SCI Nursing Journal

The Magnet Recognition Program Application Manual
The Magnet Recognition Program application manual was the primary resource utilized for assessment of institutional readiness for the Magnet journey. The application manual was also used to guide the application process. The 2005 Application Manual is organized around the 14 Forces of Magnetism. Achievement of Magnet Recognition is dependent upon the organization demonstrating that all standards/forces are met. At the time Craig Hospital completed its application, the manual was based on 14 standards with 63 criteria within those standards.

The Application Process
Craig Hospital formulated a Magnet Prep Committee in order to complete the application. It was comprised of the Magnet Coordinator; CNO; nursing leadership representing management, education, advanced practice; staff nurses; and the Director of Quality Improvement. This committee met bi-weekly for the majority of the application period, then monthly during application completion in anticipation of the site visit.

The Prep Committee completed a review of the Magnet Recognition Program application manual and determined if standards were met. Worksheets were created for each standard addressing whether the supporting materials were classified as “had it,” “need to revise it,” or “need to create it.” These worksheets assisted in developing timelines for completion of the application.

The application was submitted in February 2003 with a deadline of February 2005 for submission of documentation. Updates to the Magnet Recognition application manual, however, were released subsequent to submission of the application and were effective January 2005. This meant that programs that had submitted their applications prior to 2005, but would submit their documents after January 2005 would be required to meet 2005 standards. This change in standards spurred an acceleration of the internal deadline for Craig Hospital to submit by December 2004, to avoid changing manuals in the final 2 months of the application process. Magnet allows 2 years from the submission of the application to the submission of the documents.

The Prep Committee, led by the Magnet Coordinator, was held accountable for completion of the necessary work for the application. Firm deadlines are a must in order to achieve the ultimate deadline of documentation submission.

Staff Education
Aside from gathering the necessary documents, staff education was a significant element of the preparation process. A group of staff nurses, interested and excited about the process, were formed into the Magnet Team Leader group. These nurses, with direction from the Magnet Coordinator, were responsible for educating the nursing staff about Magnet Recognition. They also provided education to all other departments in the hospital at various periods of the application process to keep them apprised of the progress of the application.

A “survivor” theme was utilized for staff education to incorporate fun into the process. The message was to “Survive the Journey to Magnet Status.” Various educational activities were developed (see Table 1).

Table 1. Educational Activities

• Poster boards
• Puzzles
• Jeopardy games
• Weekly quizzes
• Contests between the tribes (nursing units)
• Magnet video
• Magnet specific newsletters
• Articles in the monthly nursing newsletter
• Computer education module

Updates regarding progress towards Magnet status were presented at staff meetings, the nursing practice council meetings, and to all hospital departments, including the board of directors. The survivor theme carried through Nurses Week in May 2004. Recognition gifts such as Survivor t-shirts and magnets were distributed and fun activities such as a Survivor party were planned for nurses and hospital week. Prior to the site visit, the Magnet Team Leaders created a song about Craig Hospital that was sung to all departments as a fun way to say “thank you” for staff support of the application. A pre-site visit party was organized using the Survivor theme, with hula skirts, music, and non-alcoholic frozen drinks. The purpose of the event was to re-educate staff and promote unity for the entire hospital for the site visit. The key to successful staff education is incorporating fun into the process.

Document Preparation
Document preparation is an enormous task. The Magnet Coordinator must be very detail-oriented and able to organize mass quantities of paper and information. Hints for successful documentation preparation include either printing items and filing during the process, or saving everything electronically. It is also helpful to use a printer with the capacity to handle large print jobs. Index tabs were helpful to organize the information for the supporting documentation. Documents are included only once so there may be addendum binders. The amount of documentation is astonishing; Craig Hospital’s consisted of over 2,000 pages. With a restriction on written documentation (it is currently limited to 15 inches for all binders) it was a challenge to include only relevant documents.

Stories from all disciplines were solicited as a means to describe the nursing program from an insider’s perspective and to involve staff in the written documentation presented for the application. These accounts were meant to truly tell the story of Craig Hospital-what it is like to work at the hospital, how patient care is individualized, and to illustrate that the staff truly cares about each other. These stories were an amazing and heartwarming component of the application process.

