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Engaging organizational support for the Magnet journey

Day, Cindy RN, DNP(c)

doi: 10.1097/

Cindy Day is immediate past vice president for patient care and chief nursing officer, Stanford Hospital and Clinics, Stanford, Calif.

Published this month and in future issues, Executive Extra is targeted to senior- and executive-level nurse leaders.

As hospitals and health systems identify strategies to improve care and safety, more are looking to the Magnet Recognition Program as a framework for transforming nursing practice and the environment in which nurses work. The journey to Magnetism requires the support and attention of the entire organization. In this article, I'll identify the role of one chief nursing officer (CNO) and the strategies she used to engage support for the Magnet journey.

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The CNO's role: An overview

The CNO has a unique role in the Magnet journey. As the executive responsible for providing the vision for nursing in the organization, the CNO sets the direction for the discipline and must be able to articulate the vision and corresponding strategies and tactics to achieve that vision. Development of a strategic plan for nursing and utilizing that plan to engage, articulate, and drive nursing excellence is a key to a successful Magnet journey. The entire organization needs to understand and embrace the Forces of Magnetism to successfully create a Magnet culture. CNO visibility with all levels of nursing staff is an important tenant in the leadership force and in the day-to-day work on the Magnet journey. The CNO has a key role in communication with the staff, and CNO forums, rounds, nursing e-news, and e-mail links to the CNO are useful strategies.

The CNO must be able to identify and engage key stakeholder support to bring the vision alive. Key stakeholders for the Magnet journey are staff nurses and nursing leadership, senior leadership, the board of directors or governing body, physicians, and the nursing union. Each of these constituencies must be educated about the Magnet Recognition Program, including what's needed from them to undertake the journey. Let's take a closer look at each stakeholder group.

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Nursing staff and leaders

Assessing nursing's readiness and commitment to the Magnet journey is a key first step for the CNO. In 2001, Stanford Hospital and Clinics (SHC) had recently come out of a 56-day nursing work stoppage. There was new nursing and executive leadership in the organization and significant imperatives to improve financial performance in nursing and throughout the entire organization. Nursing morale was low, staff was disengaged, and the nursing vacancy rate was high. CNO discussions with staff on rounds and in staff meetings and forums were utilized to hear the nurses' perspectives related to the work environment, nursing practice, and opportunities for improvement. Stanford Hospital, now SHC, had been one of the original 41 Magnet hospitals designated, and a number of the staff recalled the pride and excellence in nursing during that time. Use of the Magnet Recognition Program as a framework for change resulted from that early dialogue with the nursing staff.

The next step for the CNO was to identify an approach for the journey. A precursor to launching the journey was a leadership retreat where a framework of six strategic initiatives was introduced to the entire nursing and interdisciplinary leadership and management staff. Those initiatives—employee engagement, clinical excellence, patient experience, professional initiative, colleagueship, and fiscal accountability—became the framework for interdisciplinary work for the next 18 months and the foundation for the Magnet journey. Over 140 staff members participated on the teams, each of which clearly defined charters, objectives, goals, and tactics. Benefits included the numerous outcomes that the teams achieved, increased collaboration between disciplines, staff participation in decision making, and staff members seeing firsthand that leadership was committed to staff participation in decision making and change.

When the teams completed their work, a formal shared decision-making model and draft charters had been created. The teams then transitioned into multidisciplinary practice, education, quality, research, and coordinating councils. Nursing and leadership councils and unit-based councils were later implemented. A 5-year strategic plan was drafted with a great deal of input from the nursing staff, nursing managers, nursing leadership, and the Coordinating Council. (See SHC nursing strategic plan: Example goals, objectives, and tactics.) Achieving Magnet recognition was identified as a strategy in the plan. The plan was approved by the Coordinating Council and presented at staff meetings in all units and departments with nurses. Nursing endorsement and support was attained before the plan was presented to executive leadership, medical staff, and the board for endorsement.

The strategic plan for nursing was built on the hospital's vision to be “The Best Medical Center in the Nation.” To accomplish this vision, nursing, in collaboration with the other clinical disciplines, identified five Excellence Initiatives: Excellence in Clinical Practice, Excellence in Service, Excellence in Community Outreach and Partnerships, Excellence in the Professional Practice Environment, and Excellence in Business and Financial Practices. Each of these initiatives had achievable goals, objectives, tactics, and outcomes that nursing staff could understand, embrace, and see as steps toward building excellence in nursing practice and the environment. Nurses were engaged through the process of developing the plan and participated on teams and initiatives necessary for implementation. Initiatives that were important to nurses were highlighted by the plan, and nurses in turn saw the organization's commitment to addressing issues that were of importance to staff. Trust, confidence, and commitment were engendered through the planning and implementation processes.

In addition to leading the strategic planning process, the CNO utilized data from early participation in the measurement of nurse-sensitive indicators and nursing satisfaction to identify opportunities for improvement and areas of excellence. Another early strategy was to provide education for the nursing leadership team. A nationally respected CNO from a Magnet hospital was invited to provide an educational session for the nursing leaders and executive team. A national expert in shared governance was also engaged and delivered consultation and educational sessions for the managers and staff. An initial gap analysis was conducted, a work plan created, and resource needs were identified.

