In 1983, nearly thirty years ago, the American Academy of Nursing's (AAN) Task Force on Nursing Practice in Hospitals conducted a study of 163 hospitals to identify and describe variables that created an environment that attracted and retained well-qualified nurses who promoted quality patient/resident/client care. Forty-one (41) of the 163 institutions were described as “magnet” hospitals because of their ability to attract and retain professional nurses. The characteristics that seem to distinguish “Magnet” organizations from others became known as the “Forces of Magnetism”.
Today, the Magnet Recognition Program®, run by the American Nurses Credentialing Center (ANCC), is fast becoming an international phenomenon with Dr. Karen Drenkard at the helm.
Dr Drenkard, an acknowledged leader in her field, is passionate about nursing and improving nursing practice. As the Executive Director of the Magnet Recognition Program® she is deeply committed to raising the level of nursing practice, enriching the global nursing community, providing the tools to help nurse leaders manage in an ever-changing healthcare environment, and strengthening the future of nursing around the world.
Prior to joining the ANCC, Dr Drenkard was Senior Vice President of Nursing and the Chief Nurse Executive at the multi-hospital Inova Health System, in Falls Church, VA. For eight years, she was responsible for nursing practice, education, research, strategy, and operations across one of Washington, DC's largest healthcare systems. She had oversight of the nursing leadership team and more than 3,900 nurses at multiple service sites.
“While there”, she says, “I led the creation and implementation of the system's first vision for nursing services: to create a world-class nursing environment of global distinction where service, community, compassion and innovation foster excellence in nursing practice, education and research.”
“I led the implementation of Dr. Jean Watson's Human Caring Initiative to increase the time nurses spend caring for patients at the bedside, and boost nurse satisfaction and retention. And I led two hospitals to successful Magnet designation and served as the program's champion.”
Given this experience it is no wonder that in 2008 she joined the ANCC as the Director of the Magnet Recognition Program®. She says of this opportunity, “it was a natural role that appealed to me, to be able to impact nursing practice across the nation and across the world”.
“One of my first tasks was to oversee the implementation of a new Magnet® Model that puts a greater emphasis on measuring outcomes, evidence-based practice, innovation, evolving technology and patient partnership.”
The Magnet program was developed by the ANCC to recognise healthcare organisations that provide nursing excellence. Although it is becoming increasingly recognised internationally (with Magnet hospitals now appearing as far as Lebanon, Singapore and even Australia!), we asked Dr Drenkard what she believes distinguishes Magnet recognition from other continuous quality improvement endeavours.
“ANCC Magnet Recognition® is the highest and most prestigious international distinction a healthcare organization can receive for nursing excellence and quality patient care. It isn't a prize or award – it's a performance-driven recognition credential that brings both external prestige and wide-ranging internal benefits. With only 8% of US hospitals Magnet-recognized, and only 4 hospitals globally, it's clearly the gold standard.”
“Although quality improvement and nurse practice development are important components of the Journey to Magnet Excellence™, pursuing and achieving recognition is far more wide-ranging. It is a challenging, resource-intensive process that requires a fundamental culture shift throughout a healthcare organization. And the work only gets harder once recognition is achieved. Magnet hospitals must sustain their standards of excellence and demonstrate outstanding outcomes in patient care and clinical practice moving forward.”
“A growing body of independent research supports multiple, measurable benefits of Magnet status beyond quality improvement. They include improved safety; increased nurse engagement, satisfaction, and retention; better service and higher patient satisfaction; higher measurable financial return; and improved patient outcomes.”
Forces of Magnetism
The original Magnet™ research study from 1983 first identified 14 characteristics that differentiated organizations that were best able to recruit and retain nurses during the nursing shortages of the 1970s and 1980s. These characteristics became the ANCC Forces of Magnetism that provide the conceptual framework for the Magnet appraisal process.
