Heather Bertin   	 31 Jan 07    7:24 PM MST
	Discussion, week five:
The magnet force that I have chosen to discuss is Quality of Care. The American Nurses Credentialing Center (ANCC) describes this force in the following way: Quality is the systematic driving force for nursing and the organization. Nurses serving in leadership positions are responsible for providing an environment that positively influences patient outcomes. There is a pervasive perception among nurses that they provide high-quality care to patients (2006, ANCC).
I feel that Quality of Care is the basis of not only what we do, but in getting recognized as a Magnet Institution. Nurses are at the forefront providing the best care to the patients they serve each day. This care can be one of the driving forces that make your institution successful. What I also like about this force is the fact that it is not specific to one setting or if you are a Magnet designated hospital. Even if a hospital or clinic is not of Magnet status, they should be striving to provide the highest quality of care everyday.
I am fortunate to work for a Magnet designated hospital. This hospital truly believes and lives by the fourteen forces of magnetism. If you were to read our hospitals core values, you would see that two of them, caring and integrity, relate to this force very nicely. MD Anderson was awarded recognition in 2001, but we had already adopted these forces into our hospital’s culture long before that. All the forces did was put into categories what we were already doing. If you were to look at the MD Anderson website, you would see the saying, life-saving, life-changing CARE. As Bolton and Bennett (2002) state, “Recognizing the link between quality patient care and nursing excellence, the program recognizes, at a national level, nursing services in acute and long-term care facilities, and it provides consumers with an additional benchmark by which to measure the quality of care they can expect to receive” (p324). The patients at my hospital demand a high level of care and they get it. As a nurse in this hospital I can attest to the high level of care that is given to our patients, because we all believe in the core value of caring. We care for our patients and families and the mission of MD Anderson, and that is reflected in the quality of care provided.
MD Anderson believes in the care the nurses provide and listens intently to what they have to say. We are surveyed constantly on our opinions and they are always looking for ways to improve our environment or make like easier for us. The support there is tremendous and I believe it is because they value the level of expertise the nurses provide. Nurse retention is high there despite the difficult job of caring for oncology patients. I truly believe that we, as an institution and professionals, are living this force everyday.

Mason, D. J., Leavitt, J. K., & Chaffee, M. W. (2002). Policy & politics in nursing and health care (4th ed.). St. Louis, MO: Saunders/Elsevier.

Electronic reference by the American Nurses Credentialing Center. (2006, May 11).
Retrieved January 30, 2007, from http://www.nursingworld.org/ancc/magnet/getall.cfm


Margaret Imbrock 	31 Jan 07    8:00 PM MST
	Heather,
Since you have been on the Magnet journey since 2001, how was your reapplication process. Was it easier or tougher than the orginal application since the bar is set at a higher level? Have you seen a change in nurse to patient ratios? Are you allowed to utilize alternative therapies,i.e., healing touch, Reiki therapy, meditation in your patient care or do you use traditional interventions?
Marge


Laura Ballance 	1 Feb 07  11:40 AM MST
	Heather,

In the facilities that I worked in just over 3 years ago, they had a patient satisfaction survey given to them at discharge. Their suggestions, complaints, and praise were all taken seriously. The surveys were compiled quarterly and sent to each department. No names were ever mentioned. The survey included negative comments as well as positive comments on their care while in the hospital.

In this fashion, staff were able to understand what the patients believed they were missing. It gave them an opportunity to focus on what needed to be improved.

The organization that I work in now, education, does the same type of surveys, only we never see them and nothing ever really changes. How unfortunate for this organization as the growth of it is squashed or impeded.

Congratulations on being a part of a team that focuses on quality of care for the patients.

Laura Ballance
Florida


Mary Arnold 	31 Jan 07    8:06 PM MST
	Forces of Magnetism – Quality of Care


Achieving Magnet Recognition indicates to the public that the best quality of patient care will be delivered. It is almost like an insurance policy to the public, if you will, it increases the patient’s safe passage through the hospital system. As indicated by Dr. Karlene Kerfoot, facilities that have achieved Magnet status have an organized framework for the future. ( Canter & Associates, 2004).

The American Nurses Credentialing Center summarizes quality of care to be the systematic driving force for nursing and the organization. The nurses serve in leadership positions and are responsible for providing an environment that positively influences patient outcomes. The nurses perceive they provide high quality care to their patients. (ANCC, 2005).

Currently, I would have to say this is lacking in my organization because today was my last day at my old job, and I will start my new position tomorrow. However, at the last hospital I worked at, prior to my departing of that position, they had just began their magnet journey. Quality of Care was of great concern to them. I worked in an ER, and we were all about getting prompt care to the patient. In an ER, many times, every minute counts. We had standing orders for MI, and CVA, and many other types of cases that would come in that would help cut time down. The care that was given to the patient’s in the ER was top-notch, and we regularly would get patient evaluations back, with high scores. Generally the only time patient’s would get upset is if they would have to wait for long periods of time to be moved up to a floor or for a MD to come into a room, which would only happen if they were called to a code.

