Workplace Transformation: Pathway to Excellence Program Aims to Improve Conditions for RNs

By | 2022-02-11T16:36:07-05:00 October 18th, 2010|0 Comments

Judith Messer, RN, BSN, RNC-OB, director of women’s services at Las Colinas Medical Center in Irving, Texas, felt her jaw drop as she held the phone. Las Colinas had just joined an elite group of 56 hospitals nationwide that had earned the Pathway to Excellence designation.

“It is a stringent application process, and I was nervous as I waited for the results,” Messer says. “The Pathway designation is a big achievement for the nurses and staff and it compliments them for all of the effort they put into making it a great place to work.”

The designation process is facilitated by the American Nurses Credentialing Center, which also oversees the Magnet Recognition Program. Although the rigorous application process may seem similar to Magnet, there are key differences. Pathway is focused on determining whether the work environment is one in which nurses can excel, whereas Magnet is aimed at how nursing excellence influences patient outcomes. Pathway to Excellence is awarded to hospitals that meet 12 standards of practice that have been deemed critical to providing a work environment in which nurses can flourish, such as professional development opportunities and competent, accountable leadership.

Magnet applications require two years of outcome data, which is not required for Pathway. In addition, unlike Magnet, Pathway does not require a facility to engage in nursing research. (Pathway does, however, require proof of evidence-based practice at the hospital.) Magnet is also a much more expensive proposition.

The Process
The Pathway program can be traced back to 2003, when the Texas Nurses Association created the Nurse-Friendly program. The goal was to improve the workplace and retention rates of nurses in rural and small hospitals in Texas. The TNA partnered with the East Texas Area Health Education Center and received a five-year grant from the Health Resources and Services Administration to start awarding the Nurse-Friendly designation to hospitals that showed high quality nursing practice, professional development and job satisfaction through the 12 practice standards.

“The program was very successful [in terms of participation and improvements made] in Texas, and people started inquiring about how to expand it outside of Texas,” says Ellen Swartwout, RN, MSN, NEA-BC, director of the Pathway to Excellence program at ANCC.

With 51 hospitals participating, the Texas Nurse-Friendly leaders were eager to transfer the program to a larger organization that could take it to the national level. In 2007, the ANCC acquired the program and later renamed it Pathway to Excellence. The ANCC spent two years revising the program for a national audience, and in 2009 rolled out a new application manual.

The application takes months to prepare, and once submitted, it is reviewed by a team of three nurses from around the country. The reviewers may either deny the application, ask for further documentation or ask the facility to move to the next step in the process — a confidential online nurse survey to validate the information in the application. About 63% of the applicants move on to the survey, Swartwout says.
The designation is for three years, after which facilities must reapply.

“[I]t is a credential that is achievable for all types and sizes of healthcare organizations,” Swartwout says. “Most applicants have been small- to mid-sized facilities. However, large organizations have sought this credential as well.”

Although there have been no specific studies to date about Pathway’s correlation to job satisfaction rates, the 12 standards were based on the essential elements that reflect a positive work environment. “Research has demonstrated the impact of an ideal nursing practice environment on nurse satisfaction,” Swartwout says, referencing several studies published in journals, including the Journal of Nursing Care Quality and Nursing Economics. “Pathway is a new program, and I am sure more information and evidence will develop.”

Gap Analysis
For some facilities, the process of applying for Pathway can be an important litmus test before moving on to the goal of applying for Magnet status. “For bigger hospitals interested in Magnet, I would highly recommend going for Pathway first because the things we learned about shared governance, work environment and RN job satisfaction were invaluable,” says Adrienne Fugett, RN, BSN, MBA, Magnet program manager, University of New Mexico Hospital, a 480-bed hospital in Albuquerque. “It really boosted morale to identify areas of excellence as well as areas that needed improvement.”

For example, as Fugett and her committee of staff nurses began compiling information for the Pathway application, they realized that several departments were struggling with shared governance. The OR set a good example by applying “crew resource management,” a national training program that was rolled out to the other units and encourages teamwork to proactively address problems.

The hospital was awarded Pathway designation in February 2010. The plan is to start collecting data in 2011 to apply for Magnet status in 2013.

For other facilities, the Pathway designation is not necessarily an on-ramp to Magnet. “The designation demonstrates our commitment to our nursing staff,” says Christine Sigmon, RN, BSN, clinical outcomes coordinator at East Texas Medical Center, a 536-bed hospital in Tyler.

The hospital decided to pursue Nurse-Friendly status in 2006. When it was time to reapply three years later, they were eager to maintain the designation. “We see Pathway as an evidence-based format to continue to make improvements,” Sigmon says.

For example, when an RN survey revealed moderate dissatisfaction with RN-MD interactions in the post-op units, a team was assembled to create a shadowing program. The nurses rotated through pre-op, the OR and post-op, and learned from surgeons while they were performing procedures. The following year, the interaction rating had improved to “very high satisfaction.”

Though there may be various factors influencing recruitment and retention, East Texas Medical’s vacancy rate has dropped from 15% to 8% in the past two years, and retention of new graduates is up to 85% from 50% a few years ago.

Although hospitals like East Texas can point to statistics that show the benefits of Pathway designation, there also is an intangible reward that may be harder to describe in figures. “The best outcome for me was to actually see how much pride the staff took in doing this,” says Sharon Ikeler, RN, MSN, NEA-BC, chief nursing officer at Las Colinas. “Our staff worked together to prove what we are doing here, and it helps us explain to ourselves and everyone else what we do every day. This is a big deal for a hospital of any size.”

Hospitals interested in Pathway designation can use the self-assessment tool on the ANCC’s website:

Heather Stringer is a freelance writer.

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