Episode 14: Magnet Recognition Program

Cara Lunsford (00:00.329)
My wife, well, I'm sitting in my wife's music studio because it has the best sound in here. And she's a multi-instrumentalist. So actually, you look over here, ignore the mess. But if you look over here, you'll see like there's guitars. There's, I mean, we have any number of stuff.

Maureen Lal (00:18.988)
Yeah, yeah, yeah.

Maureen Lal (00:27.242)
no. That's one of my sons and he just they just released to their first album. So excited. Yeah. Yeah.

Cara Lunsford (00:32.989)
Did they? my gosh, what's your son's album, what's his group name? What's the band name?

Maureen Lal (00:41.548)
Well, it's a funny name because they picked a name that when they googled it, nothing popped up. So it's a bizarre name, but it's Gal, G-A-L, and then the second word is Fuego, like F-U-E-G-O. Gal Fuego. It worked. They had a name that when they googled it, it was hard to find them, so they changed it.

Cara Lunsford (00:56.605)
Gal Fuego. I love it.

Cara Lunsford (01:09.481)
My wife all the time, like her favorite thing to do is to say, that'd be a great band name, wouldn't it? Like, she'll say something like, starched pantyhose. And she's like, that's a great band name. And I was like, starched pantyhose. Like, what?

Maureen Lal (01:27.566)
That's so funny. Well, if you are interested and you don't have to be, believe me, I can send you the YouTube. It's not of them playing. It's just the recording.

Cara Lunsford (01:35.932)
I'd love it.

Cara Lunsford (01:39.613)
What type of music do they do? What is it?

Maureen Lal (01:42.924)
I know what you'd call it. of Coldplay-esque or you know very... which is funny because he went to Peabody Conservatory for classical guitar but he actually plays the piano in the band for most of them. He plays the bass in a couple so he does...

Cara Lunsford (01:49.448)
Okay.

Maureen Lal (02:06.198)
like your wife sounds like, multiple. He plays about six instruments. His first instrument was violin.

Cara Lunsford (02:09.331)
Yeah.

Cara Lunsford (02:16.379)
my favorite. It's my favorite and it's the one that my wife doesn't play. was like how how how on earth is it like the one thing you don't play is like my favorite instrument of all time. But for our 10th wedding anniversary, she she learned a song on a via on a violin. Just you know, just just so that she could be like, I learned violin for you.

Maureen Lal (02:16.585)
I... yeah.

that's so funny!

Maureen Lal (02:48.078)
Well that was very nice of her. What song was it?

Cara Lunsford (02:51.323)
I don't remember. No, no, no, actually, I do. I do. It was it was All of Me, which was the song that we played at our wedding. And so then she she she learned how to play All of Me on on on the violin. I know, which was very cool. Well, Maureen is Maureen Lal. Is that how you Lal or Lal Lal?

Maureen Lal (02:54.83)
I'm sure.

Maureen Lal (02:59.776)
Nice!

Maureen Lal (03:09.664)
Very nice, very nice, yeah.

Maureen Lal (03:18.872)
Wow. Yep.

Cara Lunsford (03:20.869)
Okay, so Maureen Lowe.

Welcome to the Welcome to the NurseDot Podcast take two since we tried to do this yesterday, but but I failed miserably as a podcast host. So welcome back.

Maureen Lal (03:37.322)
Well, I'm delighted to be here and technology can just be challenging sometimes. No worries.

Cara Lunsford (03:45.307)
It's so true. It's so true. And we're so reliant on it. And yet it can disappoint. It can really disappoint at times.

Maureen Lal (03:50.754)
Yeah.

Maureen Lal (03:54.508)
Yeah, yeah. When it's great, it's great. Otherwise, it's just a challenge.

Cara Lunsford (04:02.025)
You know what I love Maureen about the fact that I'm looking at your name on Riverside and I think this is a mistake, but maybe not. You have three Es.

Maureen Lal (04:16.086)
You know, typically it has two. I didn't even look, I don't even know who typed my name in. It must have been Cameron. She got carried away, got carried away with the E's.

Cara Lunsford (04:23.753)

I love it. was like, I kind of want to pronounce it like Maureen. Wow.

Maureen Lal (04:33.23)
It's to make up for the short last name. We just extended the first name.

Cara Lunsford (04:41.383)
I can tell already we're gonna have so much fun. so Maureen, can you tell me a little bit about yourself? Like how long have you been in the nursing industry and how did you find your way towards magnet?

