Nurse magnets crucial for recruitment and retention

In 1983, the American Academy of Nursing conducted a survey of 163 hospitals to learn why some hospitals attracted and retained well-qualified nurses who were devoted to quality patient care.

The survey identified 41 hospitals with “magnet” recognition and found that all of them shared similar characteristics. Those similarities became the 14 Forces of Magnetism, the heart of the American Nurses Credentialing Center’s Magnet Hospital Recognition program.

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Photos by BARRY WILLIAMS / AJC Special

Kim Sharkey, chief nursing officer and vice president of nursing at St. Joseph’s Hospital in Atlanta, speaks to a group of nurses about shared governance.

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Nurse Nancy Hutcheson checks the monitor of a patient after cardiac surgery at St. Joseph’s Hospital in Atlanta. This year the hospital earned magnet designation for the fourth time.

THE 14 FORCES OF MAGNETISM

1. Quality of nursing leadership

2. Organizational structure

3. Management style

4. Personnel policies and programs

5. Professional models of care

6. Quality of care

7. Quality improvement

8. Consultation and resources

9. Autonomy

10. Community and health care organization

11. Nurses as teachers

12. Image of nursing

13. Interdisciplinary relationships

14. Professional development

Source: American Nurses Credentialing Center

The University of Washington Medical Center in Seattle became the first ANCC-designated magnet organization in 1994. St. Joseph’s Hospital in Atlanta became the third in 1995. Since then, three other Georgia hospitals have earned what is considered the gold standard of nursing excellence:

St. Joseph’s/Candler in Savannah, Medical Center of Georgia in Macon and University Hospital in Augusta.

Leaders who have guided their institutions to magnet recognition say it’s a journey, not a destination. Here’s a look at Georgia’s four magnet hospitals.

University Hospital

“We were one of those 41 institutions that were identified as being able to retain high-quality staff in the 1980s,” said Mary Jo Goolsby, patient care research specialist and magnet coordinator at the Augusta hospital. “We had the magnet factors of strong leadership, good personnel policies, educational resources and a good work environment that empowered nurses to identify problems and seek solutions.”

The hospital began the formal process for magnet recognition in 2003 and earned it in 2005.

“At first it was overwhelming,” said Goolsby, Ed.D., MSN, NP-C, FAANP.

To be designated, a hospital must document and present evidence of how it demonstrates the 14 Forces of Magnetism.

The hospital had been operating under a shared-governance model, but had never made it a formal program.

“Now, nurses sit on five councils, task forces and committees and have a strong influence on how nursing and the hospital work,” Goolsby said.

The nursing staff recently secured a much-needed traffic signal at a hospital exit.

“Nurses feel ownership in decisions made at the unit level and decisions made at the vision level are made with recommendations from the councils” Goolsby said. “They know their voices are heard and are proud that their input is valued.”

Goolsby just mailed the redesignation application. Magnet recognition lasts for four years.

She was gratified to see so many positive changes since the hospital first became a magnet facility and to see how the 14 Forces of Magnetism are reflected throughout the hospital.

Medical Center of Central Georgia

MCCG earned its first magnet recognition in 2005 and is busy documenting its second application.

“It’s a journey of inches, and we have hundreds of nurses involved. One of the benefits of the process is that it allows everyone to tell stories of how nursing is a cut above here,” said Meryl Montgomery, MSN, RN, magnet program coordinator.

For Barb Stickel, chief nursing officer and senior vice president at MCCG, the environment is one where “nurses work constantly to challenge themselves, to grow professionally, to keep standards high, to bond with coworkers and improve the work environment.”

Magnet recognition improves MCCG’s bottom line by helping the Macon hospital attract top nursing graduates who want to grow professionally and feel empowered to advocate for patients. Nurse vacancy rates have dropped from double digits to single digits since the magnet recognition, and turnover has gone from 20 percent to between 9 percent and 13 percent per year, said Stickel, MSN.

Patient outcomes have improved and have benefited from bedside research. Recently, nurses joined college music therapists to show that low-decimal music decreased crying episodes in the neonatal nursery from seven to four a day, and from 20 minutes to five minutes per episode. Nurses presented the findings at a national conference.

“Even after you achieve magnet, you’re always striving to grow and get better. You set measurable goals every year,” Stickel said.

St. Joseph’s/Candler

“It’s nurses who consistently raise the bar, but you can’t achieve magnet [goals] without everyone being involved,” said Susan Howell, director of professional practice. “The tremendous speed with which interdisciplinary teams are able to form to address any problem is an outgrowth of magnet. The whole philosophy of teamwork is pervasive in our organization.”

