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Nursing Management:
doi: 10.1097/01.NUMA.0000357802.84257.00
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M THE MAGNETIC PULL: The nuts and bolts of Magnet site visit preparation

Conerly, Caroline RN, NE-BC, MS; Thornhill, Lisa BSN, RHIT

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Caroline Conerly is assistant vice president of quality and patient safety at St. Elizabeth Hospital in Gonzales, La. Lisa Thornhill is a risk manager at Jeff Anderson Regional Medical Center in Meridian, Miss.

Numerous resources are available for organizations considering the Magnet journey. Although many address the Forces of Magnetism, the five Magnet model components, and the benefits of Magnet recognition to patients, staff, and the community, few address the nuts and bolts of documentation submission and site visit preparation. You've done the gap analysis, begun work on areas of weakness, and submitted an application of your intent to pursue Magnet recognition—now what?

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Your organization will be notified by the Magnet Program office of the document submission date and the name of your assigned Magnet Program office analyst. The written documentation is limited to 15 inches in depth, excluding the organizational overview documents. The written documentation may be submitted on CD-ROM or hard copy. The evidence submission included in the written documentation must convince Magnet appraisers that the five Magnet model components of achieving superior performance are part of your organization's culture.

The Magnet Recognition Program publishes an application manual to guide organizations in the process of achieving Magnet designation. Applicants are required to submit written narrative statements addressing each component and source of evidence as outlined under each of the Magnet components.1 In addition to the sources of evidence, organizational overview documents and an organizational demographic information form are required. Let's take a closer look.

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Data collection responsibilities

Data collection involves many people throughout your organization. It may be helpful to form teams to work on assigned sections of the application manual. Another option is to form teams based on subject matter. This method proves useful in developing teams with similar interests and knowledge. An example of this method is to identify key topics or subjects in the application manual and assign standards based on topic. Examples of teams are human resources, education, nursing process/theory, research, and quality. Teams must report regularly to a steering committee to ensure that there's sufficient progress and no duplication of efforts. A periodic meeting of all teams also proves useful in preventing duplication of effort and encouraging information sharing.

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Demographic information

The demographic information form provides an organizational profile of your organization, as well as specific information about nursing. Due to the complexity of the data needed to complete the form, a designated individual should be responsible for the data collection and the completion of the form. The online demographic information form must be submitted at the time of document submission. It's wise to allocate sufficient time and resources for data collection before the submission date.

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Organizational overview documents

Twenty-eight items are listed in the required organizational overview documents. It's helpful to introduce each item or example with a narrative describing how the requirement is met. Following the narrative, relevant documents are included. For example, when addressing the participation of the chief nursing officer (CNO) in the credentialing, privileging, and evaluating of advanced practice nurses (APNs), include a narrative describing the process. In the narrative, refer to example documents that will be included. Include the policy related to the privileging of APNs, as well as an example of an actual privileging form (identifying information may be obscured). Minutes of committee meetings addressing privileging of APNs (such as a credentials committee) may also be included to show participation of the CNO.

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Components and evidence

There are five Magnet model components of the Magnet journey: Transformational Leadership; Structural Empowerment; Exemplary Professional Practice; New Knowledge, Innovations, and Improvements; and Empirical Outcomes. Although the five model components make up the new Magnet manual, the 14 Forces of Magnetism are alive and well within each of the components. It's still important to demonstrate evidence of each of the 14 Forces within your organization. When writing about each, it's helpful to organize information in a manner that closely follows the Magnet application manual. You may address each component with a general description of how the component is part of your organization's culture. It's acceptable to refer the reader/appraiser to sources of evidence that further describe the component. This tactic eliminates some redundancy in the documentation.

Each source of evidence is required and must be addressed. To address each, a narrative clearly describing the process and policy is imperative. This narrative should also describe any corresponding documents, which demonstrate significant compliance with the source of evidence. During this process, decisions are made regarding which examples and documents will be utilized in the document submission. Corresponding documents referred to in the narratives should be referenced with a page number so that the appraiser may easily refer to the documents discussed. Documents that are referred to more than once may be located in a reference binder to prevent including documents multiple times. Utilization of a reference binder is encouraged because organizations are limited to the submission of 15 inches of material, excluding the organizational overview documents, binding, page dividers, and tabs.

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Final preparation of documents

After the information is gathered, the narratives and reference documents must be organized, paginated, and bound unless your organization chooses to submit documentation on CD-ROM. Each document required in the organizational overview must be tabbed and included in the first volume. In addition, documents referred to multiple times and located in the cross-reference binder must be tabbed. Some type of divider should separate each of the five components. The use of photographs and colors on these dividers makes the end product both attractive and easier to use. A stapled glossary printed on colored paper must be inserted inside the front cover of the first volume. Binding of the volumes must be accomplished utilizing a material that's sturdy and allows for easy page turning; three-ring binders aren't acceptable.

