
Safety Rounds
Interdisciplinary rounds
Force 2 focuses on a organizational dynamics that supports proactive decision-making & responsiveness to change.
Nurses are in decision-making roles throughout the organization. Key forums include:
Patient Care Services Executive Committee (PCSEC) – comprised of the Directors of each of the PCS departments and the Associate Chief Nurses. Charges of the committee include evaluation & adoption of policies relating to patient care, education for nursing & health professions, and/or other matters affecting the optimal operation of PCS.
Combined Leadership – provides an opportunity for nursing leadership & triad teams to discuss & review departmental and/or hospital-wide initiatives, policies & procedures that will be implemented on the patient care units.
Unit-based staff meetings – provide an opportunity for the Nursing Director & staff to discuss issues that have a direct impact on the day-to-day operations of the unit.
The Institute for Patient Care is the new interdisciplinary structure within Patient Care Services that provides a “think and do tank” for work to unite multiple organizational efforts designed to advance high quality, cost-effective, safe care. The Institute is comprised of the following Centers: The Norman Knight Center for Clinical & Professional Development, The Yvonne L. Munn Center for Nursing Research, The Blum Patient & Family Learning Center and The Center for Innovations in Care Delivery.
The Collaborative Governance model is the core mechanism within the Professional Practice Model used to support nursing practice by bringing decision-making to the bedside. The seven committees are: Diversity, Ethics in Clinical Practice, Nursing Practice, Nursing Research, Patient Education, Quality & Staff Nurse Advisory.
The unit-based leadership triad is comprised of the Nursing Director, Clinical Nurse Specialist and Operations Coordinator. Together, they oversee the clinical operations of the unit and supporting unit-based decision-making.

20. New Knowledge, Innovation & Improvements
• Establishing new ways to achieve new heights of quality, efficiency, and effectiveness.
• Magnet organizations are in a key position to advance nursing science, learning, and discovery.

21. New Knowledge, Innovations and Improvement: Rationale
As exemplary professionals, nurses are accountable for
using and expanding nursing knowledge.
Magnet nurses should be the pioneers of our future.
Innovations in nursing care, care delivery, and the practice
environment are the hallmark of Magnet organizations.
Create new designs, models of care, evidence and
standards.

22. New Knowledge, Innovation and Improvement
Examples:
Nurses actively participate in many initiatives that improve the quality of
patient care (research, evidence-based practice (EBP) and process improvement).
Munn research awards and fellowships
EBP-driven practice, e.g. temporal thermometers
Process improvement projected guided by Plan-Do-Check-Act (PDCA)
framework
Innovation in service delivery is a novel set of behaviors, routines, and ways
working that are directed at improving health outcomes, administrative
efficiency, cost effectiveness or users’ experience and that are implemented
by planned and coordinated actions. (Greenhalgh, 2004).
Innovation Units, e.g., Attending nurse role, patient- and family notebooks,
enabling technology
Force 2 focuses on a organizational dynamics that supports proactive decision-making & responsiveness to change.
Nurses are in decision-making roles throughout the organization. Key forums include:
Patient Care Services Executive Committee (PCSEC) – comprised of the Directors of each of the PCS departments and the Associate Chief Nurses. Charges of the committee include evaluation & adoption of policies relating to patient care, education for nursing & health professions, and/or other matters affecting the optimal operation of PCS.
Combined Leadership – provides an opportunity for nursing leadership & triad teams to discuss & review departmental and/or hospital-wide initiatives, policies & procedures that will be implemented on the patient care units.
Unit-based staff meetings – provide an opportunity for the Nursing Director & staff to discuss issues that have a direct impact on the day-to-day operations of the unit.
The Institute for Patient Care is the new interdisciplinary structure within Patient Care Services that provides a “think and do tank” for work to unite multiple organizational efforts designed to advance high quality, cost-effective, safe care. The Institute is comprised of the following Centers: The Norman Knight Center for Clinical & Professional Development, The Yvonne L. Munn Center for Nursing Research, The Blum Patient & Family Learning Center and The Center for Innovations in Care Delivery.
The Collaborative Governance model is the core mechanism within the Professional Practice Model used to support nursing practice by bringing decision-making to the bedside. The seven committees are: Diversity, Ethics in Clinical Practice, Nursing Practice, Nursing Research, Patient Education, Quality & Staff Nurse Advisory.
The unit-based leadership triad is comprised of the Nursing Director, Clinical Nurse Specialist and Operations Coordinator. Together, they oversee the clinical operations of the unit and supporting unit-based decision-making.

23. Empirical Quality Results
• Focus on “What difference have you made?”
• Shift from structure and process to outcomes.
• Key indicators that paint a picture of the organization.

