What better time than 2020, the International Year of the Nurse and Midwife, to submit more than 3,500 pages of nursing excellence to the American Nurses Credentialing Center's (ANCC) Magnet Recognition Program.® This massive document, containing narrations and evidence of structural empowerment, exemplary professional practice, transformational leadership, and new knowledge from the past 4 years in nursing, encompassed the clinical excellence of each and every unit and department at a large urban medical center.1 However, in the early months of 2020, COVID-19 swept into California's Bay Area and the world at large, altering the course of healthcare and establishing nurses at the pinnacle of the public attention.
On October 20, 2020, the medical center received the call that the organization would be advancing straight to a highly anticipated Magnet site visit. Three experienced Magnet appraisers were scheduled to visit in merely 6 weeks and in observance of the shelter-in-place guidelines, it was to be a virtual visit.2 Upon hearing this news, a coalition of nursing and interprofessional leaders, from the bedside to the CNO, jumped on board to complete this next phase of the Magnet journey.
From November 30 to December 3, 2020, three Magnet appraisers were welcomed to virtually explore the medical center's robust culture of nursing excellence.3 Their visit fell immediately before a winter surge of COVID-19 patients that overwhelmed California. Despite the looming surge of positive cases, the healthcare facility didn't detract from the Magnet journey for nursing excellence. Instead, the organization forged ahead to raise the bar for nursing care and professionalism by continuing to bring therapeutic healing, hope, and compassion to its patients and sharing this passion. Daring greatly, the organization continued on this unprecedented path, boldly embracing the challenge and watching it unfold into an opportunity of reflection, celebration, and appreciation for every nurse and interprofessional team member.
Preparing for a virtual site visit in just 6 weeks, with more than 4,000 nurse professionals, over 600 inpatient beds, and 210 units/departments across inpatient, interventional platforms, ambulatory, and all departments in between, demonstrates the medical center's commitment to forward-thinking and the transformative Magnet ideals. Based on an outpouring of energy from clinical nurses and leadership, several key strategies were implemented to prepare the organization to launch an inspiring virtual site visit.
This article describes how the organization readied for the virtual Magnet site visit amidst the pandemic. Engagement was sparked by creating collaborative taskforces, including a high-level Magnet steering committee.
The Magnet steering committee
Under the leadership of the Magnet program director and the CNO, a core coalition of leaders, including nursing directors from inpatient and ambulatory care, associate CNOs, and other key influencers, established a Magnet steering committee. This committee was responsible for overseeing the preparations and technology and ensuring that the cross-functional operational structures were in place for the virtual site visit. The committee created elaborate and detailed timelines for each of the three appraisers and provided the medical units with sufficient time to showcase their quality improvement work, evidence-based practices, and outstanding morale.4
The Magnet steering committee was further divided into the following teams:
- information technology (IT) coordination
The early integration of the IT team was vital to the success of the virtual site visit. The IT team was responsible for coordinating the online meetings; one IT expert was assigned to each Magnet appraiser and was introduced to the appraiser before the site visit. These IT experts conducted a knowledge and skills assessment of their assigned appraiser's comfort level in using the chosen online conferencing program. The IT personnel remained with the appraisers throughout their virtual meetings and were available to assist with technical difficulties and provide troubleshooting tips and techniques.
Coordination with the IT team increased the ease of virtually “traveling” to ambulatory clinics, heightening the efficiency and experience for the appraisers while allowing them to visit more units and sites than previous on-site surveys. The IT team also conducted dry runs to test weak areas for the virtual sessions. Knowing locations in which the transmission was problematic allowed the appraiser's schedules to be revamped to avoid these areas.
The logistics team had myriad responsibilities, such as managing the survey operations (command) center, room coordination, staffing, human resource files, records of patient and staff complaints, and infection control guidelines, and were at the front and center of site visit coordination. This team's responsibility also included capturing participant lists for each session, totaling over 700 attendees, for which they efficiently used quick response (QR) codes. QR codes were an easy way for participants to record their name, credentials, and what aspect of the site visit they joined without the hassle of collecting pen-and-paper sign-in forms.
In addition, the logistics team provided oversight to ensure the readiness of each unit and department for the arrival of the virtual Magnet appraiser, who was broadcasted in real-time via a computer on wheels. Each unit ensured that their visibility boards showing unit-specific data, outcomes, and quality achievements were on display at locations that were easily visible to all staff and patients. The unit management teams, including their respective Magnet champions from the shared leadership council, were encouraged to review Magnet topics with their team members to confirm that everyone was prepared. Unit and department managers were encouraged to ignite contagious excitement on their unit via their authentic and transparent leadership for the upcoming Magnet site visit. Furthermore, the appraisers were made more approachable by virtually traveling on festively decorated computers on wheels.
The education team used best practices to create engaging and informative Magnet educational materials via a multimodal approach. Due to the social limitations caused by the pandemic, multimodal forms of teaching have become more important than ever to engage and pique the interest of all types of learners. These avenues included:
- an interactive, user-friendly, and password-protected website that shared the Magnet exemplars and photos across the organization. Viewers could enter their feedback or questions through a pop-up comment box, which the Magnet redesignation team, a core group of professionals who helped write and compile data and evidence for the Magnet document, answered in real time.
- summaries of the exemplars and an overview of the ANCC's Magnet Recognition Program provided by the Magnet redesignation team. Later, they efficiently partnered with the organization's Center for Education and Professional Development (CEPD) to create a dynamic Magnet tool kit for the nurses.
- an easily accessible intranet page to share an informative eBook, appealing flyers, and animated videos about Magnet. The CEPD's intranet page became a comprehensive, all-in-one portal of information for the Magnet site visit.
