# Presentation: 016409

## THE FORCES OF MAGNETISM:

- May the Forces Be With You!
- By
- Mae A. Williams RN,BC,MSN

## OBJECTIVES

- Define Magnet.
- Discuss the Forces of Magnetism.
- Analyze 3 Forces.
- Name at least 3 ways to implement the Forces.
- Discuss leadership qualities that promote excellence.
- Discuss Staff Engagement.

## What is Magnet?

- Magnet Recognition is the highest level that the American Nurses Credentialing Center can accord to healthcare organizations.
- It is **the Olympic Gold of Health Care**.
- The Magnet Journey is a “**journey that never ends”.**
- A story is written on how standards are met.
- This process empowers staff at all levels.

- We have received buy in from top management.  A steering committee has to be formed.
- This journey is a professional reaffirmation of nursing status, culture and excitement.
- Magnet cannot be accomplished in isolation.  Organizational involvement must be required.
- Why Magnet?  Magnet is a journey.. Not a destination.  It’s an investment.

- Is the Journey Worth It?  Each facility has to make that determination.
- The **Magnet Recognition Program** was created to advance three goals:
- 	Promote quality that supports professional practice;
- 	Identify excellence in the delivery of nursing services to patients/residents; and
- 	Provide a mechanism for the dissemination of best practices in nursing service.

## Characteristics of Nursing

- The **characteristics of Nursing** in a Magnet healthcare Environment are:
- 		High quality nursing care
- 		Clinical autonomy
- 		Participatory decision making
- 		Strong nurse leaders
- 		Two way communication with staff
- 		Community Involvement
- 		Opportunity and encouragement for professional development

**Magnet is not just writing it on paper **
- 		You must live it  and breathe it and believe it.
- 		Management, staff and labor partners have 	to support it.
- 		Your environment has to reflect it.
- 		It is not just a document.

## MAGNET

**M**		Magnify who and what you are
**A**		Aim for the Best in what ever you do
**G**		Go for the Gold!
**N**		 Net work with others to bring them on board.
**E**		Enthusiasm – Show enthusiasm and a caring spirit.
**T**		Team   It takes Team Work to get this journey started and to continue on
- 			This journey.

## The Magnet Recognition Program and Evidence-Based Practice

- The journey to a Magnet environment is a win-win situation.
- Evidence-based Nursing “stresses the use of research findings and other operational and evaluation data, the consensus of recognized experts, and affirmed experience to substance clinical practice.”

## Tips for Developing an EBP Culture

- Assess staff’s knowledge of EBP.
- Practice sessions for EBP.
- Journal Club
- Orientation Programs
- Policies and Procedures
- EBP Rounds
- Quality Poster Day
- Informatics

## 14 FORCES

- The 14 forces are the characteristics that form the basis for how Magnet recognition is determined (see below).
- When a MagnetTM environment is fully developed, the *Forces of Magnetism* are disseminated and become part of the culture wherever nurses practice, positively influencing all aspects of the organization

- There is mounting evidence that achieving Magnet recognition results in higher nurse satisfaction and a high performing work environment with ultimate benefit to the patients served.

- Magnet recognition is not a permanent status.
- It requires a never-ending organizational commitment.
- Given the current and projected shortage of nurses, pursuing excellence is a key proactive strategy to attract and retain nurses and achieve effective patient care.

## #1 Quality of Nursing Leadership

- 	Knowledgeable, strong nurse leaders follow a well-articulated, strategic, and visionary philosophy in the day-to-day operations of nursing and demonstrate a strong sense of advocacy and support for the staff and for the patient.

- There is congruence between the mission, vision, values, philosophy, and strategic plan of nursing and scholarly practice at the patient's side.
- 	Nurse leaders seek input from nurses at every level through decision making bodies in the organization as well as other mechanisms.

## #2 Organizational Structure 

- 	The organizational structure is dynamic and responsive to change.
- 	Strong nursing representation is evident in the organizational committee structure.

- The Chief Nursing Officer typically reports directly to the Chief Executive Officer and serves at the executive level of the organization.
- 	The nursing organization has a functioning and productive system of shared decision-making/governance.

## #3 Management Style 

- Nurse leaders use a participative management style, empowering nurses at all levels of the organization.
- Feedback is encouraged and valued.
- Nurses serving in leadership positions are visible, accessible, and committed to communicating effectively with staff.

## #4 Personnel Policies and Programs 

- 	Personnel policies and programs, created with the involvement of nurses at every level, support professional nursing practice, work/life balance, career development, and the delivery of quality care.

- Creative and flexible staffing models are used that support a safe and healthy work environment.
- 	Salaries and benefits are competitive.