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Senior leadership

The CNO has a key role in ensuring that communication and coordination with the senior leadership team takes place. Education of the executive team about what it means to be a Magnet hospital, the costs and benefits, and what's needed from each leader to have a successful journey is critical to success. Attainment of Magnet recognition isn't a nursing initiative or project; it requires an organizational culture that respects and values nursing with commitment and participation of everyone at the executive level to embed the Forces of Magnetism into the organization. The CNO needs to work with the chief executive officer (CEO) to ensure the journey is a priority for the organization. An essential early step is to help the CEO understand the resources that will be required to move through the journey, identify gaps and barriers to meeting the Forces, and develop strategies to meet the missing elements. In 2002, SHC hired a new CEO who came from a Magnet hospital. She was a strong proponent of the Magnet Recognition Program and fully endorsed and desired that SHC start the Magnet journey. Engaging the CEO's support and having her continually articulate the value and importance of nursing as a priority to the leadership team, the board, and the nursing staff is important to a successful journey.

The CNO also needs to educate nonnursing leadership about how the Forces of Magnetism translate outside of nursing. For example, the marketing executive needs to understand how the image of nursing is important and how to support that image in internal and external marketing strategies. The executive responsible for facilities must understand how nursing needs to participate in decision making about environmental and facilities work that impacts nursing practice. The human resource executive needs to be fully engaged with nursing workforce planning, nursing recruitment and retention, benefits, and the workforce demographic data and reports that are needed. Employee education and development opportunities are also important in a Magnet organization and may require human resource leadership support. Education of the entire workforce regarding the Magnet Recognition Program and its importance must occur throughout the organization.

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The board

The board of directors is a third key constituent that the CNO must engage for the journey because the highest leadership in the organization must understand and support initiatives for improvement. The CNO has an important role in educating the board about the Magnet Recognition Program and how it's related to the organization's goals. The CNO establishing Magnet as a goal, presents to the board, asks for endorsement of the initiative, provides updates and status reports, and identifies and prepares board members who will participate in the site visit interview.

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Medical staff

The medical staff is an equally important constituency in the Magnet journey. Nursing's relationship with the medical staff is crucial to meeting a number of the Forces. Teamwork, interdisciplinary collaboration, and autonomy are fundamental to the Magnet journey. In addition, physician support and partnership can help nursing's journey through participation in professional development. For example, the Neurosurgery Unit Council at SHC made a goal to significantly increase the number of staff attaining specialty certification. The team and managers designed a series of group study sessions for staff members to prepare for the exam. In partnership with the medical staff, leadership, and residents, the unit conducted evening study sessions, some of which were taught by house staff and APNs. Not only did the nurses gain the benefit of the advanced pathophysiology and clinical knowledge shared by the physicians, but the physicians gained more insight and respect for the extensive knowledge of the nurses. This strengthened the relationships and collaboration between the disciplines.

Strategies to engage the physicians include presenting and educating them in meetings and one on one. Identifying key medical staff leaders who can help carry and communicate the importance of Magnet recognition and what it means to patient care, as well as what's needed from the physicians, is important. Sharing data about improvements made throughout the journey in nursing outcomes, retention and vacancy rates, and patient satisfaction is an effective way to demonstrate to them the value of Magnet recognition.

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The nursing union

The CNO has a unique role in determining an appropriate approach with the nursing bargaining unit and communicating with union leadership. Building on the relationship that exists with the union is a first step. Early and regular conversations with union leadership are important. Clarity regarding management rights, what must be bargained or agreed upon jointly with the union, and what can be determined through shared decision making with staff is also important and requires collaboration and discussion between nursing, human resources, and the union leadership.

Communication and education of the union leadership in contractually agreed upon joint meetings is a role that the CNO needs to assume during the Magnet journey. Key leverage points include educating union leadership about the Magnet Recognition Program and demonstrating the organization's commitment to nursing by seeking recognition and the secondary benefits in terms of increased ability to hire and retain nurses and improved work environment.

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On the road to success

A successful Magnet journey requires building the Forces of Magnetism into the culture of the organization. The CNO, as the leader for nursing, must engage multiple constituencies in the organization to create that cultural change. Fundamental to success is the ability to engage all of the organization's key stakeholders, eliciting their understanding, support, and commitment to the journey.

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SHC nursing strategic plan: Example goals, objectives, and tactics

Excellence in clinical practice

Goal: Provide consistent, excellent patient care leading to optimal outcomes, built on a foundation of evidence-based professional practice, continuous improvement, interdisciplinary collaboration, and use of best demonstrated technology.

Objective 1: Utilize technological advances in clinical care and information systems

• Sample tactics: Implement smart pumps and bar-coded medication administration; develop a multidisciplinary clinical equipment council

Objective 2: Advance the standard of care through evidence-based practice and clinical research

• Sample tactics: Implement an evidence-based practice fellowship program; develop and implement a 5-year Research Council strategic plan

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Excellence in professional practice environment

Goal: Create a work environment that strategically enhances the recruitment and retention of nurses based on the model of care, staff engagement in the work environment, governance structures, and interdisciplinary relationships.

Objective 1: Recruit and retain top talent

• Sample tactics: Develop and implement a recruitment and retention strategic plan; obtain Magnet designation; sponsor presentations and attendance at conferences; develop a leadership succession plan

Objective 2: Empower staff to define, implement, and maintain evidence-based standards

• Sample tactics: Define and implement a peer review process; create and implement bylaws for an interdisciplinary professional practice governance structure

© 2008 by Lippincott Williams & Wilkins, Inc.