The Site Visit
The timeframe between submission of documents and the site visit is variable for each organization. It is not uncommon to be requested to submit additional documentation prior to scheduling of the site visit. The site visit for Craig Hospital occurred 6 months after the documents were submitted to the Magnet Commission. There were two appraisers assigned to review the application. Three options for site visit dates were provided and the first option was chosen. This allowed roughly 5 weeks for preparation. The site visit was 3 full-days. The agenda was set by the appraisers but the organization had some input and was permitted to suggest scheduling changes. Open times were scheduled for the appraisers to meet with staff. The appraisers had lunch each day with select staff and breakfast with night shift staff in a morning session. Selection of the staff is completed through randomization rules provided by the Magnet Commission. The appraisers toured all inpatient units and the outpatient clinic, spending 1 hour in each location.

Notification of Magnet Recognition
Notification of Magnet Recognition was received 8 weeks after the site visit. The CNO was contacted by the Magnet office to arrange a teleconference to be informed of the outcome of the Magnet application process. The Magnet Commission Chair conducted this teleconference. Determining who should attend that conference call is up to each organization; all staff were invited to attend at Craig Hospital. An e-mail was sent out announcing the teleconference.

An overhead public address system announcement was sent once official notification was received. This was met by great enthusiasm from the staff. An e-mail was sent to all hospital e-mail users and flyers were posted around the hospital. Advertisements to inform local and professional communities were placed in the Denver Business Journal and various nursing journals, as well as notices on the hospital website of the announcement of Magnet recognition award.
A large banner was hung outside the hospital to inform visitors. A celebration party was held for all staff that showcased the plaque and obelisk received from the Magnet Commission.

Written Notification
Several weeks after teleconference notification, the CNO received a confirmation letter from the Magnet Commission Chair and a written report of findings. The confirmation letter congratulated the organization on its achievement. The written report of findings outlined strengths of the organization as well as areas for improvement.

Craig Hospital’s strengths were in the communication and collaboration of all disciplines. The foundation of rehabilitation lies in the team approach to patient care and this was evident in the application. Craig Hospital is fortunate to have very supportive administration, allowing for flexible budget processes for nursing, ample staff development, education opportunities, and solid personnel policies. The nursing practice council (NPC) was an effective mechanism to showcase autonomous decision-making and staff involvement.

Quality improvement, research, and implementation of evidence-based practices are primary focuses of Magnet Recognition. Craig Hospital demonstrated growth in all of the areas and will continue to focus on these areas in the coming years.

Lessons Learned
There are several lessons we learned from our experience with Magnet application. It is imperative to dedicate a Magnet Project Coordinator and have adequate secretarial support. Firm deadlines must be established for completion of projects and the construction of the narratives.
The narratives were provided by a variety of members of the interdisciplinary team, medical staff, administration, and the Magnet Coordinator. Each narrative included one or two staff stories. For consistency of writing style, the CNO edited all narrative submissions. It is important to ensure the narratives do not contain redundant information.

If possible, store all documents electronically and email them directly to the printer, while also keeping a hard copy on file. Allow enough time to print, bind, and proofread the application. Expect mistakes!

Keep the excitement alive between the application and site visit and from the site visit to notification (a big challenge)! Ensure ongoing discussion of Magnet Recognition, to facilitate staff to feel proud of having applied and completing the site visit. Creating a handbook on how each Magnet standard is met by the facility may help the staff feel less stressed. As part of the preparation for the site visit, conduct practice interview sessions with staff and “role play” about how to articulate knowledge and expertise. And most important, at the end of the site visit, do not expect to know whether recognition has been achieved.

Conclusion
Craig Hospital was the 168th hospital to receive Magnet Recognition, the third hospital in Colorado, and the second “free-standing” rehabilitation program. While the application required dedication, commitment and hard work, the journey itself was enlightening and most rewarding. There is no better way to evaluate an organization’s nursing services than to analyze every facet of it. Craig Hospital learned that nursing is valued in the organization and there are many reasons to feel proud of nursing services. The hospital also learned the areas for improvement and created an action plan and timeline to achieve improvement in those areas.

The closing message for those interested in Magnet Recognition is this: Truly, it’s the journey that is important, not the plaque on the wall.

References

Aikens, L. H., Havens, D. S. & Sloane, D. M. (2000). Magnet nursing services recognition programme. Nursing Standard, 14(25), 41-46.

American Nurses Association. (2004). Scope and standards for nurse administrators (2nd ed.). Washington, DC: nursebooks.org.

American Nurses Credentialing Center. (2005). Magnet recognition program recognizing excellence in nursing services: Application manual 2005. Silver Spring, MD: American Nurses Credentialing Center.