Magnet Awards recognize best nursing practices
Certification program offers models of excellence
Only 11 health care systems in the nation have received the Magnet Nursing Services Recognition Award from the American Nurses Credentialing Center in Washington, DC. This designation acknowledges quality of patient care services and the development of successful, professional nursing practices and strategies, says Jennifer Matthews, PhD, RN, CS the program's director. (See list of Magnet hospitals, below.)
In the credentialing process, which is much like that of the Joint Commission on Accreditation of Healthcare Organizations, the hospital's nursing service is carefully scrutinized by ANCC surveyors during a two-day site visit. They conduct chart review and hold conferences with staff, management and executive-level nurses to determine how well the service measures up to these standards and criteria from the American Nurses Association's Scope and Standards for Nurse Administrators:
· management philosophy and practices of nursing services;
· adhering to standards for improving quality of patient care;
· leadership of the chief nurse executive in supporting continued competence of nursing personnel;
· attending to the cultural and ethnic diversity of patients, their significant others, and care providers;
· showing leadership in nursing research and integration of research findings into practice;
· participating in community service;
· adhering to standards that improve the quality of patient care;
· maintaining professional nursing practices and continued competence of nursing personnel;
· managing fiscal resources.
Healthcare Benchmarks talked with two Magnet facilities to find out more about their best practices in nursing. At the Children's Hospital at University of California at Davis Medical Center in Sacramento, medication errors decreased by 50% and incident reports dropped just three months after implementing a primary nursing care model, says Lynne Boehret, RN, pediatric manager. In this model, each patient is assigned to a primary nurse, who follows the child during current and subsequent admissions.
The average patient who is hospitalized for three to five days will see a minimum of two nursing staff, Boehret explains. "Each patient has one primary nurse, and the remainder of the nurses sign up to be his or her associates."
The primary nurse provides all bedside care for three to four patients at time and collaborates with other health care team members, coordinating care conferences, identifying and planning for discharge needs, and developing individualized teaching plans. However, the primary nurse is different from a case manager in that the latter does not generally provide direct bedside care, she says.
In addition to reductions in lengths of stay and patient complications and incidents, there were fewer readmissions because of unclear discharge teaching or failed home health coordination, she says. Work efficiency has increased as well. "While we have not changed our staffing patterns, we are seeing efficiencies at both unit and systems level. As nurses spend less time collecting data because they know their case load so well, they can spend more time on planning and implementing care."
Previously, even though the facility had a 95% skill mix, it was difficult to maintain consistency in care delivery because nurses worked two to four 12-hour shifts per week.
At Saint Joseph's Hospital of Atlanta, nurses also were feeling the frustration of fragmented care. Already operating at a 75% skill mix, the facility didn't want to add unlicensed assistive personnel. The solution was to change clerical portions of the care delivery system. RNs now spend 50% of their time in direct patient care, rather than 38%, says Vickie Moore, RN, MSN, chief nurse executive and vice president of operations.
The effort to tame the paper tiger began in 1993 with a Deloitte and Touche survey that compared how many hours nurses spent in direct patient care and non-nursing activities such as performing inventory, transport, and paperwork functions.
Then a "care delivery task force" comprising a clinical nurse specialist, representatives from risk management and quality management, and staff nurses, took the suggestions and devised a time frame and a plan for implementing them.
First, the team freed up more of nurses' time by creating standardized forms and logs for the unit secretary. "Our goal was to make the secretary the information person on each unit," explains Moore. "We wanted secretaries to have more information about the unit's activities and its patients so they could field telephone questions from other departments and not interrupt the nurses when they were giving direct patient care."
The team also trained secretaries to run more interference for nurses by using new technology to communicate rather than the noisier intercoms. "We bought nurses and assistants pagers that can script a message so secretaries can send a message and nurses can quickly glance down and see if it can wait or needs to be answered immediately."
Then the team eliminated the time nurses spent charging and inventorying 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," she says. The team worked with the finance depart ment to find out how much it costs to charge back items under $20. "After they examined how much was lost in nursing time as compared to how much revenue they could get back, it averaged out. We eliminated about 600 items." To make up for lost revenue, room charges were increased incrementally.
Finally, the team established par levels for supply stock so material management staff can examine the carts themselves. "Nurses now have no involvement with stocking. We pay them too much to have them be stock clerks," she says.
For more details, contact Lynne Boehret, UC Davis Medical Center, 2315 Stockton Blvd., Sacramento, CA 95817. Or contact Brenda Dugger RN, MS, CAN, director of nursing consultation, and Vickie Moore, Saint Joseph's Hospital of Atlanta, 5665 Peachtree Dunwoody Road NE, Atlanta, GA 30342. Telephone: (404) 851-7594. Jennifer Matthews, PhD, RN, CS, can be reached at the American Nurses Credentialing Center, 600 Maryland Ave. SW, Suite 100 W, Washington, DC 20024-5071. Telephone: (800) 284-2378.
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