Maureen Lal (05:00.272)
Sure. I actually was one of those people that always wanted to be a nurse, right? Like I, that was always my goal. and when I was in high school, I grew up in upstate New York and when I was in high school, they had a pilot program that you could get your LPN while you were in high school. And, so I took the course, I graduated. I also had my LPN license and

My first job, the work environment, was incredibly toxic. It was a horrible experience. So here I had thought, like I had this whole plan, get my LPN, it's gonna pay for me to go to college, I don't have to worry about loans and things, I'll work, I'll go to school, graduate. And I was like, no, I don't think I wanna be a nurse. This isn't the right place for me to be.

And so I got a degree in humanities, which for whatever that is worth. then fast forward a few years, had my children. was married. had my children. And I just kept feeling like I was a nurse and I wanted to be a nurse. And so I

Went back to school, got my RN, my associate degree, then got my bachelor's and got my master's and my DNP more recently. I would say I've done this the longest, hardest way possible. But the reason I tell that story is because that drives why I do what I do and where I am today. Because of that work environment experience, I never want to lose another nurse.

because of what I experienced. I never want to have another nurse have to work in that experience. I was fortunate that I was able to quit, get a job doing something else, and continue my education. But it really did drive the majority of my decisions. Once I had the opportunity to understand

Maureen Lal (07:18.74)
and really think about, had the maturity really to look back at that experience and realize, no, what we promote, we promote and I need to be somebody who no longer allows that to happen.

Cara Lunsford (07:32.755)
Wow. I love that. Anyone who's listened to this podcast for any length of time will hear me say that.

our past experiences are so influential and so important. And the hard things that happen in our lives are oftentimes sometimes by design because they put us on our path, right? They put us on a path to do exactly what we are meant to be doing. And I think that that's exactly the case for you, right? Like it just like drove you right into this path.

Maureen Lal (08:13.262)
Absolutely, it has absolutely formed who I am as a nurse and decisions I've made. I loved patient care. It was never really my intention to move from it as quickly as I did. But it was that idea of making organizational change and having the ability to have that impact that has driven really everything I've done.

Cara Lunsford (08:38.759)
That's amazing. And you know, it's really wonderful when I think back because I worked at Children's Hospital Los Angeles and I was there during the time when we were getting magnet accreditation. that, and I...

remember what our CNO and our CEO and what they were doing and the huge celebration that we had when we were awarded a designation as magnet, how exciting that was for us. But you know what's so interesting is that I was actually...

can't remember exactly what year that was, but I know I was like in the midst of really being a relatively new nurse. And, you know, within the first like five years or so of my career, I've been a nurse for 17 years, but I'm looking back and I'm thinking, well, you know, it was definitely during the beginning and I didn't truly understand at that time what it meant.

Maureen Lal (09:56.77)
Mm-hmm. Mm-hmm.

Cara Lunsford (09:57.447)
I was just too busy trying to figure out how to be a nurse.

Maureen Lal (10:02.338)
Yeah. You worked with Mary D. Hacker then who was, yeah, because actually when I first joined ANCC Magna, I worked as one of the analysts and I had California and that was one of my hospitals and I worked with them during their second designation.

Cara Lunsford (10:05.871)
I did!

Cara Lunsford (10:23.246)
my gosh, that, what a small world.

Maureen Lal (10:27.404)
No, I know. I was like when you were telling that story I was like, my gosh, I feel like I was there with you.

Cara Lunsford (10:34.021)
You were there with me. And I remember this video that was done and these pictures. And there was all these mountains of paperwork that had to be submitted. And I remember a picture of Rich Cordova at the time. And it was Mary D. Hacker. And they had all these mountains of papers. And I was like, that looked like a lot of work. And that was as much as I knew at the time. But I thought that was a lot.

Maureen Lal (10:47.509)
Yes!

Maureen Lal (10:53.752)
Yeah.

Maureen Lal (11:01.9)
Yeah. Yeah. Well, and back then the documents were even more onerous than now, which I know our magnet organizations would say, how is that possible? But we used to limit the size of the document that was sent in to 15 inches, because they were all hard copy. We didn't have e-copies at the time.

And so we would actually have to measure them because some people would send us like 25 inches so we'd be like there's no way. So my gosh can you imagine now? Yeah. Yeah.

