Magnet coordinators share how their nurses have changed since achieving Magnet status and how they have embraced transformational leadership, one of the five Forces of Magnetism. Here are their answers to the following two questions:
1. How have your nurses changed since achieving Magnet status? For example, do you find your nurses have taken on more leadership roles?
2. Transformational leadership is one of the five Forces of Magnetism. How has your facility embraced this force?
Donna Sherrill, RN, BSN, MM, NE-BC, director of maternal child health, Winchester (Mass.) HospitalDonna Sherrill, RN
Our nurses are more autonomous, more professional, take great pride in what they do and are more driven to constantly excel. They have embraced the journey to advance their education.
Our councils are led and driven by staff nurses. In the beginning, our councils were led by nursing leadership. That role has been transitioned to staff nurses, and the majority of our research studies are being proposed and conducted by nurses.
Transformational Leadership is evident throughout Winchester Hospitals nursing practice. Our nurses consider themselves catalysts for change, facing each new idea and suggestion with courage and conviction. Our nurses are visionaries who excel when dealing with complex issues.
Donna M. Roe, MS, ARNP, BC, CEN, Magnet program director, St. Joseph Hospital, Nashua, N.H.Donna M. Roe, RN
Nurses at all levels now seek educational opportunities in the form of advanced degrees and conferences. Before the start of our initial journey for Magnet designation, nurses worked their eight- or 12-hour shifts and went home.
Since our initial designation in 2005 and as we pursued our redesignation, nurses became actively engaged in their own practice. They have raised the bar for themselves and their peers; leadership didnt have to do it for them. They talk among themselves and encourage each other to join professional nursing organizations and go back to school. Several who never could imagine themselves back in school after 20 years are enrolling. It is great, as a nurse leader, to see so many nurses engaged in the profession like never before.
Our hospital, which was the first community hospital in New Hampshire to achieve Magnet designation, prides itself on its leadership abilities and the power to develop and transform every nurse at the bedside to a leader. Nurses are chairs of organizational committees and have a strong voice at the table. Senior non-nurse leaders listen to nurses and make strategic changes based on feedback.
Nurses at the hospital have a shared governance model, in which all nurses who practice, regardless if they work at the bedside or are a CNO, assume a patient care assignment to stay current in practice. Nurses make decisions for their own practice, and Magnet organizations embrace this concept.
Suzelle Saint-Eloi, RN, MS, program director of nursing quality and Magnet project director, and Kathleen McDermott, RN, BSN, OCN, research nurse, Dana-Farber Cancer Institute, BostonSuzelle Saint-Eloi, RN
Our nurses continue to sustain the momentum that led to a successful Magnet re-designation. Staff at all levels in the organization are involved and leading several key initiatives within the department of nursing and the organization.
Nurses are encouraged to maintain a high level of functioning and autonomy and are striving to further evolve scholarship through evidence-based practice projects and professional development activities.Kathleen McDermott, RN
The CNO and nurse leaders solicit input from nurses at all levels to develop goals and priorities that will advance our quality and safety and our focus on patients and families as our healthcare system undergoes reform. For example, a strategic priority will be a collaborative and interdisciplinary initiative to develop a reliable approach for patient education across the continuum of care.
We embrace the idea that our professional nursing staff are transformational leaders, and that we collectively assure excellence and impact organizationally and worldwide through our work in knowledge generation by nurse scientists in our Cantor Center for Nursing Research and in our work in disseminating best practices through initiatives that our nursing staff are involved in, such as the Oncology Nursing Societys evidence-based practice program.
Colleen Smith, RN, MSN, NEA-BC, vice president for nursing, Middlesex Hospital, Middletown, Conn.Colleen Smith, RN
Our nurses have embraced the Magnet model. They have matured over the past 10 years since we have been on this Magnet journey. We now have nurses leading their unit councils, involved in evidence-based projects and participating on all types of interdisciplinary committees. Examples include a nurse co-chair of our organizations ethics committee and co-leader of our monthly Schwartz Rounds. We now conduct joint journal clubs with the family medicine department. Many nurses have returned to school for advanced degrees, and 60% of our nurses are certified in their specialty.
Nurses at all levels engage in peer review of their practice. Our nurses developed, refined and disseminated our professional practice model, developed out of focus groups with representative groups of staff nurses across all settings. Middlesex nurses can speak to our professional practice model because it is reflective of the values that drive their practice and underscore their relationship with the patient.
