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Magnet journey creates parallel paths

The Magnet™ journey provides the framework for the transformation and ongoing refinement of the professional practice environment and the quality of care. This transformation is aligned with the 14 forces of Magnetism, and, in the new Magnet model, these five components: transformational leadership; structural empowerment; exemplary professional practice; new knowledge, innovation, and improvements; and empirical outcomes.
At our hospital, when the nursing department began its journey, other departments were affected and became part of the change. In particular, our respiratory department eagerly embraced our change process. This article explains the transformation in our nursing and our respiratory departments.

Transformational leadership  
Transformational leaders influence people to find approaches to practice that meet the demands of the future. The change in values, beliefs, and behaviors requires a well-defined vision.
At our hospital, all departments are guided by the hospital’s vision, “to achieve national recognition as a premier children’s hospital.” Members of patient care services (PCS), including the respiratory department, decided to develop a shared vision, a critical first step in team building and meeting the needs of our patients. In PCS, the vision is to be “simply the best.”
A group of nurses wrote the nursing philosophy statement during an off-site retreat, and the nursing staff adopted it. The respiratory staff, led by Organizational Development, created the respiratory philosophy statement. Although the processes were different, the two philosophies are related. In both, the healthcare providers are compassionate, possess exceptional clinical expertise, and won’t settle for anything short of full implementation of their beliefs.

Structural empowerment  
Nursing develops strong relationships and a partnership for the purpose of improving the health of the community it serves. Structures and processes provide an environment in which professional practice blooms, and the vision and values give life to activities that accomplish the goals of the strategic plan.
Our nursing department refined its committee organization to provide a shared governance structure. The director of respiratory services and the Magnet coordinator regularly attended the clinical directors’ staff meetings. Through sharing and informal dialogue, the director of respiratory services saw the benefits of shared governance and conveyed them to her staff members, who quickly changed their own governance structure.
The PCS leadership team found that respiratory and other PCS departments wanted to become part of a larger shared governance structure. The vice president of PCS, who is also our chief nursing officer, called a meeting to revise the nursing shared governance structure to ensure multidisciplinary membership in a PCS shared governance structure.

Exemplary professional practice  
The essence of a Magnet facility comes from excellence in professional nursing practice. The goal is related to the establishment of a professional practice and an accounting of its accomplishments.
The nursing and respiratory staffs were committed to developing a professional practice environment that was part of the strategic plan. Nursing faculty members from local colleges were invited to serve as members of the shared governance structure, and a faculty program allowed our nurses to teach at local schools of nursing. The respiratory staff developed a respiratory pediatric residency program. And a critical care fellowship program for therapists who worked with adults and are interested in specializing in pediatrics was also developed.
The nursing and respiratory departments also set discipline-specific certification targets. In 2008, the nursing certification level increased substantially, and all respiratory leaders and practitioners became certified in a neonatal-pediatric specialty.

New knowledge, innovation, and improvements  
Because our facility is Magnet-designated, we have a responsibility to contribute to patient care, the hospital, and the healthcare profession in terms of new knowledge, innovations, and improvements. For example, our nurses developed a nursing research fellowship and evidence-based scholars programs, which led to two peer-reviewed research papers and many oral and poster presentations locally and nationally.Recently, we established a sabbatical program for nursing and other allied heath departments, including the respiratory department. Staff members can take paid leave to conduct projects that mutually benefit the staff, the organization, and the patients and their families.

Empirical outcomes  
Outcomes follow structure and process. In the Magnet environment, we emphasize the impact on clinical, patient, workforce, and organizational outcomes. For example, the multidisciplinary rapid response team conducted a 30-month retrospective chart review. The findings indicated that 69% of patients had signs and symptoms before the code and that the staff recognized the signs and symptoms and intervened appropriately. After the nursing and respiratory departments set targets for vacancy rates, the respiratory vacancy rate dropped from 18% to 3% from fiscal years 2006 to 2008. In direct-care nursing, vacancy rates dropped from 14.6% to –1.9% from fiscal year 2005 to 2007. These numbers reflect the Magnet effect—the creation of a professional practice environment focused on quality and safety in care.


Magnet effect  
The Magnet journey affects not only nursing but the entire organization. At our hospital, many departments changed because of the Magnet transformation, but the journey of the respiratory department most closely mirrored ours. Last year, our nursing department received Magnet designation, and we are proud to say that the nursing department and the entire organization have been recognized for their dedication to their professional practice and for the exemplary programs and services provided to the children and families in our care.

Selected references
American Nurses Credentialing Center. Announcing a New Model for ANCC’s Magnet Recognition Program. 2008. http://www.nursecredentialing.org/MagnetNewsArchive2008/NewMagnetModel.aspx. Accessed February 11, 2009.
Disch J, Beilman G, Ingbar D. Medical directors as partners in creating healthy work environments. AACN Clin Issues. 2001;12:366-377.
Goulette C. Data Set: CalNOC Study inconclusive on staffing numbers. Advance for Nurses. 2008;5:21-22.
Saver C. Nursing today and beyond: leaders discuss current trends and predict future developments. Am Nurse Today. 2006;1:18-25.

Toni M. Christopherson is director of nursing at Yuba College in Marysville, California. She recently served as the Magnet coordinator at Children’s Hospital of Orange County (CHOC) in Orange, California. Maila Factora is executive director of family and respiratory services, pulmonary function at CHOC.

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