I have checked with the facility to see how their progress is going on their magnet status application. I am told that it is progressing nicely.

References:

American Nurses Credentialing Center, (2005). Introduction to the magnet recognition program for students of nursing. Retrieved January 31, 2007. http://www.nursingworld.org/ancc/magnet/forms/studentmanuel.pdf

Canter & Associates. (Executive Producer). (2004). The nurse leader: New perspectives on the profession. Los Angeles: Dr. Karlene Kerfoot.


Krista Winslow 	31 Jan 07    9:07 PM MST
	Mary,
It sounds like the ER you worked at before was top notch. Time is one of the most valuable things you have in the ER, even for patients who are not critical but don't want to have to wait for hours to get treated. Thats great that your patient satisfaction scores were so high. Its obvious the nurses had a lot to do with that because the times when the patients were unsatisfied, the nurse had no control over (waiting for the MD, transfer to another floor).
While I don't work in our ER, I think it is very similar to yours. We have standing orders and wait time is one thing that everyone tries to minimize. If the rest of the hospital lives up to the other 13 forces of magnetism, they should be well on their way to magnet status!


Karen Kelsall 	1 Feb 07    4:53 PM MST
	Mary,
First of all congratulations on your new position. I should think it will be challenging and enjoyable.
I would like to comment on your posting in regards to Emergency Departments. I am in fact an ED nurse and you are so right when you say every second counts. We do have standing orders and protocols we initiate straight from triage to "speed up" if you would have it the patients care. I find these protocols quite effective and now that they have been in effect for a while I can see where the rest of the staff including the doctors find them to be an effective tool as well. These protocols were initiated by a team of nurses that felt it would be best patient practice to start labs/test while the patients were waiting instead of doing nothing. We have an administrator who wanted us to gain an entire new way of thinking. She felt that the old way was the patients were not actually ED patients until they got back into a room. That while they were in the lobby they were still in limbo. Now she has us thinking that once they sign in no matter where they are physically they are ED patients and need to be cared for as such. This does take some great communication on the staffs part when we are looking for labs and tests to match up with patients who are still in the lobby but it all works out. I find that the patients are much happier once the tests have been initiated. I guess they feel like something is being done for them.
I have noticed that most people are reasonable and understandable if you just explain the reason for delay and show them that everything we can do right now for them is being done.
Our magnet status journey has just begun but I see it as an exciting journey to show us exactly what we need to achieve such a high standard of care. I already feel like we deliver high quality patient care and that we all care about each patient as an individual so it will be an eye opener to me what exactly Magnet thinks of the care we deliver.
Just out of curiosity what is your new position and does that facility hold a magnet status? I don't think a facility has to hold magnet status in order to be deemed a good facility. I am sure there are a number of facilities out there that deliver high quality patient care and respect their staff that don't have the status for one reason or another. What are your thoughts on Magnet vs. Non magnet facilities? Do you notice a difference from a patients point of view and what about from an employees point of view?
Thanks for sharing.
Karen Kelsall
PA


Christine Higbie 	1 Feb 07    7:40 PM MST
	Mary,
To piggyback onto what Karen asked; What differences to you see in or expect to see in the new facility compared to the one you just left?
Quality patient care is important in every facility, whether is is magnet or not. I have been fortunate to work in facilities that provide quality care and are not Magnet certified. i feel that the Magnet certification makes strong facilities stronger and good facilities better.

Chris


Mary Arnold 	2 Feb 07  10:02 PM MST
	Karen & Christine:

Thanks for asking about my new position. My new position is not at a hospital setting it is with a Cardiovascular Thoracic Surgeon. There's a total of 3 surgeons and 1 cardiologist in the practice. I have only been there a total of 2 1/2 days, but I have to say, by far this organization/practice would qualify for magnet status. The previous practice that I came from had many flaws in it. I could honestly say that none of the 14 forces were practiced. In fact one of my biggest complaints was the lack of respect for employees and patients and lack of HIPPA compliance there was in the office. I could continue. My new position has given me a renewed balance, trust, breath of fresh air, and respect. HIPPA is observed and respected,patients and staff are valued in this office. The staff is respected. The nurses all have offices with doors that we can shut to help with privacy. The practice only employs RN's. I do believe that there is a difference between a magnet facility and non-magnet facility. If physician offices/practices could apply for magnet status I feel that they would meet the standards.

Mary Lynn, RN, BSN
IL