Cara Lunsford (11:37.793)
can't I can't so okay so for we're gonna assume that many people who are listening to this actually do know what magnet designation is but for people who are not privy to that information or don't know for some reason can you tell the listeners a little bit about like what is magnet how did it come about and what is it exactly

Maureen Lal (12:06.254)
Sure. Well, I'll start with where Magnet is today as part of ANCC, the American Nurses Credentialing Center. And it is one of the programs that does organizational credentials along with Pathway to Excellence, Nurse Credentialing and Professional Development, PTAP, the Practice Transition Program, and APFA, which looks at the transition for PAs and APNs.

So it's a family of credentials that all sits together and they all leverage each other. But what sets Magnet a little bit different from the other ones is we are built from a study. Back in 1983, I love telling this story because it's so pertinent to where we are today. Back in 1983, there was a shortage very similar to what we're experiencing today.

And at the time, when you think about how revolutionary this was, because at the time, nurse research was just not known or done regularly. But there were these four nurse researchers through the Academy of Nursing, the American Academy of Nursing, who said, why is it that some hospitals don't have a problem? Why is it that they can keep their nurses? They don't have problems bringing in new nurses, hence the attract and retain magnet idea.

And they did a study and they looked at those hospitals and said there are 14 forces that really do bring in those nurses and they engage the nurses. Then in 2008, another study was done and they said absolutely those same 14 characteristics are the same today. However, there's been maturity, there's been evolution of those same characteristics. Like instead of participatory management,

change to shared governance. know, some of those, it was just a maturity of processes. So that really created the model that we see today with the five different components. It's also when they added the empirical outcomes, when they said, how do we really know that the Donabedian model of structure processes as effective as when you look at that outcome piece. So there's a significant

Maureen Lal (14:27.79)
look at outcomes when you look at the current manual. Sorry, was just stumbling a little bit, Cameron. You can fix this part. She told me to tell her if I stumble. So, pause. Well, I'll just say that

Cara Lunsford (14:42.729)
It's totally fine. If you want to repeat it, you can.

Maureen Lal (14:49.664)
You know, so the current model includes the empirical outcomes, which is based on the Donabedian quality model where we look at structure and processes and then outcomes and Magnet says, okay, you have to have the outcomes to really demonstrate that what you are doing is indeed effective. So along with that, they said, you know, we really need to be contributing to the bigger picture of nursing. And so they also brought in

Nursing research is one of the hallmarks of Magnet. So that's really where we were today with the 2023 manual. Each manual has raised the bar. It's looked at what's currently happening. It's all evidence-based. Every time there's a very big deep dive into that. Now the exciting piece is right now there are two independent researchers doing a look at what they're calling Magnet 3.0.

So they are looking at not only all of that history of Magnet and where we are today in the current post pandemic climate, but they're also including international because Magnet has really grown to be a global as all the ANCC programs have, but we have several of our organizations that we work with in the global arena. So really proud of that.

the ability to influence care not just domestically, but throughout the world.

Cara Lunsford (16:16.861)
Yeah, it's, so I definitely understand how you have to tie, I feel like you have to tie everything back to outcomes, right? Like because obviously if,

if the changes that you're making within your organization do not result in, well, A, either better patient care and better patient outcomes, and if they don't result in less attrition, if they don't result. So is that part of the outcomes? that where you look at the attrition of a hospital and you say, you still qualify?

you don't?

Maureen Lal (17:03.342)
So we don't look at attrition per se. What we look at is nurse engagement. So we do require organizations to provide benchmark data. So it has to be through a third-party vendor. It has to have a national comparison group that has a meaningful comparison for nurse engagement, patient experience, and also clinical indicators.

because we know the commission absolutely understands the tie between the three of those criteria. If you have a nurse that's not engaged and they walk into that patient room, and we've all seen this unfortunately, but they walk in and they say, I'm, you know, really busy today. have six patients and, you know, what do you need and here's your meds and goodbye. That patient is less likely to say,

Do you have a moment? I really need to walk to the restroom. I really need to have something. And instead they get up, they try to go to the restroom on their own. They have a fall. Now you have the traumatic, the emotional response to having the experience to fall with injury, but you're delayed care and increased risk for other injury. So with the three of those tied, the commission on magnet, back in 2008 said we really have to know

how you're doing. We not only need to be collecting that data, but how do you compare? And actually, I was still working in the clinical setting when we started having to submit that data. And I always say this story because I remember it so vividly that we were insulted, right? Like, what do you mean we're not doing a good job? Of course we're doing a good job. We, you know, we take care of our patients. And then we saw that benchmark data and we went,

hmm, we're doing a really good job on this, but there's some opportunity over here. And we also, I don't think as a profession, really understood how our care as an individual could directly impact the long-term outcome of that patient. And I think that's something that has really changed in part two, collecting that data and understanding how we impact that patient.

