When HUP Nursing applied for Magnet accreditation in 2007, the structures and processes leading to nursing excellence were in their infancy. Now, as they seek to gain Magnet 2.0 three years later, the focus is on innovation, new knowledge and outcomes.
“We can no longer do the same things in the same way,” said Victoria Rich, PhD, chief nurse executive, UPMC. “Magnet wants to know how we are taking science and using it to move nursing to the next level.”
Transformational Leadership: Getting Us Where We Need to Be
Magnet 2.0 comprises five Model Components, which must be “thoroughly described and demonstrated,” said Danielle Calabrese, MSN, RN, Magnet Program director.
Transformational leadership is one of the key components. As the ANCC (American Nurses Credentialing Center, which awards Magnet accreditation) noted on its Magnet website, “It is relatively easy to lead people where they want to go. The transformational leader must lead people to where they need to be in order to meet the demands of the future.”
And Rich has done just that. In creating shared governance, she gave all nurses a voice in patient care. “The nursing voice is now coming from the bottom up, not the top down,” she said. Together with PJ Brennan, MD, the Health System’s chief medical officer, Rich worked to initiate unit-based clinical leadership, an interdisciplinary approach to patient care in which nursing knowledge and input play a key role.
Over the past three years, Rich explained, HUP’s nursing leadership has also been transformed. “We are now servant leaders. We provide the resources, the needed equipment, and the guidance, mentorship, and coaching for the successful practice of the clinical nurse at the bedside,” she said.
But, with this empowerment, comes responsibility. “Nursing voices need to be powerful, balanced, knowledgeable. In the first Magnet journey, we invited clinical nurses to be part of it, to learn about nursing excellence,” Rich continued. “Now they are expected to act like Magnet nurses. It is no longer an invitation.”
Rich is also initiating a peer-review process for clinical nurses. “Nurses who work together each day know each other’s clinical skills,” she said. “We’re going to make peer review the gold standard for evaluation.”
Key Components: Generating Knowledge and Giving Back
To retain Magnet status, the nursing staff must continually accrue new knowledge to improve patient care. “I want our nurses to ask ‘Why do we always do something in a certain way? Let’s do a study examining why and see if it really make a difference.’” Rich said. To help nurses expand their research capabilities, she hired a research specialist who will be “coach and mentor to clinical nurses at bedside to increase new knowledge and innovation skills. I’m giving them tools to get this knowledge and then I will hold them accountable to generate new knowledge. Again, I expect them to do it…. I’m not just inviting them.”
With such high expectations, it’s no surprise that the overall education level of HUP nurses has risen since 2007. While 71 percent of clinical nurses held a BSN at the time of the first Magnet application, today almost 85 percent hold that degree – and many are actively pursuing an advanced degree.
This time around, the AACN wants to see measurable outcomes or, as Rich put it, “Are our efforts making an impact?” Many examples show that they are. Catheter-associated UTIs (urinary tract infections) fell more than 60 percent between FY06 and FY10 while bloodstream infections plummeted 80 percent. Patient falls decreased by 30 percent during that same time period. HUP’s eight Beacon units also attest to our nursing excellence. Only two percent of critical-care units in the U.S. have received Beacon awards and HUP is the only hospital in the country to have achieved eight.
Outcomes must also be demonstrated in community outreach efforts. Nursing formed Circle of Women, the steering committee through which volunteer efforts are coordinated, but, for Magnet 2.0, it’s more than just showing that nurses volunteer. “We have to be able to show we’re making a difference, on many levels,” Rich said.
All of this information – and much more – will be captured on HUP’s application. The five-component approach simplifies the process somewhat from the initial 14 Forces of Magnet, but the final application could be no less voluminous than the original, which was more than 2,000 pages long! The arduous task of writing has already begun, with a June 2011 deadline for submission. Calabrese said that following a site visit, the decision could come by the end of that year.