## #5 Professional Models of Care 

- 	A professional practice model describes how nurses practice, collaborate, communicate and develop professionally to provide the highest quality care for those served by the organizations (patients, families, and community).

- Nurses create models for the provision of care that delineate the nurses' authority and accountability for clinical decision-making and outcomes.

## #6 Quality of Care 

- Nurses serving in leadership positions are responsible for providing an environment that positively influences patient outcomes.
- There is a pervasive perception among nurses that they provide high-quality care to patients.

## #7 Quality Improvement 

- The organization has structures and processes for measuring and improving the quality of care.
-  There is involvement of nurses at every level of the organization in quality improvement.

- There is ongoing monitoring, evaluation, and improvement of nurse-sensitive outcomes appropriate to the clinical setting(s) and benchmarked with external entities.
- Research and evidence-based practice are conscientiously integrated into clinical and operational processes consistent with the institutional and community resources.

## #8 Consultation and Resources 

- The healthcare organization provides adequate resources, support, and opportunities for the utilization of experts, particularly advanced practice nurses.
- In addition, the organization promotes involvement of nurses in professional organizations and among peers in the community.

## #9 Autonomy 

- 	Autonomy in nursing is the ability of the nurse to assess and perform nursing actions for patient care based on competence, professional expertise, and knowledge.

- The nurse is expected to practice autonomously, exercising independent judgment within the context of interdisciplinary and multidisciplinary approaches to patient care.

## #10 Community and the Hospital 

- Relationships are established within and among all types of healthcare organizations and other community organizations, to develop strong partnerships that support improved patient outcomes and the health of the communities they serve.

## #11 Nurses as Teachers 

- Professional nurses are involved in educational activities within the organization and community. Nurses include teaching in all aspects of their practice.
- There is a development and mentoring program for staff preceptors for every level of students, including undergraduates, new graduates, and experienced nurses.
- There is a patient and family education program that meets the diverse needs of patients in all of the care settings of the organization.

## #12 Image of Nursing 

- 	The services provided by nurses are characterized as essential by other members of the healthcare team.
- 	Nurses effectively influence system-wide processes and are viewed as integral to the healthcare organization's ability to provide care.

## #13 Interdisciplinary Relationships 

- Collegial working relationships within and among the disciplines are valued by the organization and its employees.
- Mutual respect is based on the premise that all members of the healthcare team make essential and meaningful contributions in the achievement of clinical outcomes.

## #14 Professional Development 

- The healthcare organization values and supports the personal and professional growth and development of staff; a continuous learning environment is evident.
- Programs that promote formal education, professional certification, and career development are evident.
- Competency-based clinical and leadership/management development is promoted and adequate human and fiscal resources for all professional development programs are provided.

## A Road for Creating a Magnet Work Environment

- Nursing Staff perceive the “Magnetism of the work environment differently, depending on the developmental level of the unit.
- Nursing leaders agree tat creating a positive work environment is highly desirable.

- A road map emerges for moving healthcare teams, units, and organizations to high performance without focusing on all 14 Forces at the same time.
- Nurse managers working with reactive units should focus on 3 Forces identified as the primary priority forces.
- Once the responsive level has been achieved, the next 6 forces should be achieved.

## Organizational Models as Background Framework

**Reactive Unit/team/organization**
- 	There exists a crisis mentality, minimal teamwork, small “Cliques, a focus on survival, paranoia, distrust and pessimism.
**Responsive Unit**
- 	Staff exhibits an ability to handle most situations effectively.
- 	Staff cohesiveness, a focus on achieving near-term goals, a feeling of “health” and a team that “follows the rules.”

## Proactive Team

- 	Will be able to anticipate and handle difficult situations
- 	The future is seen as a choice to be made.
- 	There is strong shared vision and values.
- 	The staff is beginning to use innovative and creative approaches.

## High Performing Unit

- There is a high level of synergy among team members, high energy and spirit.
- Staff is capable of going beyond expectations, and is highly creative and innovative.

## Transformational Model

- Professional Practice
- Process
- Primary Outcomes
- Strategic Outcomes
- The subsets are:  transformational leadership, care delivery systems, professional growth, and collaborative practice.
- The end result being a framework for moving healthcare teams to high performance.

## Why is achieving Magnet such a challenge?

- Sheer Volume of demands on nursing managers
- Many variables that go into creating a Magnet Work Environment
- It has been demonstrated that the 14 Forces of Magnetism, taken together can create a culture of a Magnet Hospital.