We believe nurses at all levels are leaders. All of our nurse leaders are visible and accessible to the staff, and rounding is part of their daily activities. As CNO, I co-chair our professional practice council along with a staff nurse co-chair. The council meets for four hours every month. In addition, we developed a unit council development committee with a goal to grow leadership ability, share best practices across settings and develop standardized approaches to conducting business at the unit council level.
Nurse leaders continuously strive to improve their leadership practice by engaging in formal leadership peer review. Succession planning takes place at all levels, and 63% of our nurse leaders are certified in their specialties.
Kathleen S. Jose, RN, MSN, senior vice president and CNO, Lahey Clinic Medical Center, Burlington, Mass.Kathleen S. Jose, RN
The nurses always have been interested in taking on leadership roles; theres a huge interdisciplinary team spirit at Lahey. Weve seen a really great influx in participation at the nursing councils and committees. So many nurses attend that its usually standing room-only. The energy in the room is palpable since the nurses are so engaged. At the last strategic training retreat, we had more nurses attend than could fit in the room.
The nurses are extremely involved in taking the next step in creating Laheys peer-review process and curriculum. They bring creative ideas to the process and are always working to adjust staffing to meet the needs of the patients.
I encourage them to be involved at every level of the organization and I participate in the shared governance meetings monthly and take suggestions from them on how to make things better. For example, they have started a pressure ulcer prevention program, revamped the medicine delivery system and are extremely involved in the development of the electronic health record.
Our nurses want patients to have the best care possible. They also are highly involved in the DAISY recognition program, writing for publications and even submitted abstracts to the Magnet national conference. They are proud to be Magnet nurses.
Lynne M. Hancock, RN, MSN, NE-BC, project manager of patient care operations and Magnet program director, Children’s Hospital, BostonLynne M. Hancock, RN
The hospitals Magnet designation validated and made visible the importance and value of nursing within the organization. The process of achieving Magnet engaged nurses from all areas and levels in open dialogues about practice, and nurses developed relationships between and among various departments and units. Nurses have become increasingly aware of their nurse peer achievements, which has increased the level of pride nurses experience as a member of the nursing department.
The following increases in trends have been observed: the number of nurses seeking additional training and recognition through national professional certifications programs; the number of nurses pursuing advanced nursing degrees; publications in peer-reviewed journals; and podium and poster presentations at national professional conferences.
One of the big changes is that staff nurses are able to connect themselves to the larger system. Children’s has had shared governance in place for more than 20 years. But because of undertaking the process to achieve Magnet, nurses can articulate how shared decision making is not just about work done in committees but also how changes at the bedside connect to the whole nursing organization. For example, a nurse questions practice and develops a unit-based, evidence-based practice project. The results of this project then are discussed at the departments Nursing Practice and Quality Outcomes Measurement Committee. The committee may then recommend implementation and dissemination across the organization, thus leading to departmentwide nursing practice and policy changes that are evidence-based and improve the quality of nursing care.
Nurses have assumed leadership roles in two major national collaboratives: The Institute of Healthcare Improvements Transforming Care at the Bedside and the Child Health Corporation of America Skin Collaborative. Nurses also are actively involved in providing leadership in pediatric nursing education internationally in Vietnam, Cambodia, China and Saudi Arabia, to name a few.
All nurses are considered clinical leaders. Leadership concepts are included in new hire orientation, and nurses are mentored and coached at the unit and department level along the leadership continuum. Leadership attributes and expectations are embedded in many of the nursing departments foundational documents. Leadership attributes are included in job documents and performance evaluations, The Professional Advancement process, nursing philosophy and model of care, and the nursing governance structure.
The TCAB collaborative are staff nurse-led, unit-based projects. Nurses are empowered to lead efforts to develop innovations and actively make changes they can test and implement to improve their environment, patient safety and patient-centered care. The nurses share in decisions and create an environment where the multidisciplinary care team serves the patient and family. This process creates motivated nurse leaders who are decision-makers rather than simply implementers.
Examples of successful nurse-led TCAB projects include improved response time to patient call lights, improved workspace efficiencies and cleanliness, reduction in the level of unit noise and improved nurse presence and involvement during med/surg team patient rounds.