Department: Leadership Q&A
Q Our hospital recently merged with a large health system and there's talk of downsizing. I'm the director of medical-surgical nursing in one facility. Should I be looking for another job?
The answer is maybe. It's hard to know what the new organizational structure will be because every organization does it differently and there's no single answer. Many factors determine the table of organization, ranging from personal preference of the CNO or CEO, to the business model for patient-care services, to the size and scope of services, and more.
It's okay to ask where you stand and how you can strengthen your position. Do a reality check on your effectiveness. You've positioned yourself well if you're a valued nurse leader who contributes to goal achievement, is flexible with projects and assignments, and builds collaborative working relationships with the team. You may be offered a bonus to stay on during the transition, which is a positive sign. Be open to other positions in the restructured organization, both locally and within the system.
In any event, it's always good to be prepared for opportunities that may come your way. Polish up your resume, network, and think about your career goals. If you're downsized, negotiate the best deal you can, including outplacement services if possible. One of the wonderful things about nursing is the breadth of opportunities we have in our careers. Whatever happens, you'll learn from the experience and grow from the next steps. You'll be surprised how when one door closes, another opens. Stay positive and keep your spirit of enthusiasm and determination.
Q I'm a chief nurse executive of a 100-bed hospital with an average daily census of 80 patients. Is pursuing Magnet® designation even worth considering?
This is a case in which size doesn't matter. There are over 380 designated Magnet facilities on the American Nurses Credentialing Center (ANCC) website, and they aren't all large academic medical centers. A description of Magnet organization characteristics on the ANCC website indicates there are 24 designated organizations with a licensed bed range of 0 to 100.1 The three goals of the program—quality, excellence, and best practice—are universal to nursing.
Perform a cost/risk-benefit analysis to build the business case, as well as a gap analysis to help make your decision to press forward. The business case establishes the value and achievability for your organization. There's a growing body of evidence that improved quality and nurse/patient satisfaction are definable benefits.2,3 The gap analysis establishes the work ahead and the scope of the plan for achievement. Both of these reviews will assist in determining if you have the resources you need and can balance the costs against the benefits. They're also the basis for your proposal to the CEO and the board. Keep in mind that although pursuing designation is a choice, pursuing excellence in practice isn't.
Some advantages for you as a smaller organization are that it may be less complex to describe and ensure your evidence, and possibly even to truly involve all RNs in living the Magnet concepts. However, due to your size, you may have to be creative in collaborating with or even bartering help from area nursing universities, healthcare systems, or consultants. Benchmarking with like units/hospitals will also have to be established. There are numerous resources on the ANCC website.
Use the Magnet Recognition Program® to guide your strategic plan for nursing and your organization will benefit even if you decide not to declare yourself officially on the journey. Good luck to you!
1. American Nurses Credentialing Center. Characteristics of Magnet organizations
2. Drenkard K. The business case for Magnet. J Nurs Adm
3. Chiarenza D. The CNO/ROI factor of accreditation. Nurs Manage