24. Empirical Outcomes Examples: Regulatory Readiness
Robust Quality and Safety Committee Structure
Safety reporting system (root cause analysis)
Measurement and tracking of nursing sensitive indicators: clinical quality indicators, patient satisfaction and staff satisfaction
Staff safety programs (e.g. needle stick injuries, flu vaccines)
Promotion of safety in environment of care (e.g., equipment, supplies, construction)
Force 2 focuses on a organizational dynamics that supports proactive decision-making & responsiveness to change.
Nurses are in decision-making roles throughout the organization. Key forums include:
Patient Care Services Executive Committee (PCSEC) – comprised of the Directors of each of the PCS departments and the Associate Chief Nurses. Charges of the committee include evaluation & adoption of policies relating to patient care, education for nursing & health professions, and/or other matters affecting the optimal operation of PCS.
Combined Leadership – provides an opportunity for nursing leadership & triad teams to discuss & review departmental and/or hospital-wide initiatives, policies & procedures that will be implemented on the patient care units.
Unit-based staff meetings – provide an opportunity for the Nursing Director & staff to discuss issues that have a direct impact on the day-to-day operations of the unit.
The Institute for Patient Care is the new interdisciplinary structure within Patient Care Services that provides a “think and do tank” for work to unite multiple organizational efforts designed to advance high quality, cost-effective, safe care. The Institute is comprised of the following Centers: The Norman Knight Center for Clinical & Professional Development, The Yvonne L. Munn Center for Nursing Research, The Blum Patient & Family Learning Center and The Center for Innovations in Care Delivery.
The Collaborative Governance model is the core mechanism within the Professional Practice Model used to support nursing practice by bringing decision-making to the bedside. The seven committees are: Diversity, Ethics in Clinical Practice, Nursing Practice, Nursing Research, Patient Education, Quality & Staff Nurse Advisory.
The unit-based leadership triad is comprised of the Nursing Director, Clinical Nurse Specialist and Operations Coordinator. Together, they oversee the clinical operations of the unit and supporting unit-based decision-making.

25. When you add it all together…
So what happens when you put the concepts of transformational leadership, structural empowerment, exemplary professional practice, new knowledge, innovations and improvement, and empirical outcomes together?
Here’s where I remind you that I promised you a one-sentence summary…..

26. A New Model for ANCC’s Magnet Recognition Program ®
© American Nurses Credentialing Center

27. ANCC 5 Model Components & 14 Forces of Magnetism
Model Elements
Rationale
Forces of Magnetism
Transformational Leadership
Pivotal driving
factor which
should spread over time.
F1: Quality of Nursing Leadership
F3: Management Style
Structured Empowerment
Initially critical for Magnet work to occur; should become hardwired over time.
F2: Organizational Structure
F4: Personnel Policies & Programs
F10: Community
F14: Professional Development
F12: Image of Nursing
Exemplary Professional Nursing Practice
The key driver of Magnet outcomes. Should drive better outcomes over time as it becomes hardwired.
F5: Models of Care
F9: Autonomy
F11: Nurses as Teachers
F13: Interdisciplinary Relations
F8: Resources & Consultation
New Knowledge, Innovation & Improvement
Drives the model; should become stronger over time.
F7: Quality Improvement
(research & EBP)
Empirical Quality Results
Use for dashboard; should improve over time.
F6: Quality of Care

28. Champions
Staff nurse representatives from each practice area along with all
members of the
Hospital community
Role:
To discover
To communicate
To motivate
Operationalized
through Collaborative
Governance structure

29. Magnet Re-designation Timeline
April 2010 – October 2012 Evidence collection and writing
October 1, Submitted evidence to ANCC
October 1, 2012 – Prepare for site visit
Site visit 2013
TBD in Site Visit
TBD Magnet Commission Vote
This timeline highlights key activities that have been completed to date as well as planning and preparation that will take place in the beginning of 2008.

30. Site Visit – Foci Numerous meetings with MGH Staff Nurses
Visits to patient care units
Meetings with department of nursing committees
Organizational meetings:
Hospital Senior Leadership plus representatives from MGH Board of Trustees
Leadership of Quality & Safety Initiatives
Physicians
Nursing Directors and other nursing leaders
Case Managers
Support services
Nursing Executive Operations Group
Patient Care Services Executive Committee
Additional groups: Patients, Families and Volunteers, Interdisciplinary Committees, Community and educational institution representatives, Critical Care Committee, and Human Resources)
Document review

31. Communications & Education Plan
Each week, 1 topic is covered by the 5 strategies below,
and repeated as time allows
Magnet Monday → electronic and web portal
Weekly Conference → content is covered live in O’Keeffe allowing for Q&A and other dialogue
Tool Box → material is provided to the ND/CNS/CG Champion to use
Leadership → materials are reviewed with the ND and CNS groups by a member of the subcommittee
Unit – Based → tool box contents are covered at the local level

32. Topics 11/12 Introduction to Magnet
Components of the model, why Magnet is important to MGH
11/19 Preparing for the Survey
What to expect during survey, bios of the survey team, how to interact with them
11/26 Professional Practice Model and Patient Care Delivery Model
Differentiate between the two; What Magnet is evaluating – detailed for leadership, general for staff
12/3 Outcomes 101
How do our interventions make a difference? How did we measure outcomes? Why is it important?
12/10 Nursing Sensitive Indicators
Which are measured on their unit, which were used in the submission; RN and Patient Satisfaction; scenarios
12/17 Support of Staff to pursue formal education & certification
12/24 Professional Development
Educational needs assessment and continuing education
12/31 Performance Evaluation
Self-assessment, peer review, assessment of competencies > how you develop your goals
1/7 Differentiating between evidence-based practice, research, and process improvement
1/14 Internal/External resources to promote EBP research and ethical decision-making (unit-based CNSs with specific areas of expertise, visiting scholars)
1/21 through site visit Mock Surveys and recycle through information above

33. Critical Success Factors
Interdisciplinary teamwork that supports patient- and family-centered care delivery model.
Nurses are expected to practice with autonomy and control over practice.
Collaborative clinician-physician relationships.
Compliance with documentation standards.
Voice in decisions regarding practice and quality of work-life.
Integration of quality initiatives across the entire organization; strong empirical outcomes.
Nurses and patients receive a high level of support from hospital and nursing administration.