Cara Lunsford (19:21.107)
So how was that data collected from different, because obviously we know that there's different.

Maureen Lal (19:28.856)
Yeah.

Cara Lunsford (19:30.533)
software is available now. There's different patient experience and employee engagement and different survey platforms and technology has really made a lot of this easier for us. But there was a period of time where it was very paper. I mean, there was just a lot of paper.

Maureen Lal (19:52.014)
Absolutely it was and it was a lot but I will say we don't really get involved for the vendor benchmark data with the criteria and the definitions. We rely on the vendor that they have contracted with. We do review the vendors just to make sure that they, what they're collecting aligns with what we require like at the unit level that they have the right benchmarks, that they have the right

questions that correspond with our evidence-based questions that we know are valid. So we look at that, but we don't look at the other pieces because it's really up to the vendor, especially for clinical indicators, to have a consistent definition. And then it's up to the organization to be applying that definition and to ensure that they are indeed following the

the guidelines that that vendor has set up. So we don't really get involved with that, but what we do is we really look at the data for that, what we call outperformance, meaning that the majority of their units are doing better than average, than the average benchmark the majority of the time.

Cara Lunsford (21:03.281)
Okay, okay. so, prior to there being, you know, some of these vendors,

Were you just getting, was it all done kind of internally? Was so much of this done internally or do you know? Like I'm always curious how people are collecting information and how that changes over time, right? Like it's because I, again, keep looking back on like mountains of paperwork. That's like the visual in my head of how labor intensive that could be.

Maureen Lal (21:25.836)
Yeah!

Maureen Lal (21:30.317)
Yeah.

Maureen Lal (21:42.546)
So with the 2008 study, it was still pretty new, that whole idea. I'm sure organizations were collecting data, but that whole idea of using a vendor and being consistent with it was actually, it's hard to believe in 2024.

that it was that recent, right? It seems like we should have been doing this forever, but we just didn't have the tier point technology. We didn't have the knowledge base. We did a lot of things in nursing for a very long time because we always had, right? We didn't have the evidence behind it. It seemed to work, but nobody had actually researched it. And so, again, it go back to the evolution of nursing as a profession, how we really moved from

A role that was seen as an extension of the physician to being a profession. You know, we provide 80 to 90 % of all patient care, whether you are ambulatory or inpatient. are, you know, you are the person that is the go-to for that patient now. When we think about owning our profession, we think about autonomy, we think about being able to contribute to research and conduct research. We think about the fact that

We are identified as a profession, but when you really look at how our roles have changed in the time that I've practiced in the 30 some years since I did my LPN, and I think about, used to stand up when the doctor walked in, you know, we used to wear caps. Can you imagine the germs that we were carrying around? you know, some of the things that we did with the best of intentions.

Cara Lunsford (23:28.039)
Yeah, of course.

Maureen Lal (23:29.25)
but was not to the benefit of our patients. So now, in the last 30 years, that paradigm has changed where now nursing does own its own profession. And if they're not, then I say, please do, because this is really about scope of practice, working at the top of your license, making sure that you have a voice in the care of that patient. And that's really, to me, why Magnet is so powerful.

because it really does stand for all of that.

Cara Lunsford (24:02.409)
How many hospitals within the United States, and I don't know if you the answer to this question, but how many hospitals have achieved magnet designation?

Maureen Lal (24:12.142)
I do know that. Currently, we have 617 organizations. However, 16 of those are from the international. So we have 601 domestic, which is about just short of 10%. It's about like 9 and 3 quarters percent of hospitals. And we take that data by the number of hospitals according to the AHA.

and we do that calculation based on that.

Cara Lunsford (24:43.643)
And how on and again, if you don't need the answer, this is OK. But like on average, how would you say that a magnet hospital compares in terms of turnover to a non magnet hospital? in like just even percentage wise, like, you know.

Maureen Lal (24:58.168)
Mm-hmm.

Maureen Lal (25:05.294)
Yeah. So I don't have current data, but last year when you looked at national average in the magnet organizations. So this is unfortunately 2023 data. We're lagging a little bit here. But at that time, we had the magnet organization showed about a 13%, whereas nationally it was about 27%.

