Journal of Nursing Administration:
Departments: Magnet(R) Perspectives
Author Affiliation: Executive Director, Nursing Affairs, King Faisal Specialist Hospital & Research Centre (Gen. Org.)–Jeddah, Saudi Arabia.
The author declares no conflicts of interest.
Correspondence: Dr Lovering, Nursing Affairs, King Faisal Specialist Hospital & Research Centre (Gen. Org.)–Jeddah, MBC J-73, PO Box 40047, Jeddah, Saudi Arabia 21499 (email@example.com@gmail.com).
On July 3, 2013, we received a phone call from Deborah Zimmermann, chair of the Commission on Magnet® Recognition, saying “It is my great honor and privilege to officially notify you that the Commission on Magnet has unanimously voted to credential the King Faisal Specialist Hospital & Research Centre in Jeddah as the first Magnet hospital in Saudi Arabia.” The hospital auditorium erupted in cheers, green and white Saudi flags waved, and balloons flew. As I watched from the front, I reflected back on the long journey to this amazing scene.
King Faisal Specialist Hospital & Research Centre (Gen. Org)–Jeddah, located in the coastal city of Jeddah, Saudi Arabia, is a 350-bed, tertiary, specialist hospital providing care to Saudi patients. In 2005, my chief operating officer, Dr Tariq Linjawi, said, “We have Joint Commission international accreditation, but we need to set the bar higher. What is the highest credential in nursing?” I said, “Magnet recognition.” He replied, “Can we achieve Magnet? Can you lead us there?” At that time, I had no idea what was required or whether Magnet recognition could be achieved in a hospital in Saudi Arabia. Our staff is recruited from more than 30 different countries, with Asian nurses in the majority. The Magnet Recognition Program® was United States based, with only 3 international hospitals awarded this designation. As fewer than 2% of our nurses were from the United States, Magnet was an unknown concept. I replied to Dr Linjawi, “Yes, let’s set the bar for nursing excellence in the region.” Our goal: to become the 1st hospital in Saudi Arabia to achieve Magnet recognition.
Nursing is global, with the focus on providing excellent patient care. However, the way nursing is practiced reflects the local context and status of the nursing profession.1 In Saudi Arabia, professional governance structures including a Nurse Practice Act and Nursing Code of Ethics are under development, and nurses from diverse backgrounds bring their own cultural models to the care of patients and their professional practice. Building a unified professional practice model (PPM) for our hospital was the key strategy to provide the framework for our nursing governance and practice and to bridge diverse nursing perspectives in our non-Western setting.
Tim Porter-O’Grady’s2 Shared Governance Model was our framework to transform our leadership model and practice environment. Many on our team did not believe you could implement a “Western-derived” concept such as shared governance in our culturally complex, hierarchy-driven environment. Our PPM council structure (central councils and unit councils) provides the framework for shared governance, with accountability for annual goal setting around quality improvement, practice, nurse satisfaction, and professional development outcomes. We adapted Porter-O’Grady’s2 recommended council structure to reflect our unique cultural context through establishing an Ethics and Cultural Advisory Council.
Our shared governance structure ensures that all cultural groups have their voices heard as equal partners. The empowerment of the bedside nurse around practice and the work environment transformed our nurses’ sense of autonomy and brought the nursing team cohesion around 1 goal: excellent patient care. The outcome of embedding shared governance at the bedside can be seen in our 2013 National Database of Nursing Quality Indicators® (NDNQI®) RN satisfaction results, where decision-making subscale t scores (57.55) outperformed the Magnet mean (51.55), and professional status subscale t scores (71.68) also outperformed the Magnet mean (69.71).
Benchmarking nurse-sensitive indicators is an important element in building a professional practice environment, as it encourages nurses to think beyond local context and focus on outcomes. In 2005, there was no international benchmarking database available, and NDNQI was limited to US hospitals. Through a supportive NDNQI team, King Faisal Specialist Hospital & Research Centre (Gen. Org.)–Jeddah became the 1st hospital outside the United States to join the NDNQI database in 2007. Staff argued, “We can’t compare our results to the United States, as we are in Saudi Arabia.” When the goal became “to be better than the international benchmark,” and efforts focused on the nurses’ practice and best evidence, we soon achieved better-than-the-benchmark results for the majority of nurse-sensitive indicators.
A theory-based nursing model to guide the care of patients is essential in a PPM. Our nursing model needed to assist our culturally diverse nursing team to provide culturally congruent care to our Saudi patients. Through research, we developed the Crescent of Care Nursing Model (COCM), a culture-specific nursing model for the care of Arab Muslim patients3 focused on spiritual, cultural, psychosocial, interpersonal, and clinical caring needs. The COCM places the patient and family at the center of care, consistent with Saudi cultural values. The COCM has recently been selected for development as a nursing model for the entire Middle East region.
ANCC’s Magnet Recognition Program provides a template to achieve nursing excellence in diverse cultural contexts and healthcare systems. On reflection, achieving Magnet designation at King Faisal Specialist Hospital & Research Centre (Gen. Org.)–Jeddah has been a journey to bridge the cultures of our diverse nursing team by creating a shared vision of patient care excellence in a professional practice environment. We discovered that the tenets of professional nursing practice are global but need to be applied within the local context. The Magnet Recognition Program has enabled King Faisal Specialist Hospital & Research Centre (Gen. Org.)–Jeddah to raise nursing practice standards and to become a model for nursing excellence in the region. At a recent national nursing conference, Saudi nurses were excited to hear of our Magnet designation, saying, “We are so proud. As you have shown it can be done in Saudi Arabia, we can also achieve this.”
1. Lovering S. How universal are the caring models used by nurses? Divers Equal Health Care. 2012; 9: 167–170.
3. Lovering S. The crescent of care: a nursing model to guide the care of Arab Muslim patients. Divers Equal Health Care. 2012b; 9: 171–178.