The Magnet Nursing Services Recognition Program MNSR-P The Modern Health Care System

1. The Magnet Nursing Services Recognition Program  (MNSR-P)The Modern Health Care System Wipa Iamsumang

2. Objective Conceptualize the MNSR-P Identify main concepts in the MNSR-P Identity the benefits of becoming a “Magnet” hospital Identity how to become a “Magnet” hospital Identity the barriers of the implementation of the MNSR-P

3. Contents Introduction Meaning & History in MNSR-P Forces of Magnetism Benefits of becoming a“Magnet”hospital How to become a “Magnet” hospital Barriers of the implementation Conclusion

4. Introduction http://www.uihealthcare.com/news/news/2004/01/12magnet.html

5. Why should we be a “Magnet” hospital? The growth of managed care & associated market competition Controlling rapid increases in health care costs Compromising the Quality of Medical Care 80% of the public polled wanted to know how to evaluate the quality of hospital care. (NCHC, 1997 cited in Aiken, Havens, & Sloane, 2000).

6. What is “Magnet” status? A potential way for informing consumers about the quality of hospital nursing care An award by the ANCC to hospitals that satisfy a demanding set of criteria measuring the strength & quality of nursing

7. History of the “Magnet” hospital In 1983, the original 41 hospitals designated as a reputation “Magnet” hospital By AAN (American Academy of Nursing) **For identifying hospitals attracted & retained nurses **For identifying organizational features =>successful no application process & based on national reputation. Strong Memorial Hospital (U. of Rochester Medical Center) After that, there was a blank in this program

8. History of the “Magnet” hospital(cont.) December, 1990, a proposal of the “Magnet Hospital Recognition program for Excellence in Nursing Services” was approved by ANA (American Nurses Association) Board of Directors Aim to approve hospitals for recognition by ANCC (American Nurses Credentialing Center) application process

9. History of the “Magnet” hospital(cont.) This program: built upon the foundation of the 1983 initiative, creating baseline criteria following the ANA’s Standards for Organized Nursing Services & Responsibilities of Nurse Administrators Across All Setting.

10. History of the “Magnet” hospital(cont.) 1993 -National recognition on dynamic, innovative, health care organizations In 1994-the university of Washington Medical Center in Seattle received the first “Magnet” hospital under the new program. In 1997- updating criteria changing “Magnet Nursing Services Recognition Program” (MNSR-P).

11. History of the “Magnet” hospital(cont.) 119 institutions in the U.S., 1 in England (Rochdale Infirmary& Birch Hill Hospital) had been awarded In NY: Long Island Jewish Medical Center => First : Rochester General Hospital (Sep.04-Sep.08) : Strong Memorial Hospital : U.of Rochester Medical Center (August 04-August08) http://www.nursingworld.org/ancc/magnet/facilities.html

12. Objectives of MNSR-P (ANCC, 2004) Recognize nursing services using the Scope and Standards for Nurse Administrators (ANA, 2003) to build programs of nursing excellence for the delivery of nursing care to patients Promote quality in an environment Provide a way for the dissemination of successful nursing practices & strategies among health care organizations using the services of registered professional nurses Promote positive patient outcomes

13. Forces of Magnetism 14 Characteristics ** based on quality indicators & Standards of Nursing Practice Distinguish Magnet organization Fostering a work environment **promoting excellence in interdisciplinary teamwork, research, education, and patient care.

14. 14 Forces of Magnetism Quality of nursing leadership Organizational structure Management style Personnel policies & programs Professional models of care Quality of care Quality improvement

15. 14 Forces of Magnetism (cont.) 8. Consultation & Resources 9. Contribution to the community 10. Autonomy 11. Image of nursing 12. Nurses as teachers or educators 13. Interdisciplinary relationships 14. Professional Development

16. Looking for Clues Clues to help you determine whether or not a hospital may have or be working toward obtaining “Magnet” hospital status. Following 14 Forces of Magnetism

17. I. Quality of nursing leadership The nurse leaders => Perceived as… ** knowledgeable, strong, respected, accessible risk-takers **Board members of the hospital or health care system ** convey both advocacy and support for staff.

18. II. Organizational structure The flat organizational structure Unit-based decision-making Decentralized nursing departments

19. III. Management style Managers involve staff at all levels of organization. Nursing leaders visible, accessible, and constantly communicate with all levels of staff. Feedback among & between all levels of personnel in the organization ** Encouraged & Valued

20. III. Management style (cont.) Ex. For a particular management style “The Shared Governance Model” The structural centerpiece of the “Magnet” status

21. “The Shared Governance Model” A new organizational paradigm based on the values interdependence and accountability => allow nurses to make decisions in a decentralized En. (Sullivan & Decker, 2001) A framework for building organization format =>Empowerment & Point-of-service decision-making (Porter-O'Grady, 2001)

22. “The Shared Governance Model”(cont.) An administration and deployment of the organization’s services through a partnership model of managers and staff (Porter-O'Grady, Hawkins, & Parker, 1997). Shared Governance (Porter-O'Grady, 2003) *A dynamic structure :partnership, accountability, equity, and ownership *A structural model : allow nurses to express & manage their practice with a higher level of professional autonomy

23. IV. Personnel policies & programs Competitive salaries & benefits Minimal rotating shifts Creative & flexible staffing model Employee friendly personnel policies Administrative & Clinical promotions being favorable to employee.

