ANA Magnet program promotes excellence
ANA Magnet program promotes excellence
Singled-out facilities are showcasing distinction
Is your hospital one of ten around the nation that meet new quality nursing standards? You'd know it - "Magnet" hospitals aren't shy about their designation because it signifies outstanding nursing care. In fact, they've been flying flags and mounting advertising campaigns to flaunt the honor.
The American Nurses Association (ANA) in Washington has been awarding its nursing seal of approval since 1993 to hospitals that have passed muster - and that paid their process costs, which can run between $1,000 and $7,500, depending on size. More than 70 hospitals have applied for Magnet status, and these have gained the title to date:
· University of Washington at Seattle Medical Center
· Hackensack (NJ) University Medical Center
· University of California at Davis Medical Center
· St. Joseph's Hospital of Atlanta
· Inova Fairfax (VA) Hospital in Fairfax
· Mayo-Rochester (MN) Hospital
· Robert Wood Johnson University Hospital in New Brunswick, NJ
· Jersey Shore Medical Center in Neptune, NJ
· The Miriam Hospital in Providence, RI
· St. Peter's Medical Center in New Brunswick, NJ
The ANA Credentialing Center's program concentrates on excellence in nursing service and care. The standards measure everything from how much time nurses spend with patients to how many patients get bedsores. Some input comes from self-evaluation by the nurses of the facility. Submitted documentation and evidence are reviewed by professional nurse appraisers for two levels of achievement:
· Meeting the essential core. If a single core criterion is unmet, the application process goes no further and the application and fee are returned to the applicant.
· Meeting Magnet criteria. Appraisers first scrutinize written documentation of Magnet criteria and decide if a facility achieves a minimum score. When the appraisers determine that the written evidence and documentation satisfy the Magnet criteria, a two-day site appraisal is scheduled and conducted. The thorough appraisal verifies, clarifies, and amplifies all information from the written documentation as well as on-site requirements.
Evidence from the self-evaluation, from community input, and from the site appraisal are presented to the commissioners of the Magnet program, and they then vote on whether a facility is awarded the designation.
'Let nurses be nurses'
St. Joseph's Hospital in Atlanta became a Magnet facility by letting nurses be nurses - not inventory clerks, patient transporters, or paper chasers. Vickie Moore, RN, MSN, chief nurse executive and vice president of operations at St. Joseph's, says rather than increasing nursing efficiency by employing more aides, the hospital changed clerical and clinical portions of its care delivery system. As a result of a project initiated a few years ago, nurses now spend 50% of their time in direct patient care, rather than 38%, says Moore.
"It's a natural tendency to look at the nursing payroll and to attempt to decrease it by reducing the number of nurses and adding more aides, but a system can be made more efficient also by making changes that allow nurses to do their jobs more effectively," says Moore. After an assessment revealed that performing inventory, transport, and paperwork functions reduced the amount of time at bedside, a task force composed of a clinical nurse specialist, representatives from risk management and quality management, and staff nurses devised a time frame and a plan for its implementation.
For their four-month pilot project, they selected a floor that contained a 23-bed renal/ pulmonary unit and a 25-bed cardiology unit. The task force selected those units because they were distinctly different: The renal/pulmonary patients had an average length of stay of 5.1 days, while cardiology patients stay 2.42 days on average. "We figured if these changes would work on the pilot floor, they would work throughout the med-surg division," says Shahin Vojdani, RN, St. Joseph's nursing project leader.
'We pay nurses too much to just do chores'
The team tracked qualitative and quantitative data prior to implementation, including patient falls, medication errors, infection rates, patient satisfaction, overtime/additional hours, hours per patient day for direct caregivers, and occupancy. "We wanted to make sure changes were not affecting our quality in a negative way," explains Vojdani.
Although team members would spend another 19 months implementing the project on 11 units, they provided paperwork relief by implementing several clerical changes facilitywide in fewer than six weeks, including giving secretaries sufficient information about the unit's activities and patients so they could field telephone questions and not interrupt the nurses.
Team members also collected a sample of forms such as those used at admission, asked nurses the purpose of each, and consolidated the essential elements, cutting the total number in half.
In addition, the team eliminated the time nurses spent in charging and taking inventory on supplies. "We looked at how much time it to took to apply stickers or bar codes to send to central supply. It may seem like an insignificant amount of time, but it does add up," Vojdani says. "Nurses now have no involvement with stocking. We pay them too much to have them be stock clerks," she says.
[Editor's note: For further information on the Magnet program, call (202) 651-7264, and speak to Cheryl Hay, Fay Gold, Jennifer Matthews, or Carolyn Lewis.]
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