Magnetism and the Nursing Workforce

Magnetism and the Nursing Workforce
The focus of this chapter is to highlight practice exemplars and research fi ndings
related to the fi ve 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 fi ndings from scholarly
publications and describe how the fi ndings 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®.
In her September 1980 Presidential address to the American Academy of Nursing
(AAN), Linda Aiken articulated the scope of the nursing shortage; over 80% of
American Hospitals do not have the adequate staffi ng with some 100,000 vacancies
in hospital nursing positions, which is having a crippling effect on dayto-day
operations (AAN, 1983; ANA, 2010 reissue). In order to identify ways to
Magnetism and the Nursing Workforce
help solve this problem, the Governing Council of the AAN appointed a Task
Force on Nursing Practice to examine the characteristics of systems facilitating
professional practice in hospitals (McClure, Poulin, Sovie, & Wandelt, 2002).
Selected AAN Fellows were asked to nominate potential Magnet hospitals that
demonstrated success in recruiting and retaining professional nurses on their
staffs (AAN, 1983; ANA, 2010 reissue).
Out of the 165 hospitals nominated, 46 were selected with 41 participating.
Five of the nominated hospitals were unable to participate because of scheduling
problems. A staff nurse representative along with the director of nursing
engaged in separate group interviews and articulated their concepts of the conditions
that made their hospital a good place to work. The 14 Forces of Magnetism
evolved from this original Magnet Study. Aiken’s (1994) study demonstrated
lower Medicare mortality in Magnet Hospitals. Aiken, Havens, and Sloane’s
(2009) research documented that American Nurses Credentialing Center (ANCC)
Magnet hospital designation is a valid marker of good nursing care. An associated
energy is created in nurses of Magnet-designated facilities as a forum for nursing
staff to showcase their work is created, resulting in a great deal of organizational
pride (Horstman et al., 2006). The following is a brief overview of the original 14
Forces of Magnetism as defi ned by the ANCC (2005, 2008a, 2008b).
Force 1. Quality of Nursing Leadership: Knowledgeable, strong, risk-taking
nurse leaders follow a well-articulated, strategic, and visionary philosophy in the
day-to-day operations of the nursing services. Nursing leaders, at all levels of the
organization, convey a strong sense of advocacy and support for the staff and for
the patient. The results of quality leadership are evident in the nursing practice at
the patient’s side (ANCC Magnet Recognition Program, 2005). Drenkard (2005)
indicated that the chief nurse offi cer (CNO)must be the role model for living the
concepts in the Magnet Forces.
Force 2. Organizational Structure: Organizational structures are generally
fl at, rather than vertical, and decentralized decision-making prevails. The organizational
structure is dynamic and responsive to change. Strong nursing representation
is evident in the organizational committee structure. Executive-level
nursing leaders serve at the executive level of the organization. The CNO typically
reports directly to CNO. The organization has a functioning and productive
system of shared decision-making (ANCC Magnet Recognition Program,
2005). Batcheller (2010) noted that the CNO’s tenure is affected when there is
a confl ict with the chief executive offi cer and that the challenge nurse leaders
face are to develop a competency model and roadmap in becoming transformational
leaders.
Force 3. Management Style: Health care organization and nursing leaders
create an environment supporting participation. Feedback is encouraged and
valued and is incorporated from the staff at all levels of the organization. Nursing
serving in leadership positions are visible, accessible, and committed to communicating
effectively with staff (ANCC Magnet Recognition Program, 2005).
Caroselli (2008) stressed that although the role of the chief nurse executive was
complex, daunting, risk-laden, it provided unprecedented opportunities to infl uence
the care of patents in a very broad context.
Force 4. Personnel Policies and Programs: Salaries and benefi ts are competitive.