So significantly less. Yeah. Yeah. So, you know, the pandemic absolutely impacted everything. Nurses, we hear anecdotally from organizations that the framework absolutely helped them. But we also know that there were a lot of challenges everywhere and there was not a magic.

Cara Lunsford (25:37.587)
Wow, it's like half.

Maureen Lal (26:04.014)
framework or anything that could be in place as much as we all wish there could have been during that time frame. So, you know, as we continue to see that recovery, we are seeing that Magnet hospitals, actually Magnet and Pathway to Excellent hospitals are recovering quicker and have really returned to some of that data of

They have higher than non-magnet hospitals for nurse engagement scores and some of that other data. I'm always cautious though, and I love that I can say this publicly because I always get a little anxious when I see studies that say magnet versus non-magnet. And I say always take that data with a little bit of critical analysis because remember those non-magnets.

might be using the framework but haven't applied. They might actually be an applicant but not yet designated. They might be a pathway organization. They may have a great framework in place. so, you know, that data is not as clean as you might hope that it could be. I would love there to be three comparison groups of Magnet,

organizations using the framework or the pathway framework and that truly that hospital that's not yet really understood the value of an evidence-based framework to their organization.

Cara Lunsford (27:45.683)
What is...

I'm guessing that there's some soft cost and hard cost to even going through the magnet process. Soft cost meaning like, you have to have the resources, you have to have the people just to be able to do the, you have to have like the people and the resources and the time and to be able to apply for something like magnet. I'm sure it takes a certain amount of people power.

just to do that and could be the reason why some organizations are like, we're gonna follow the framework, but we're not gonna apply or we don't have the funds or we don't have the people power to do it. Would that be true?

Maureen Lal (28:30.954)
So yes, are, you know, a lot of times we hear about the cost of Magnet, but it's really not so much the cost of the program. Just like everybody else, have to pay. One of the values of Magnet is that it is a peer review program and we have to pay people to do that work. We have to pay our internal team. We pay for brick and mortar, just like everyone else. So yes, there is a fee, but the bigger costs tend to be those internal costs, as you say.

We still use in nursing, which is terrible language, but that non-productive time, which is of course a misnomer because it's very productive time, but it's at time not spent at the bedside. And so when you look at the cost of putting a shared governance in place, and other committees so that nurses can really contribute,

to having a plan and influencing where they are, the environment they work in, the care they are providing. That is time not at the bedside. So yes, it does cost money. But again, when you look at that return on investment, when you invest in your nurses, when you invest in the framework, then you're ultimately gonna save money because we know to the point we made earlier that there is decreased turnover.

Research tells us this. It's not Maureen Lowe making this up. It is really data-based and we have reference to some of the studies on the website. We know that patients tend to have fewer falls. And again, when you look at falls with injury and every time you prevent one of those falls, not only the actual impact and the delayed care, the longer length of stay,

potentially more surgery, all of those pieces that are cost, you know, they drive cost, but there's also the psychological cost, not only to the patient, but to the nurse that was caring for them or the physical therapist or whoever was providing that care. So is there a cost? Absolutely. But you have to do an analysis of your environment and you have to really weigh that out.

Maureen Lal (30:51.288)
There are other costs, some organizations, we talked about the vendors, there's a cost for vendors, but you have to be collecting data anyway. CMS says you have to get data for them. So you're collecting data already. So that's not really the cost of the program.

Some organizations use consultants, which absolutely, if you need a consultant to come in and help you put a framework in place or to help with that assistance, there is a place for that. But those are those indirect costs versus the direct cost of what we charge and what has to come into the program.

Cara Lunsford (31:31.561)
Where do most people find consultants that could help? If you are an organization that is saying, we might be a little stretched thin, we might, are there a variety of different organizations that provide that type of service or a place that they can go to?

Maureen Lal (31:38.124)
Yeah...

Maureen Lal (31:50.754)
Well, there are multiple vendors out there that provide consulting services. I will tell you, we have a big firewall even with the ANA, the American Nurses Enterprise consultants. They do not get any extra information. We do not have a relationship. It would be a breach of credentialing if we shared anything about the review process with the consulting group. Again,

Cara Lunsford (32:13.885)
Yes.