Described as the heart of the Magnet Recognition Program®, the Forces of Magnetism may be thought of as attributes or outcomes that exemplify excellence in nursing. The full expression of the current 14 Forces of Magnetism is the requirement for designation as a Magnet facility and embodies a professional environment guided by a strong and visionary nursing leader who advocates and supports excellence in nursing practice.
“However”, Dr Drenkard says, “In 2008, the Commission on Magnet Recognition introduced a new conceptual model that grouped the 14 Forces of Magnetism into five key components: Transformational Leadership; Structural Empowerment; Exemplary Professional Practice; New Knowledge, Innovations, & Improvements; and Empirical Outcomes. The new, simpler model reflects a greater focus on measuring outcomes and allows for more streamlined documentation, while retaining the 14 Forces as foundational to the program.”
Evidence-based practice and Magnet recognition
Creating a culture of enquiry and quality improvement is central to the Magnet journey and Dr Drenkard recognises that evidence-based practice has an important role to play. She says, “Evidence-based practice (EBP) is internationally acclaimed as the gold standard for delivering the highest quality nursing care. An essential component of the Forces of Magnetism, EBP characterizes nursing excellence in Magnet organizations.”
“Transforming the nursing work environment to promote and support EBP, and integrating it into the professional nursing culture, are essential processes for hospitals on the Magnet journey. To do so, hospitals must establish a spirit of clinical inquiry, formulate clinical questions, critique the available literature, and develop evidence-based protocols and guidelines to improve care.”
The Magnet journey
The Magnet Accreditation process is often described as representing a “journey” whereby an organisation seeks to promote quality in a setting that supports professional practice, identify excellence in the delivery of nursing services to patients/residents and disseminate ‘best practices’ in nursing services.
The Magnet journey can be both rewarding and challenging for organisations. As Dr Drenkard explains, “Magnet recognition is a cultural transformation that involves two essential elements – transformational leaders; and empowered and accountable clinicians. These nurses work together to be involved in care, autonomous in practice, and participating in decision making about that clinical practice.”
“Leading that transformation in partnership between leaders and clinicians is both the most challenging and the most rewarding. The team approach in reaching Magnet is essential as well, and everyone working towards the same goal of excellence in practice is a very rewarding element of Magnet organizations.”
As the Magnet Program continues to become a global phenomenon, Dr Drenkard reflects on her experience over the last three years of watching organisations progress through the application process and the rewarding nature of the work she is involved in.
“Improving nursing status, recognition, leadership, and job satisfaction around the world. Also, contributing to the global improvement of patient care quality and clinical outcomes.”
“Working towards excellence in practice (rather than just meeting minimal standards) is an amazing force. Even if organizations do not achieve Magnet status the first time, they have improved their care by working to meet the standards of excellence in nursing. That is just amazing to watch.”
The next generation
“The next generation of Magnet includes the Magnet hospitals themselves; the world of nursing; the outcomes that are needed to provide the best care for patients; the elements needed to meet the future of an aging population with chronic disease - new models, new paradigms, new ways of delivering nursing care.”
“As we look forward, we see a growing community of Magnet hospitals that extends around the world, and a new generation of global “gold standards” that guide quality patient care. Nursing at the forefront of that excellence ultimately benefits our patients.”
An active teacher, researcher, nurse advocate and fellow in the prestigious American Academy of Nursing, Dr Drenkard is clearly a true leader in her field. She believes that serious culture change and transformational leadership are the keys to the future of nursing and improving health outcomes. It is this thinking that drives her work as Executive Director of the Magnet Recognition Program® and it is this thinking that will ensure the success of the program and of hospitals across the world, to evolve new models of work and care and to foster cultures of innovation in the health sector.
To learn more about the Magnet Recognition Program or to get started on you Journey to Magnet Excellence, please visit: http://www.nursecredentialing.org/Magnet.aspx where you will find a wide range of information including a variety of supplemental resources for international hospitals interested in Magnet or Pathway.