Discovery

It’s Magnetic! Ohio State Hospitals Achieve Magnet® Redesignation

By Jaron Terry, APR

Two Ohio State University Medical Center hospitals have earned the greatest distinction in professional nursing. Fewer than 5 percent of the hospitals in the United States have been awarded Magnet status by the American Nurses Credentialing Center (ANCC), and even fewer – less than 2 percent – have earned redesignation for nursing excellence. Ohio State’s University Hospital and Richard M. Ross Heart Hospital are the first in central Ohio to earn this distinction. “Anytime anyone thinks of The Ohio State University Medical Center, we want them to be thinking of national excellence, national significance, national recognition,” says Peter Geier, chief executive officer of Ohio State’s Health System group of hospitals. “Designation as a Magnet organization not only reinforces Ohio State’s national prominence, but also represents delivery of the best care our patients can receive.” he adds.

Currently, fewer than 300 hospitals nationwide – fewer than 5 percent of all healthcare organizations in the country – have achieved Magnet designation, and even fewer than that – only 2 percent – have been redesignated as Ohio State has. The ANCC Magnet Recognition Program® rewards organizations for the highest quality of nursing practice. ANCC is the world’s largest and most prestigious nurse credentialing organization and a subsidiary of the American Nurses Association (ANA). In 2005, University Hospital and the Ross Heart Hospital became the first hospitals in central Ohio to achieve Magnet status; in 2009 they were the first to be redesignated.

“Excellent nurses working in an excellent environment provide excellent care,” says Steven G. Gabbe, MD, senior vice president for Health Sciences and chief executive officer of Ohio State’s Medical Center, in summarizing the essence of Ohio State’s Magnet redesignation from the American Nurses Credentialing Center.

“Achieving redesignation for an additional four-year period speaks to the high quality of our nursing leaders and their ability to articulate a strategic and visionary philosophy that improves day-to-day nursing practice,” explains Geier, who also is chief operating officer of Ohio State’s Medical Center. “It also speaks to the support and respect our senior administrative team has for our nursing colleagues. But more importantly, this achievement speaks to the ability of strong, knowledgeable nurses at every level of the organization who meet the highest standards of excellence in caring for our patients and their families.”

The Magnet Journey

“There was a time, during the huge national nursing shortage in the United States, when hospitals went begging for nurses,” recalls Mary Nash, PhD, RN, FAAN, chief nurse executive for Ohio State’s Health System. “But at the same time, there were other hospitals that had no problem attracting and retaining good nurses. The American Academy of Nursing (AAN) wanted to know why.”

That was the genesis of the original Magnet Study, which began nearly 30 years ago. The AAN, created by the ANA to advance health policy and practice through nursing, appointed a task force to determine the characteristics of these “magnet” hospitals for professional nurses.

Many of the qualities they uncovered have a long history of academic study, including leadership, organizational performance, worker autonomy and motivation, coordination, communication and other attributes, which today are reflected in the Magnet program’s 14 “Forces of Magnetism” (see sidebar story). The ANCC, created in 2004, evaluates hospitals across the country to see how well they demonstrate these attributes.

“Achieving Magnet designation is a journey, and everyone in the organization has to be on board to arrive at the desired destination,” notes Nash, who is an ANCC appraiser, serving on a review team for hospitals throughout the country. According to her, no single “Force of Magnetism” outweighs another, but the commitment and effort must start at the highest levels of an organization.

A BREATH OF FRESH AIR

“Hospitals are a scary place for some people,” says Kristin Calvitti, RN, nurse staff development specialist on the 9 West Doan patient floor in Ohio State’s University Hospital. “When nursing staff work with other disciplines to make the hospital experience as good as possible for patients and their families, it can make a difference for everyone,” she adds. She believes “Interdisciplinary Relationships” is one of the most important “Forces of Magnetism” .

“I recall a 77-year-old gentleman who came to Ohio State’s Burn Center with severe burns he received in putting out a brush fire,” says Calvitti, who is working toward her master’s degree and Clinical Nurse Specialist certification. “More than anything, he wanted to go outside for a breath of fresh air. Because we saw this as so important for his spiritual and psychological well-being, several disciplines worked together to honor his request,” she recalls. Nurses from Surgical ICU and the Burn Unit coordinated with one another and with physical and occupational therapists, pharmacists, social workers, chaplains and others to give him time outdoors.

“Our concern for the welfare of this one patient – showing him and his family that we saw him as a person and not just as a patient – is a real testimony to why Ohio State is able to retain its Magnet designation,” she adds.

“It is necessary that the vision, mission and values of an organization are embodied in the organization’s leadership and are nurtured to cascade through every aspect of the institution, creating a framework for excellence,” Nash says, noting that the framework ensures consistent standards for quality throughout the organization. This is evidenced by the fact that the other Ohio State hospitals – including the James Cancer Hospital and Solove Research Institute, OSU Harding and University Hospital East – are also on the journey to Magnet, and are preparing their applications.