Maureen Lal (32:20.074)
no matter who they're part of, ANA or otherwise. So we can't really speak to that because we really don't engage with them. What they're doing is independent to us. And we do have a lot of resources within the program. As we always say, we can't consult, but we can coach. And we have a lot of coaching tools that we provide, which means we can't tell you the how, just like

Cara Lunsford (32:29.32)
Yeah.

Maureen Lal (32:49.932)
the program itself, the framework itself can't tell you the how. We can tell you what should be in place. How you do it is going to look differently depending on your organization, the size, the resources, where are you located in the US, where are you located in the globe, you know, across the world. If you're located in a, if you're a critical access hospital in the middle of,

Nevada, you know, it's going to look very different than if you're an urban hospital that's associated with an academic setting. you know, it really is going to be dependent on where you are. But what we also know is it doesn't matter what the size of your organization is. have hospitals, there are small hospitals slash acute critical access.

as small as 25 beds and we have those that are over 2000 beds. anybody can use the framework and can be designated, but it just depends on those priorities and whether you choose to move it forward. We always say two things. Even if you don't want to go for the credential, that's fine. Use the framework because the framework will benefit the nurses and the patients and we believe

strongly in that. That's why I do this work. The other thing we say is if you choose to get the credential, what the credential does is it shows the world that you have that nurse engagement in place, that you have those patient outcomes, that you have all of that. But almost just as importantly, if not more, is it holds your organization accountable. Because if you don't continue to feed and water that culture, you're not going to be able to maintain it.

Cara Lunsford (34:41.769)
Yeah, you're going to lose the designation and spoiler alert, Maureen, you may or may not know this about nurse.com. But when we work with them, when we work with companies who are seeking to recruit nurses and they would like to put their jobs on on the job board for nurse.com nurse.com has been around for 30 years. And we have recently probably in the last year and a half or so revamped our our job posting experience.

Maureen Lal (34:44.462)
Exactly.

Cara Lunsford (35:12.095)
One of those things is that we offer employers an employer landing page, essentially. So a profile, an employer profile. And one of the things that we say to employers when we are talking to them is that if you want to differentiate yourself, you should make sure that you are sharing your magnet logo or that you are a Daisy partner or that you are a top workplace.

you know, and all of those things matter to the nurses who are coming and looking for employment. How do you stand out? And so that's something that we've been talking about. so we talk about magnet all the time over here.

Maureen Lal (35:49.006)
Mm-hmm.

Maureen Lal (35:56.334)
I believe that 100 % that really showing the world, you know, really does hold them accountable. But I would also say, I love that you're doing that. We talk a lot about, have the transition to practice program. And whether you're a new graduate or whether you are transferring into a new organization, you should know, are they PTAP accredited?

you know, do they have that credential? Because what is that experience? Or at least ask the questions. It's also a criteria for magnet that they have a practice transition program. But it's really how are you getting that nurse and getting them to feel part of that culture to really feel like they belong? That sense of belonging is so important to nurses. It drives a lot of us. That's a very, we tend to be whether

We're still about 13 % male across the US for our percentages. But I think that in general, we tend to be very people connected. So we want to feel that sense of belonging. So how are they bringing you in? Do they have a PTAP credential or do they have a program for bringing you in and transitioning to practice?

And we say that for the new grads too. Like there's things you should look for in an organization and at least have these interview questions. We actually have a document that certification, NCPD, PTAP Pathway, and MAGNET all created together on questions to ask when you're interviewing about that. Like how do you bring us in? How do you continue that relationship? Yeah.

Cara Lunsford (37:39.155)
We're gonna have to make sure that we share all of those resources. so for those of you who are listening, we'll make sure that on our landing page, so on thenurse.com forward slash podcast, you'll be able to find this episode. And when you find this episode, we'll make sure that we have some resources there available for you. One of them, I think really interesting that you just mentioned is those questions that you could be asking in your interview process. Because it starts to,

Maureen Lal (38:05.038)
Yeah? Yeah?

Cara Lunsford (38:09.098)
a that these organizations,

they start to listen to those questions that are being asked of them. They start to go, gosh, you know what? The last 20 applicants that have come through here have asked us about, we have a residency program? What are these resources that are available to me as an employee? And you start to raise the bar just by

showing them that you have this expectation.