## From Framework to Road Map

- Pace of technological advancements
- Global financial pressures
- Increasing inpatient acuity
- Unit manager faced with conflicting priorities
- Addressing patients and families
- Physicians needs
- Interviews and hiring
- Employee evaluations
- QI Initiatives
- Patient throughput
- Mentoring
- Technological Challenges
- Regulator requirements
- Scheduling Challenges

- A manageable number of specific strategies for achieving a Magnetized, high performing work environment are clear-cut and integrated with manager’s other daily priorities, achieving a high performance, Magnetized “ team becomes an achievable goal.

## Primary Priority Forces in High-Performing Magnetized Teams

- Organizational structures
- Structures are flat
- Unit-based decision making prevails.
- There is strong nursing representation in the organizational committee structure.

## Management Style

- Feedback is encouraged and valued.
- Nursing Leaders are visible, accessible, and committed to communicating effectively with staff.
- Hospital and Nursing leaders a participative style, that incorporates feedback from staff at all levels

## Interdisciplinary Relationships

- Characterized as positive.
- Mutual respect is exhibited among all disciplines.

## Secondary Priority Forces

- Personnel policies and programs
- 	Salaries and benefits are competitive
- 	Creative and flexible staffing models are used.
- 	Staff is involved in personnel policies
- 	Significant clinical promotional opportunities exist.

## Professional Models of Care

- Transformation Model gives authority and responsibility for patient care
- Nurses are accountable for own practice.
- Nurses are coordinators of care.

## Quality of Care

- Nurses perceive they are providing high quality care.
- Providing quality care is seen as an organizational priority.

## Consultation and Resources

- Experts, especially advanced practice nurses, are available and used.
- Peer support is given within and outside the nursing division.

## Autonomy

- Nurses are permitted and expected to practice autonomously, consistent with standards.
- Independent judgment is expected within multidisciplinary approach to care

## Interdisciplinary relationships

- Characterized as positive.
- Mutual respect is exhibited among all disciplines.

## Implications for Nursing Leaders

- Magnet Recognition Program fosters excellence in nursing services through the development of a professional nursing practice environment.
- Findings have shown job satisfaction with key elements in the Magnet work environment have a positive link to retention.

## Implementing the 14 Forces of Magnetism

- Support educational advancement for nurses at all levels.
- Encourage professional certifications for all levels of nurses.  Encourage participation in professional organizations.
- Include nurses across the organization, in all programs and activities that impact on nursing practice and care.

## Implementing the 14 Forces of Magnetism

- Use data driven approaches in developing and monitoring personnel and supply and expense budgets.  Include staff nurses as well as managers, in all appropriate aspects of the budgeting process.
- Measure staff satisfaction on a regular basis.
- Implement decentralized decision making through unit-based and service line committees and councils.

## Implementing the 14 Forces of Magnetism

- Ensure that senior nursing leaders represent nursing at the highest levels of the organization and that are seen as advocates for nurses and patient care.
- Be visible and accessible to all levels of nurses.  Create opportunities for communication with staff through rounds, meetings, email, and other means.

## Implementing the 14 Forces of Magnetism

- Institute formal and informal performance appraisal processes that include peer review.
- Identify diversity needs in the community and within the organization.  Ensure that nurses are culturally competent in patient care.

- Develop a recruitment and retention strategic plan and include staff nurse in activities.
- Use the ANA Principles of Nurse Staffing in staffing plans and practices.

## Implementing the 14 Forces of Magnetism

- Support career development and advancement trough creative and innovative programs and practices.
- Employ an evidence-based approach in developing models of care.

- Ensure that there is a strong participation of nurses at all levels in performance improvement activities.

## Implementing the 14 Forces of Magnetism

- Ensure nurses are prepared to manage ethical issues in their work environment at that the ANA Code for Ethics for Nurses is implemented in all settings.
- Develop a nursing research program appropriate to the organizational setting.
- Develop a strong mentoring program for new nurse or nurse transitioning into other practice areas.  Develop succession planning.

## Implementing the 14 Forces of Magnetism

- Provide expert advanced practice nurses to support nurses in providing quality patient care through consultation or as employees.
- Ensure that all levels of nurses practice autonomously.
- Educate nurses in teaching processes and support their role as a teacher.

## Implementing the 14 Forces of Magnetism

- Develop a strong relationship with community agencies and programs and include all levels of nurses in community activities.
- Support all levels of nurses to participate with other disciplines in patient care activities and decisions.
- Create a learning environment with emphasis on orientation, continuing education , and career advancement.
- Recognize, reward, and celebrate accomplishments and achievements for all levels of nurses.