Nursing leaders set magnet recognition as a goal when St. Joseph’s and Candler hospitals in Savannah began talking about a joint-operation agreement in the late 1990s.

“We had two nursing systems with deep professional roots. Each had had a school of nursing,” said Sherry Danello, MSN, RN, NEA-BC, vice president of patient care and chief nursing officer. “Magnet became the vision and the road map for pulling two hospitals together.”

The two-campus system achieved magnet recognition in 2002 and again in 2006.

“It’s very exciting to look back and see the strides we’ve made. Magnet gives us that focus and keeps us on the right path,” said Howell, MSN, Ed.D., RN.

Excitement is another byproduct of the magnet journey. At regular intervals, hospital leaders and board of trustees members are exposed to the human side of health care when nurses share stories of how their care made a difference with a patient.

“Sometimes there is silence for two minutes afterward. The stories that nurses tell can blow you away,” Howell said. “That’s the art of the profession. People focus on the science and forget that piece.”

St. Joseph’s Hospital

Kim Sharkey, chief nursing officer and vice president of nursing at St. Joseph’s Hospital in Atlanta, remembers exactly when hospital officials found out it had earned a record fourth magnet designation — March 17 at 10:30 a.m.

St. Joseph’s was another of the original 41 hospitals that was cited for magnetic qualities that attracted nurses.

“Earning our first designation in 1995 was a validation of programs that we had already put in place,” said Sharkey, BSN, RN, MBA, NEA-BC.

The hospital had already utilized shared governance that allowed nurses closest to patient care to make decisions, following the theories of Tim Porter O’Grady — considered the guru of shared governance, Sharkey said. St. Joseph’s also established a clinical advancement program that rewarded nurses for involvement in practice change and development.

Annual self-evaluations kept the hospital on track as patient care/nurse-development leaders through its second (2000) and third magnet designations (2005).

After 2005, changes at the hospital made nurses nervous about a fourth magnet application.

“It was a period of transition,” Sharkey said. “Our CEO left, as did one of our physician groups. Compensation and reimbursement became issues. The new CEO decided to take nursing out of its traditional alignment under one CNO [chief nursing officer] and make four service lines instead.”

The changes resulted in the loss of a CNO, a pivotal nursing director, workforce reduction and new pay practices.

“As challenging as it was to go through those transitions, writing about them in the magnet application was even more challenging,” said Marianne Baird, RN, MN, clinical nurse specialist and magnet coordinator. “We had no idea how our staff would respond at the site visit [a required step after an application is accepted].”

The nurses came through with flying colors.

“What we learned is that despite everything, our level of care had prevailed and nurses were still quite proud of their accomplishments and their peers,” Baird said.

Adapting to change has strengthened the nursing work force at St. Joseph’s, Baird said.

“Maintaining a magnet environment isn’t about maintaining the status quo,” she said. “It’s about keeping the magnet standards, even in the midst of chaos. When you commit to excellence, you have to be creative and resilient enough to figure out a way to maintain it.”

Hospitals band together to promote good nursing

After the 2007 National Magnet Conference in Atlanta, nursing leaders at Georgia’s four magnet-designated hospitals formed a consortium to share ideas.

“Part of our mission statement is to provide a venue for nursing excellence in Georgia and to attract more nurses to the state,” said Sherry Danello, MSN, RN, NEA-BC, vice president of patient care and chief nursing officer at St. Joseph’s/Candler in Savannah.

“Working collaboratively to identify best practices, to find similar strengths and opportunities will help us all become stronger,” said Marianne Baird, RN, MN, clinical nurse specialist and magnet coordinator at St. Joseph’s Hospital in Atlanta. “We’d like to see every hospital in Georgia become a magnet hospital, because it stands for the best possible care.”

The consortium is advising other hospitals that are pursuing magnet designation.

“This is the perfect time to go for magnet…,” said Meryl Montgomery, MSN, RN, magnet program coordinator at the Medical Center of Central Georgia in Macon. “Magnet helps focus nurses on why they went into the profession in the first place.”

Once MCCG was involved in the magnet application process, Montgomery saw staff meetings move from a litany of complaints and to-do lists to a celebration of how nurses were making a difference.

“A magnet hospital is a whole different environment, because the nurses make different choices,” Montgomery said. “They’re choices that lead to an environment of excellence.”