Maureen Lal (38:48.034)
Yeah. And I will say not only the ones that we've already talked about, but wellness. The Pathway to Excellence program has just developed a whole new wellness credential. And what are they doing for their nurses to make sure that they have a moment if something has happened? And I saw your background. You, I'm sure, had many times that you really needed a moment.

to gather your thoughts and to care for yourself. And this wellness program or wellness credential that Pathway has developed is exactly about that. Like what are you doing for your nurses? And as Dr. Christine Pabico, who leads that program, always says, you know, it's not unusual to say, what do you have in place for your wellness? And they'll give you a list of things.

but as it being utilized, is it what the nurses actually looked for? So that's kind of the difference between, okay, we have a framework, but are you really implementing it the right way? Are you really having nurses helping making those decisions, which is, again, a huge hallmark of Magnet.

Cara Lunsford (39:43.111)
Yes.

Cara Lunsford (39:56.521)
Yes, that's exactly right. And sometimes I think organizations think, well, I'll spend $200,000 and we'll hire a chief wellness officer. And you're like, well, that didn't do anything for us. therapy, having access to therapy, that goes a long way. For example, in

for first responders or for even for the police, right? Like you fire your gun. If you fire your gun, you're immediately like sitting down with somebody and you're having to talk about that, right? Like there's a debriefing that happens and immediately there's an intervention, right? And that's not the case. Like with nurses, I was just having this conversation

Maureen Lal (40:39.371)
Mm-hmm. Yeah.

Cara Lunsford (40:55.403)
other day where I was recalling this time where I had two patients that passed away in the same evening, a six-year-old and a two-year-old and the attending who was on service, know, lovely, lovely woman. She said, I need you to bring the two-year-old downstairs and I need you to assist in the autopsy.

I was very new, I didn't know whether I should say yes to that or no to that or you know, that's probably gonna really devastate me and then I was just back the next day.

Maureen Lal (41:36.27)
Yeah. Yeah.

Cara Lunsford (41:36.957)
without, you know, I don't recall anyone actually asking me, do I need the day off? Do I need to have some debriefing? And we were a magnet hospital at the time, you know? But magnets come a long way, right? And to your point is that you are implementing things like wellness.

Maureen Lal (41:49.326)
Yeah

Maureen Lal (41:59.086)
Yeah, magnet does have criteria for wellness. And I will say again, it's that evolution of where we are, not only as a profession, but as a society where I think we have a lot more awareness and and it's, you know, my parents generation and even I would say some of my generation would have that idea of, know, you just tough it out, you know, it's it is what it is move on.

Cara Lunsford (42:21.448)
Yep.

Maureen Lal (42:24.526)
Fortunately, now we do understand the emotional impact and we do have criteria in the magnet framework that organizations have to provide examples on wellness and we see a lot of examples now about doing kind of a meeting with the nurses to have that debrief and be able to talk about what they're going through. We also see a lot of

Therapy such as offering Reiki, offering massage, you know, and obviously you can't necessarily do that, but there's a recognition that nurses need to pause and be able to take care of themselves. And they have to have the right tools, the tools that work for them, because what you need might be very different than what I need. And so how are they making sure that whoever the nurse is,

they have the right tools in place to be able to help them.

Cara Lunsford (43:24.851)
Yep.

Yeah, it's not everybody, it's not a one size fits all. There's some people who need to talk and have talk therapy and there's other people who want EMDR or other forms of therapeutic intervention. But having that space, and I think now more than ever, if you're an institution thinking about

Should I, should we be thinking about doing magnet? Should we think, be thinking about, you know, just even enacting the foundational elements of, of magnet in preparation for maybe eventually applying for, for the recognition. But I can't impress upon people enough the importance of, of doing, of doing this because nurses have to have this

of structure. They have to have these foundational elements. In order for this to be sustainable, this practice won't be sustainable otherwise.

Maureen Lal (44:35.05)
it's, you know, when we talk about nurses feeling unsupported, it's because they don't have those resources in their organization. and I don't think there's a hospital today that doesn't have an EAP program and things like that. But I would say nurses are still hesitant to take advantage of mental health.

support sometimes and certainly we would encourage anyone to do that. And I think that we need to make sure that people feel that there isn't going to be any kind of stigma attached to it and just be supportive because it's a tough job. It's a really tough job and it's you're exactly right. I think police did a really nice job very quickly on providing supports. I think that the

first responders followed suit fairly quickly, I even there's opportunity I'm sure in all the professions to continue to really figure out how to do a better job.

Cara Lunsford (45:39.805)
Yeah, I'm a big fan of kind of real time surveying of nurses and really.