Creative and fl exible staffi ng models that support a safe and healthy work
environment are used. Personnel policies are created with direct care nurse
involvement. Signifi cant opportunities for professional growth exist in administrative
and clinical tracks. Personnel policies and programs support professional
nursing practice, work/life balance, and the delivery of quality care (ANCC
Magnet Recognition Program, 2005). Laschinger, Finegan, Shamian, and Wilk
(2001) identifi ed that by linking structural empowerment with psychological
empowerment, employees’ emotional connectedness with the work setting were
positively infl uenced. Jasovsky et al. (2005) reported on a cost-effective on-line
system for collecting the demographic data for the Magnet monitoring reports.
Force 5. Professional Models of Care: There are models of care that give nurses
the responsibility and authority for the provision of direct patient care. Nurses
are accountable for their own practice as well as the coordination of care. The
models of care (i.e., primary nursing, case management, family-centered, district,
and holistic) provide for the continuity of care across the continuum. The models
take into consideration patients’ unique needs and provide skilled nurses and
adequate resources to accomplish desired outcomes (ANCC Magnet Recognition
Program, 2005). Wolf and Greenhouse (2007) believed that successful transformation
and integration of a care delivery model into the DNA of the organization
must be led by the CNO with unrelenting passion. The model should serve as the
foundation for assessment, planning, organizing, job description, a reward and
recognition system, recruitment, staff development and research.
Force 6. Quality of Care: Quality is the systematic driving force for nursing
and the organization. Nurses serving in leadership positions are responsible for
providing an environment that positively infl uences patient outcomes. There
is a pervasive perception among nurses that they provide high-quality care to
patients (ANCC Magnet Recognition Program, 2005). Magnet hospital nurses
always rate the essential element of ‘working with other nurses who are clinically
competent” as “important” for quality of care and “present” in Magnet
hospitals. Magnet hospital staff consider specialty certifi cation, advanced
education, and both formal and informal peer review as evidence of clinical
competency (Kramer & Schmalenberg, 2004). Gawlinski (2007) stressed that
outcome variables should be measured before (at baseline) and after the practice

change. Measurement at these time points allows comparison and evaluation of
the effects of practice change. The sustainability of the practice change can also
be evaluated by measuring the process and outcome variables 6–12 months
after implementation.
Force 7. Quality Improvement: The organization has structures and processes
for the measurement if quality and programs for improving the quality of
care and services within the organization (ANCC Magnet Recognition Program,
2005). Hinshaw (2006) reported that translating the Institute of Medicine’s
recommendations, Keeping Patient Safe: Transforming the Work Environment of
Nurses into practice required an extensive collaboration among nurse administrators
and nurse researchers to advance the quality of care. This was supported
by Kramer and Schmalenberg (2005) who reported that the Magnet
Recognition Program stimulated valuable and insightful research related to
outcomes since staff nurses identifi ed process/functions most essential to quality
patient care.
Force 8. Consultation and Resources: The health care organization provides
adequate resources, support, and opportunities for the utilization of experts,
particularly advanced practice nurses. In addition, the organization promotes
involvement of nurses in professional organizations and among peers in the community
(ANCC Magnet Recognition Program, 2005). Evidence-based practice
for advanced practice nurses incorporates critical thinking, accessing research
resources, using evidence-based tools such as clinical practice guidelines and
implementing the recommendations into clinical practice (Kleinpell & Gawlinski,
2005; Kleinpell, Gawlinski, & Burns, 2006).
Force 9. Autonomy: Autonomous nursing care is the ability of a nurse to
assess and provide nursing actions as appropriate for patient care based on
competence, professional expertise, and knowledge. The nurse is expected to
practice autonomously, consistent with professional standards. Independent
judgment is expected to be exercised within the context of their interdisciplinary
and multidisciplinary approaches to patient/resident/client care (ANCC Magnet
Recognition Program, 2005). Magnet hospitals have demonstrated better patient
outcomes, safer patient care, increased autonomy and greater nurse satisfaction
through mentoring programs (Fundeburk, 2008).