## Leadership Qualifications

- Competence
- 	The Competence Outcomes and Performance Models identifies 8 Core Competencies.
- 		Assessment
- 		Critical Thinking
- 		Teaching
- 		Human Caring Relationships
- 		Knowledge Integration
- 		Management
- 		Leadership
- 		Communication Skills

## Leadership Qualifications

**Character**
- 	Trust is a summary element of character.
- 	Trust encompasses
- 		respect for others and yourself
- 		responsibility for actions taken and the 	responsibility to act
- 		fairness in dealing with others
- 		caring for others and personal needs
- 		citizenship the participation in the community

## Leadership Qualifications

**Empowerment**
- 	It is more than a connection with other people.
- 	Connection implies knowing or sharing some common ground with another person.
- 	Nursing embodies the parable, “If you give  a man a fish, you feed him for a day.  If you teach a man to fish you feed him for life.”
- 	The progression of Professional Development is enabled through empowering relationships.

## Leadership Qualifications

- Measurement
- 	The real test of a leader is followers.
- 	Leadership implies followers and it is follower’s behaviors that give the most meaning.  Follower’s behaviors can be measured by:

## Leadership Qualifications

- Their numbers
- The direction they are moving
- Their speed of action
- Whether they continue to perform in the absence of their leader
- Their innovation
- Persistence in pursuing the goal
- Satisfaction in achieving results
- Mutual rapport, respect, and trust with the leader.

## Staff Engagement:  It Starts With the Leader

- Nursing cannot grow stronger unless we can recruit and sustain a cadre of engaged, spirited, and involved leaders.
- The body is designed to work most effectively in a series of 90-minute increments with recovery time in between.

- The science of leader/management can be seen as a game of chess.
- Creating an optimistic culture where people feel they have hope & freedom to grow and mature will create a sense of engagement.

## Engagement and Recovery

- We need recovery times which results in real physical and psychological recovery.
- Organize life on units as intensive times of interactions and recovery.
- A unit that “stresses” together can relax together and build in a sense of recovery easily and effectively.

## Engagement and Recognition

- Recognition is an important part of engagement.
- Meaningful recognition means that the true essence and uniqueness of the individual is recognized and honored.

- The last thing staff want is to be considered one of the many nameless and insignificant people who are not valued for their uniqueness and contributions.

## Engagement and Honoring Uniqueness

- Leaders who create engagement do so by carefully matching the person’s characteristics or strengths with the work that is needed for the unit.
- This means that when someone joins or leaves the unit an assessment must be made about how the unit’s process can be molded.

## Engagement and Energy

- Energy comes from knowing that you are significant.
- Your work is important.
- You work in an environment that fosters and supports your passions.
- The leader who is engaged and passionate about the work will communicate this to staff who will then feel the contagion and the excitement.

## Engagement and Energy

- The energy of a Magnet-designated facility is usually felt by everyone because they are committed to the front-line staff.
- As leaders model engagement and connection, the staff will follow.

## Bibliography

- Brady-Schwartz DC. Further evidence on the Magnet Recognition program: implications for nursing leaders. J Nurs Adm. 2005;35:397-403.
-  Clark, Martha L.  The Magnet Recognition Program and Evidence-Based Practice, JPeriAnesthesia Nursing. 2006;21:186-189.
- Kerfoot, Karlene,  “On Leadership, Staff Engagement:  It Starts With the Leader”
- 	Urologic Nursing/October 2007/Vol 27 Number 5.
- 	Milot, Lori.   These Forces Are with Me! ANCC Posted 2007 http://www.medscape.com/viewarticle/564683_print.
- 	Morgan, Shirley, The Forces of Magnetism:  Core Characteristics to Achieve Magnet Recognition, ANCC Posted 2007 http://www.medscape.com/viewarticle/562944_print.

## Bibliography

- O’Rourke, Maria. Role-Based Nurse Managers:  A Linchpin to Practice Excellence. Nurse Leader August 2007 44-53.
- The Forces of Magnetism: Core Characteristics to Achieve Magnet Recognition
**	****Shirley H. Morgan, MSN, RN, CNAA, BC**
- 	ANCC.  2007; ©2007 American Nurses Credentialing Center
- 	Posted 09/27/2007
- 	_[http://www.medscape.com/viewarticle/562944](http://www.medscape.com/viewarticle/562944)__ _
- Urquahart, Cathy.  Leadership:  A Shortage With the Nursing Shortage, The Alabama Nurse. 12/ 2007 &  1 & 2/2008:18.
- VHA National Nursing Strategic Plan 2008-2012
- Wolf, GA and Greenhouse.  A Road Map for Creating a Magnet Work Environment, J Nurs Adm, 2006 36 (10) 458-62