“Magnet designation is really just the prize at the end of the road,” says Nash, adding that it’s the journey itself that makes a difference for patients and families. “The Magnet journey includes commitment to quality in our daily practice, commitment to making evidence-based changes when necessary and a commitment to helping nurses achieve their absolute personal best.”

Fine-Toothed Comb

Linda Chase, RN, MA, NEA-BC, chief nursing officer of University Hospital and Ross Heart Hospital, agrees, noting that Magnet-designated healthcare organizations not only share the “Forces of Magnetism” characteristics, but that these characteristics add up to create a tangible culture of excellence.

“The entire Ohio State Health System shares a culture that drives us to keep doing things better and better, that encourages us to never be satisfied with the status quo,” says Chase, who also is an appraiser for ANCC.

“In a nutshell, that’s what Magnet is: having a nursing staff – from nurse leaders to the bedside nurses – that strives for excellence and works as a team to go above and beyond what patients expect.” She explains that often patients expect the “human touch,” which they receive at Ohio State, but they don’t realize the record-keeping, research-based protocols, collaboration and ongoing education that ensure the high-quality clinical care they receive.

When asked which of the 14 “Forces of Magnetism” is the most important, Chase points out that excellence is about quality; therefore, the Forces that have to do with quality percolate to the top in her mind.

“It’s really the drive for quality that touches everything else – taking steps to be sure our patients are receiving the best evidence-based, quality care possible – that’s where the rubber hits the road on this journey,” she emphasizes.

“And when an organization is willing to open its doors and invite ANCC appraisers to comb through everything, that is the sign of a high-performing organization,” Chase adds.

FORCES OF MAGNETISM

The 14 Forces of Magnetism are those characteristics of nursing excellence that distinguish Magnet-designated hospitals from others:

1. Quality of Nursing Leadership – Knowledgeable, strong leaders are willing to take risks and advocate for their staff.

2. Organizational Structure – There is unit-based decision making and strong nurse representation with a nurse administrator serving at the executive level of organization.

3. Management Style – Communication at all levels.

4. Personnel Policies and Programs – Salaries are competitive, staffing is flexible and there are opportunities for promotion.

5. Professional Models of Care – Nurses are responsible and accountable.

6. Quality of Care – Nurses provide high-quality care to patients.

7. Quality Improvement – Nurses participate in the quality improvement process.

8. Consultation and Resources – Consultation, including advanced practice nurses and peer support, is available.

9. Autonomy – Nurses work autonomously with the interdisciplinary team.

10. Community and the Hospital – Hospitals maintain a strong presence in the community with outreach programs.

11. Nurses as Teachers – Nurses teach in all aspects of their practice.

12. Image of Nursing – Nurses are seen as essential and integral in delivering patient care.

13. Interdisciplinary Relationships – Members of the healthcare team treat each other with mutual respect.

14. Professional Development – Orientation, inservice education, continuing education, formal education and career development are emphasized.
Source: ANCC

Opening the doors to scrutiny involves months of planning, paperwork and preparation to organize information and evidence for the Magnet application. Mary Jean Girard, RN, BSN, MBA, director of Nursing Magnet and Professional Practice for Ohio State’s Heath System, worked with nursing leaders and staff at all levels to create a 3,000-page, 10-volume document detailing how University Hospital and the Ross Heart Hospital meet Magnet redesignation requirements.

“When I became director of Nursing Magnet in September 2008, my responsibility was to compile the evidence that others had collected to support each of the 14 Forces,” Girard recalls. “Every member of the team had an opportunity for input into telling our story of excellence.”

ANCC appraisers spent four days at Ohio State in April 2009, poring over the application and verifying, clarifying and amplifying the submitted evidence. Their visit led to redesignation of the Magnet status that Ohio State had first achieved in 2005.

“It was such an inspiring experience, seeing firsthand how the unique characteristics of various nursing units and centers throughout the system come together through our common mission,” Girard says.

“Ohio State nurses truly are empowered, working in a structure that involves them in decision-making and in an environment where they are an integral part of the team, able to do their best work every day,” Girard adds. “I’m very proud to be an Ohio State nurse. It’s no wonder great nurses want to work here.”

Stepping Up

“What Ohio State has accomplished is a real tribute to their commitment to their nurses, their patients, and indeed the central Ohio community,” says Karen Drenkard, PhD, RN, FAAN, national director of the Magnet Recognition Program of the ANCC in Chicago.

“By being redesignated as a Magnet organization, Ohio State has again met the top standards, indicating they remain in the upper tier of hospitals nationwide that demonstrate truly outstanding nursing practice. Ohio State has exceeded the requirements of a very, very difficult journey that takes time and commitment by the entire staff and hospital leadership. It’s our pleasure to retain Ohio State as a member of the Magnet community,” Drenkard adds.

Story Summary

Ohio State hospitals are among the elite 2 percent of United States hospitals that have earned Magnet nursing redesignation.
There are 14 characteristics that distinguish Magnet-designated hospitals from others, including management style, quality improvement programs and professional development.
Magnet designation and redesignation resulted from studying the hospitals that recruited best during the nursing shortages of the 1970s and 80s.