24. V. Professional models of care Models : give nurses responsibility & authority for patient care **The Shared Governance ** Nurses are accountable for their own practice & coordinate patient care

25. VI. Quality of care Should be the highest priority of the staff and the nursing leaders. The nursing staffs believe that it is able to provide high-quality care find the ways which patient outcomes reflect their organization’s commitment to excellence.

26. VII. Quality improvement Quality improvement studies Staff nurses should: Participate in data collection & data analysis Be free to recommend changes in practice that may be warranted by the findings Be reimbursed for involvement in quality-improvement and other professional activities.

27. VIII. Consultation & Resources Staff nurses should be able to consult clinical experts such as clinical nurse specialists & nurse practitioners & Peer support

28. IX. Contribution to the community Hospitals maintain a strong relationship with the community. Ex. : Doing something to contribute to the community (A variety of long-term outreach programs) : Asking residents whether the hospital is viewed as having a favorable influence on the community

29. X. Autonomy Nurses practice by using: Independent judgment based on professional standards & appropriate state’s Nurse Practice Act A multidisciplinary approach to patient care.

30. XI. Image of nursing Nurses are perceived as an essential key to provide excellent patient care by other health care team members

31. XII. Nurses as teachers or educators The prospective nurses in the hospital has time for the teaching of patients & peers in order to promote the teaching component of nursing practice

32. XIII. Interdisciplinary relationships There is mutual respect among nurses, physicians, and other health care professionals, consistent evidence of positive interdisciplinary relationships.

33. XIV. Professional Development Emphasizing on orientation, career development, and in-service, continuing & formal education. Personal & professional growth and development are valued.

34. Benefits of becoming a “Magnet” hospital(ANCC,nd; Aiken, Havens, & Sloane, 2000) Allowing nurses to success the entire organization **Support nursing practice ** Focus on professional autonomy/decision-making at the bedside Fostering a dynamic & positive environment for professional nurses

35. Benefits of becoming a “Magnet” hospital (cont.) Being a major factor in recruitment & retention of nurses Reinforcing positive collaborative relationships Higher quality nurses in hospital, the more attract high quality physicians Improving patient quality outcomes A Competitive advantage

37. Please stay for a while

38. How to become a “Magnet” hospital Eligibility requirements (ANCC, nd) *Existing in a health care organization *Including=> one or more nursing settings with single governing authority => one individual for CNO (Chief Nursing Officer) =>CNO : MS *Scope & Standards for Nurse Administors (ANA Publishing) *No committing an unfair labor practice (5 yr.) *Participating in a national database

39. The Application Process 1.The Application phase 2005-2006 Application form $2,500 2.The Submission of Written & Evaluation phase $1ooo review fee for each appraiser

40. The Application Process (cont.) 3. Site visit *Documents accepted *Site visit to verify, clarify, and amplify the contents, to evaluate the organizational environment * $1,500 per day per appraiser 4. Internal operations at the Magnet Program office =>Notify A Magnet Status ** Must reapply for a Magnet Status every 4 yr.

41. Barriers of Implementation of MNSR-P Staff nurses=> do not understand their active roles in united operations with the MNSR-P => confused about what they have the power to change Leaders => Struggle to work with colleagues who ignore Prepare document => not easy Communication => take time Changing from autocratic to democratic leader => not easy (Brooks, 2004)

42. Is it possible to implement the MNSR-P  in Thailand? In Thailand In same as the US.=>to find an indicator of the high-quality hospital care The HA-Thailand program (Hospital Accreditation) **Under the Ministry of Public Health **Institute of Hospital Quality Improvement and Accreditation

43. Three stages in HA-Thailand program 1. Hospital Safety Program Is the hospital a safe place to be in? 2. Quality Assurance Program. Do the hospital and its departments have systems in place to efficiently carry out its function and meet its mission and its purpose? 3. Hospital Accreditation Program. Are the health care providers working together interdependently as a team to self-assess and evaluate their activities to determine a better and safer way to provide appropriate care, diagnosis and treatment to fulfill their mandate, mission and purpose?

44. Problems Focus the final outcome more than environment Nurses are a vital part of the entire process The hospitals in the accreditation program have applied a variety of different quality indicators

45. Using the MNSR-P Quality of nursing leadership ** HA enhance respected nursing leadership Organizational structure ** The centralized organizational structure Management style **Should be the shared governance model** Personnel policies & programs **No focus seriously Professional models of care **Vary Standards of care and practice Quality of care **no report seriously Quality improvement **no report seriously

46. Using the MNSR-P 8. Consultation & Resources **experts by co-worker but lack health care information 9. Contribution to the community **work with community by networks 10. Autonomy 11. Image of nursing 12. Nurses as teachers or educators 13. Interdisciplinary relationships 14. Professional Development

47. Conclusion Cost and quality in health care is not always a trade-off, and improvement does not always require a great deal of resources, but only commitment to do a better job. By starting to improve quality, we improve efficiency , and then reduce cost.