When the staff members heard about the Magnet appraisers' scheduled visit, their excitement was palpable because the principles of Magnet are already deeply entrenched throughout the healthcare system. Communication from the enculturation team harnessed this energy and mobilized staff organization-wide by keeping everyone up-to-date. The enculturation team was responsible for making sure both the staff and the public were aware of the site visit. The team also sent calendar invites for all virtual meetings and meal sessions, fielded questions, and boosted energy and morale. The calendar invites included information about the session, topics to be familiar with, sample questions, and information on pop-in practice sessions and a downloadable Magnet virtual background.
Using multimedia QR codes as a method of readily available communication was an essential component of the overall communication strategy. Because the pandemic was ongoing, virtual platforms were already incorporated into the organization's communication network. Staff were prepared for the site visit using internal and external communication, social media, virtual meetings and drop-in online practice sessions, newsletters, and internal and external websites. All communication was informative, fun, and included photos to capture the nurses' attention.
In partnership with the organization's formal and informal nurse leaders from the shared leadership council, Magnet roadshows joined by the CNO and occasionally the chief medical officer rounded on inpatient and outpatient units. Additionally, a socially distanced Magnet fair was held for the Magnet champions, who are members of the organization's shared leadership councils. During this engaging fair, flyers tailored to each unit containing QR codes linked to their Magnet exemplars were distributed, along with sample questions the Magnet appraisers might ask. These sample questions were printed on stickers with photos of the nurses and were then placed on the treats that were passed out, making the event more fun and engaging. This energetic event was a dynamic way for the enculturation team to ignite the council member's passion, enhance organization-wide collaboration, and infuse pizazz into the deeply embedded culture of nursing excellence.
The lasting impact
During the virtual site visit, over 16 years of dedication to the evidence-based Magnet components were shared with the appraisers. Throughout this visit, the nurses and interprofessional team members felt rejuvenated and empowered by celebrating their dedication to excellent patient care. The crux of this successful virtual Magnet site visit was teamwork among the interprofessional team members and across the entire organization, from inpatient to ambulatory and every department in between.
The outcomes were more profound than the goal of achieving the fourth Magnet redesignation, being recognized for seven outstanding exemplars, and joining the top 2% of hospitals in the nation. After the site visit, the nurses expressed that they were injected with a renewed energy to continue caring for their patients, colleagues, and community. The opportunity for nurses to reflect on and share their stories, professionalism, innovations, and patient-centered culture with the appraisers was a moving experience that came at a time when it was needed the most—during the grueling COVID-19 pandemic.
Implications for nurse leaders
If you're a nurse leader and you're wondering how you can prepare your staff for a virtual Magnet site visit, start by garnering support from key stakeholders. This group could include your CNO/chief nurse executive, assistant CNOs, executive directors, and both formal and informal leaders from shared governance councils. It's beneficial to have diverse and inclusive representation from all levels of leadership and across the organization (ambulatory, interventional platforms, inpatient, and everywhere in between). Create collaborative taskforces that embrace engagement and allow for the sharing of dynamic ideas.
Once you have a core group of strategic team members, find enthusiastic change agents across your organization to champion unit-level preparations. For us, these were clinical nurses from our shared leadership councils who partnered with the Magnet redesignation team. These nurses were already knowledgeable and excited about the Magnet principles and were eager to educate and engage others.
The lessons we learned from our virtual Magnet site visit will still be beneficial once the pandemic is over. When planning for a Magnet survey, always remember to “dot your i's” (inspire, innovate, ignite, involve, and individualize):
- inspire. Instead of having one team responsible for planning and execution, spreading the work across the organization's leaders boosts engagement and helps everyone play an integral part in the facility's Magnet success. Every nurse's daily commitment to excellence is what makes an organization a Magnet facility. During your Magnet survey, you can empower your nurses to shine. Make the visit an inspirational reflection of everyone's exemplary professional practice and be sure to celebrate together afterward.
- innovate. Incorporating technology such as QR codes helps during all stages of planning, especially during the education and enculturation phases. Use innovations even when the world is no longer in the throes of a pandemic. For example, creating electronic educational materials increases accessibility and ease of sharing. Hosting some meetings virtually can increase the number of nurses who are able to attend. Also, using social media platforms to spread Magnet information will help you reach a broader audience.
- ignite. In general, everyone was excited for the Magnet appraisers to visit, and smaller clinics felt honored when they were included in the appraisers' schedule. Try to include as many care areas as you can to ignite the passion for Magnet. With the visit being virtual, we were able to showcase more ambulatory sites than ever before by cutting out the appraisers' driving time.
- involve and individualize. Have fun! Activities, such as decorating the computers on wheels, creating virtual backgrounds, holding the Magnet Fair with a photo booth, and roadshows with treats and colorful flyers, add an element of fun to the Magnet site visit while involving all members of the organization. Through this commitment to involve each and every nurse, we were able to translate our collective philosophy that Magnet is by the nurses and for the nurses. Additionally, take the time to individualize the information you share, such as tailoring flyers for specific units and giving personalized presentations to each unit. Viewing the visit as a way to celebrate the work from the past 4 years frames the process as a time to reflect, rejoice, and be appreciative of the accomplishments of colleagues.
Celebrating our nurses
Executing a successful virtual Magnet site visit, despite the uncertainty during the COVID-19 pandemic, became an inspirational celebration of nurses and the organization's collective commitment to come together to dare greatly. Whether you're a small community hospital or a large academic medical center, the hard work of planning and executing a virtual Magnet site visit will come back 10-fold when you witness the joy of celebrating the hard work and dedication of your nurses.
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