If there's a platform that you have access to or that as an organization you have access to where you can survey a nurse one or two questions even at the beginning end of their shift I think that these are really important things like did you feel like the care you provided today was safe? know, did you were you able to provide safe patient care? You know, do you feel like you need any? Assistance, know, is there you know, have you experienced?

any kind of trauma? Do you feel, you know, are you feeling unsafe psychologically or emotionally? And is there any resources that you need? Even something like saying yes could be enough to alert a manager or someone that maybe you need help. So I think we need to do more of that because I think we we are really good about doing surveys and we do them sometimes yearly or quarterly or

whatever it may be, but sometimes there's things that are needed really in the moment.

Maureen Lal (46:57.01)
absolutely, absolutely. And that's an interesting idea of a real time daily kind of check in. I suspect that it's driven by the unit that they're on, the type of care they provide. And I bet some are much more in tune to that. that is, I know that the ANA side of the ANA enterprise

is releasing a new standards on ethics and I suspect that there will be some of that more self-care. And the American Nurses Foundation has a whole toolkit for wellness of nurses. So there are other resources within the enterprise.

Cara Lunsford (47:29.309)
Yes.

Cara Lunsford (47:45.789)
Yeah, I had the opportunity to interview Cinder Rushden.

Maureen Lal (47:51.081)
yes.

Cara Lunsford (47:52.131)
just love Cinda and about the resilient nurses initiative and and we interviewed Lucas about he's the founder of something called Slow Talk, which is also really amazing. And so I I'm excited to see how technology, but also like just the trailblazers, the people who have been doing this work for decades and how that

Maureen Lal (48:05.186)
Yes, I have spoken with them. Yeah. Yeah.

Cara Lunsford (48:21.947)
combination of bringing people in like yourself or like Cynda Rushton or you know and bringing them in and pairing them with with new technologies that that can really I think move our profession forward and and get us the type of information and feedback we need in order to make make real-time changes you know impactful changes for nurses.

Maureen Lal (48:49.452)
Yeah, it's funny, Cinda and I did talk about Slow Talk. met with Lucas and fascinating program. I absolutely agree. And what's funny is, is when I was doing my masters at Hopkins, Cinda was one of my professors and I said, I don't know if you remember me. Of course, she didn't. She's had a million students since then, but it always makes me smile a little bit.

To your point, it's not even just nurses. We have to be thinking bigger and we need to be thinking about how we can impact the entire profession. And I think that when we start at the organization level with Magnet or a framework that is evidence-based and we make that change and we're doing that research and we're driving some of that expectations for culture, and then we continue to look beyond that in how we're talking to other nurses and

Then moving beyond that to the global piece, I love telling this story because I think about it's so true of nursing and how much we can connect and impact each other. I was visiting a hospital in Saudi Arabia and I was touring one of the units and the chief nurse said to me, we have nurses from 21 countries that work on this unit.

And I said, how do you work with that, with all the DEI initiatives and, you know, what do you have in place to ensure that the nurses are collaborating and you're having good outcomes? And he just looked at me and I'll never forget like the surprise on his face that I would ask this question because it just seemed so foreign to him. And he said, we all speak nursing. And I think that

is where we need to be. We all need to be speaking nursing and we all need to be supporting each other and programs that we like we have at ANCC really do help to promote that because as we put these in place globally then we can all be on the same page and driving our profession.

Cara Lunsford (50:56.189)
That, well, perfectly said. You could not have ended this with anything better than that, Maureen. Maureen with three E's.

Maureen Lal (51:08.706)
to compensate for the last name.

Maureen Lal (51:13.782)
This has been so much fun. was a little anxious, I have to admit. I was like, I don't know, a podcast is not something I've done before. It's been so much fun and you've made it fun. Yeah.

Cara Lunsford (51:22.205)
Well, now you've done it. So now you're going to be asked on many, many other podcasts.

Maureen Lal (51:30.964)
see. I do very much appreciate your listening to my stories and asking the great questions about the program.

Cara Lunsford (51:40.009)
Absolutely. Well, it's been an absolute pleasure having you and happy holidays. know when this goes live the holidays will be over, but it'll give people a little indication of how early we record.

Maureen Lal (51:53.838)
Same to you Kara, happy holidays. I really appreciate everything. Thank you.

Cara Lunsford (51:57.033)
Happy Holidays!

Maureen Lal (52:02.594)
Mm-hmm.