Journey to Magnet: cost vs. benefits

As hospitals and health systems strive to be an "Employer of Choice", one important goal for their nursing leaders has been the decision to embark on their journey of becoming a designated Magnet facility. Approximately 12 months ago, conversations with a few chief nursing executives uncovered a hot topic concerning the achievement/designation of Magnet status and specifically its cost benefits. With more and more hospitals obtaining Magnet status, these nurse leaders did not know how other organizations felt about their journey including outcomes and were very interested in learning more details about their colleagues' experiences.

Bridging the communication gap through implementation of a Patient Navigator program

All healthcare providers working in an acute setting need to be empowered to provide an optimal patient experience with quality outcomes. The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey is a national standardized survey instrument designed to assess the patient's perspective of hospital care for public reporting purposes. These results are posted on the Center for Medicare and Medicaid Services (CMS) website for consumers to access comparison data related to a hospital's performance, create new incentives for hospitals to improve quality outcomes and enhance accountability through transparency (1). HCAHPS has 10 measures that evaluate the patient's recent hospital experience. Six of these are summary measures. One key measure, "communication with nurses," can directly affect both the patient satisfaction and patient safety scores (2). Patients tend to rate this domain based on the caregivers, and this rating can have a financial impact upon the institution. The skills and art associated with service are neither innate nor automatic. Communication skills are acquired and refined only through practice. The Magnet recognition program was developed to recognize health care organizations that provide nursing excellence and a vehicle for disseminating successful nursing practices and strategies (3). To assist the nurse in the patient's perception to care, a Patient Navigator program was developed to provide patients with the best possible hospital experience. The Patient Navigator program compliments the direct patient care that is provided on the patient care unit. HCAHPS is a national standardized survey instrument designed to assess the patients' perspective of hospital care for public reporting purposes. There are a total of 27 survey items that are divided into six composite measures, two individual items and two global ratings. The six summary measures and two global ratings are listed below.

Clinical supervision using the 4S model 3: how to support supervisors and sustain schemes

This final article in a three part series on establishing clinical supervision discusses essential support for supervisors after training, and how to sustain supervision schemes, including issues such as evaluation and ongoing training. Part 1 examined initial structural arrangements and policy development; part 2 described training for supervisors.

Economic theory and nursing administration research--is this a good combination?

TOPIC

Economic theory is used to describe and explain decision making in the context of scarce resources.

PURPOSE

This paper presents two applications of economic theory to the delivery of nursing services in acute care hospitals and evaluates its usefulness in guiding nursing administration research.

SOURCES OF INFORMATION

The description of economic theory and the proposed applications for nursing are based on current nursing, healthcare, and economic literature. Evaluation of the potential usefulness of economic theory in guiding nursing administration research is based on the criteria of significance and testability as described by Fawcett and Downs.

CONCLUSIONS

While economic theory can be very useful in explaining how decisions about nursing time allocation and nursing care production are made, it will not address the issue of how they should be made. Normative theories and ethical frameworks also must be incorporated in the decision-making process around these issues. Economic theory and nursing administration are a good fit when balanced with the values and goals of nursing.

Magnetism and the nursing workforce

The focus of this chapter is to highlight practice exemplars and research findings related to the five components of the new Magnet Model. A brief overview of the historical development and professional evolution of the American Nurses Credentialing Center (ANCC) Magnet Recognition Program is presented followed by a brief overview of the original fourteen forces of magnetism. Content related to empirical practice-based research framed under the components of transformational leadership; structural empowerment; exemplary professional practice; new knowledge, innovation, and improvement; and empirical outcomes is presented and discussed. The authors provide key findings from scholarly publications and describe how the findings contribute to the creation of work environments based on the tenets of magnetism. The chapter concludes with a brief over of the ANCC Pathway to Excellence Program.

A study of a nursing department performance measurement system: using the Balanced Scorecard and the Analytic Hierarchy Process

The health care industry is under pressure from government and private entities as well as from market conditions to contain costs. In an effort to respond to these pressures, the case hospital in this study implemented a Balanced Scorecard (BSC) in January 2003 and integrated it with the hospital's formal incentive plan for non-physicians in January 2005. The nursing department's performance improved in the 2 years following the introduction of the plan. This study contributes to the literature by demonstrating the performance improvement that results from integrating the BSC with an incentive plan in the nursing field. The results provide insight into the current BSC performance metrics applied by the case nursing department, and could be used as guidelines by other health care organizations that wish to implement BSC-based incentive plans.

The American Association of Critical Care Nurse's Beacon Award: a framework for quality

The Beacon Award for Critical Care Excellence recognizes individual critical care units that have met rigid criteria for excellence, exhibiting high-quality standards and exceptional care of patients and their families. Used as a framework for quality, the award criteria focus on structure, process, and outcomes that enable quality to emerge in the critical care environment. The journey toward meeting Beacon Award criteria can produce long-lasting changes that transform unit-based culture and lead to sustained excellence.

The changing reimbursement landscape: nurses' role in quality and operational excellence

Operational excellence, care quality, and financial performance are increasingly linked as key drivers of hospital performance. This environment may be seen as a challenge, but it is also an excellent opportunity for nursing services to further demonstrate their value in patient care outcomes and support financial performance. Nursing contributions toward reduced complications, reductions in length of stay, and lower costs per case should be measured, rewarded, and made transparent to the public. Staff nurses should not view quality as simply another task on which to focus their attention, but rather a continuous process that requires critical thinking about how care is delivered and its effect on the entire care progression of a patient. Nursing management must focus on continually educating their staff on appropriate care, as well as developing and supporting a culture of safety and accountability. Nursing leadership must improve nurse retention and recruiting efforts, encourage interdisciplinary collaboration and, most importantly, demonstrate to the rest of the organization the value nursing brings to the organization through consistently tracking quality and financial indicators and tying them to nursing initiatives.

Work environment, health outcomes and magnet hospital traits in the Canadian nephrology nursing scene

Nephrology, like others areas of health care, is confronting a nursing shortage. Unless action is taken to address nursing shortages, patient care may be negatively affected (American Nephrology Nurses' Association, 2007). Previous studies have been conducted on magnet hospital traits, quality of nursing worklife, empowerment, job satisfaction, burnout, health outcomes, and their influence on nursing retention in Canada. However, there is little research in this area specific to nephrology nursing. This descriptive study examined whether magnet hospital traits, empowerment, and organizational support contribute to Canadian nephrology nurses' job satisfaction, health outcomes, and perceived quality of patient care. A randomly selected sample of 300 nurse members of the Canadian Association of Nephrology Nurses and Technologists (CANNT) was asked to complete a survey consisting of four instruments: The Nursing Work Index (Lake, 2002), the Conditions of Work Effectiveness Questionnaire II (Laschinger, Finegan, Shamian, & Wilk, 2001), the Pressure Management Indicator (Williams & Cooper, 1998), and the Maslach Burnout Inventory (Maslach, Jackson, & Leiter, 1996). There was a 48.1% response rate. Results demonstrated that some aspects of the Canadian nephrology nursing environment were rated quite favourably (e.g., high standards of care are expected; good working relationships with peers), but areas requiring improvement were evident (e.g., assignments that foster continuity of care). Overall, the nurses felt empowered. The results of the Pressure Management Indicator and Maslach Burnout Inventory indicated that nephrology nurses are generally coping well, but that some of them are struggling. Strategies that improve work environments could promote the recruitment and retention of nephrology nurses. Further research in this area is warranted.