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Visit prep

If the documents submitted meet the requirements, your organization will be awarded a Magnet site visit. The number of appraisers and the length of the site visit are specific for each organization, depending on its size and complexity. Because the site visit is your organization's opportunity to show the appraisers how the five Magnet model components are enculturated into your organization, preparation is extremely important. After the site visit agenda is received and approved by all parties, your organization should have an individual or team in place to coordinate the preparation. Choosing the right individuals for each interview, sending invitations, arranging for conference rooms, and choosing meals are all important but time-consuming tasks. Attention to detail is important for a successful site visit.

The time between receipt of the site visit agenda and the actual visit will be limited, so preparation must be organized and focused. First steps include public display of the written documents and posting of public notice, which can be accomplished by placing posters throughout your organization in public elevators or on your organization's Web site and by distributing information through flyers and e-mails to all staff. The Magnet appraisers will tour the facility to confirm placement of public notices and location and availability of the written documents. Open forums, unit staff meetings, newsletters, intranet news bulletins, and e-mails can accomplish important organizational communication concerning all aspects of site visit preparation.

If your organization has utilized nurse champions during the document preparation and submission process, it's now time to get them involved in preparing for the site visit. Nurse champions can assist nursing units to prepare storyboards about performance improvement, nursing-sensitive outcomes/quality indicator data, and answers to commonly asked questions. Because the Magnet appraisers allow only nurses to be involved in the unit tours, choose two or three of your most outstanding nurse champions to prepare for the tours. The nurse champions should be familiar with all nursing units both on- and off-site. Before the site visit, allow the nurse champions time to visit all areas in which nurses work. It's also important to provide your champions with a list of all nursing areas and contact information for each.

Get to know your Magnet appraisers. If time permits, read their research and journal articles. Before scheduling their flights, hotel reservations, and meals, find out their preferences. Because the appraisers set the agenda, if you have questions or need to make revisions to interview dates or times, work with the team leader quickly to make the changes. It takes time to prepare and send letters of invitations to community stakeholders, board members, and physicians.

You've now completed the details for the site visit. During the final week before the visit, use the time to prepare the nursing units. Nursing units may want to display welcome banners, staff photo posters, posters recognizing nurses' accomplishments, balloons, or flowers. The nurse champions may want to have special T-shirts made with their theme and names. Allow staff to be creative and make the site visit fun. You've done the hard work of document submission; it's now time for the nurses to shine and tell their stories.

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The actual visit

In order to ensure an organized site visit, the Magnet program director or another appointed staff member should be in charge of managing the flow of individuals to different interviews. If possible, it's better to have different conference rooms already set up for scheduled interviews so that rooms can be alternated, allowing for food setup and cleanup following meals and interviews. The appraisers will want attendance rosters for each interview and nursing unit tour. Because of the detailed information required from each interview participant, having the roster available before the start of the interview allows time for completion. The appraisers will be choosing many staff nurses from all shifts to have a lunch, breakfast, or evening meal with them, so nursing directors may need to staff up for the site visit or have a back-up plan for how to cover for the nurses invited to attend the interviews.

All employees, patients, and community leaders should be asked and even encouraged to attend the open session on the last day of the site visit. This is a wonderful opportunity for staff to share stories, brag about their organization, and ask questions of the Magnet appraisers. It should be a very positive and therapeutic experience.

Following the site visit, reflect on what was learned from the experience and what opportunities for improvement are present. This is also a good time to send personalized thank you notes to departments and individuals who supported nursing during preparation for the site visit, such as food and nutrition services, environmental services, and the marketing department. It's wonderful to have reached this point in the Magnet journey and you should celebrate your accomplishment.

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You've only just begun

After completion of the site visit, the appraisal team will submit a confidential report to the Commission on Magnet Recognition based on its review of the written documents and observations from the site visit. The Commission makes the final decision and informs your organization. The waiting period for the decision may be several weeks, which can be an anxious time for staff. It's important to maintain good communication during the wait time. If you have an internal Web site for nurses, provide frequent updates. Most importantly, fill this time with reflections from the Magnet journey and the accomplishments of nursing. Emphasize to staff that the journey has been a valuable time of growth for the organization and that it doesn't end. Magnet organizations continually seek excellence and always search for ways to improve for staff, visitors, patients, and the community.

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REFERENCE

1. American Nurses Credentialing Center. Magnet Recognition Program Application Manual. Silver Spring, MD: American Nurses Credentialing Center; 2008.

© 2009 by Lippincott Williams & Wilkins, Inc.

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