Creating structures to support systems can be a challenge for organizations in balancing individual organization culture with the advantages of the greater good. The journey for nursing excellence in pursuit of Magnet(R) designation is one example of a challenge in melding individualization with system efficiencies. While Magnet Program Directors (MPDs) are faced with creating a Magnet culture for their individual hospitals, they need to attain the resources and support to be successful with designation or redesignation. The resources and support can be optimized through a system approach to designation. This article describes a method of creating and supporting nursing excellence in a healthcare system through creation of an enterprise-wide Magnet Program Director Council.
The setting is the University of Pittsburgh Medical Center (UPMC), a 40-hospital health system and insurance provider, based in Pittsburgh, Pennsylvania. The system uses 92 000 staff members including more than 15 000 nurses. Care is provided in community, rural, and academic settings across Pennsylvania, New York, and Maryland with international programs located in China, Italy, Ireland, and Kazakhstan.
Creation of a Council
UPMC has a Center of Nursing Excellence with a system chief nurse executive (CNE). The system CNE meets regularly with all the chief nursing officers (CNOs) within the health system. One of the goals identified at the system level was for all hospitals to consider Magnet designation. System initiatives are shared to drive local goals to be in alignment with the Magnet model. Two specific system initiatives were to increase the percentage of BSN hires and for nurses to become certified within their specialty. In 2009, in the Southwestern region of Pennsylvania, 1 hospital in the UPMC system was Magnet designated with 2 more hospitals in the application phase. The Magnet-designated hospital was a 249-bed teaching hospital. In the application phase were a 520-bed academic medical center and a 300+ bed children's specialty hospital. The diversity of these 3 original Magnet hospitals brought different perspectives and unique challenges of meeting the Magnet exemplars. The CNOs and MPD from the 3 hospitals met to interpret the Magnet manual requirements and support each other during phases of the process. While providing support was the initial intent, as the group continued to meet, a collegial bond formed as they assisted each other with preparing for document submission, document editing, and mock site visits. Other CNOs in the system determined they were capable of meeting the Magnet requirements for application and asked to be included in the partnership. CNO support and sponsorship throughout the system included mentoring and precepting for interested hospitals. The MPD Council provided a vehicle for Magnet enculturation and the foundation to pursuing Magnet designation. By 2010, the UPMC Council became an internal consortium with all hospitals in the system invited to join and participate regardless of intent to apply or stage of Magnet readiness.
Onboarding of New Magnet Program Director
Prior to the inception of the system council, onboarding of an MPD required self-learning and site visits across the enterprise to orient to the role. Through the MPD Council, the role accountabilities and duties of the MPD have been standardized (Supplemental Digital Content 1, http://links.lww.com/JONA/A927). Newly hired MPDs are expected to become members of the system MPD Council. As a component of their orientation, the MPD is paired with a senior MPD. The senior MPD acts as a preceptor and mentor for the new MPD. The senior mentor is available to guide the transition to practice in this new role and initiate organizational assessment activities such as a gap analysis. Each new MPD completes a gap analysis to evaluate current state of the hospital. The new MPD then identifies opportunities and priorities of the hospital. Priorities are then reiterated to all staff and shared leadership council to create implementation plans to better outcomes.
In 2019, a residency program for MPDs was created by senior MPDs. The senior MPDs gathered information from the literature related to residency programs and created a curriculum specific to the MPD role. The curriculum consisted of Magnet fundamentals, scope and development, review of the Magnet manual, education, shared governance, initiating application, nurse strategic planning, engagement of key stakeholders, and data analysis, inclusive of inpatient and ambulatory areas.
System Council Accomplishments
As supplemental educational support, the MPDs developed an online toolkit to support the MPD in building successful structures and processes. Supporting nursing excellence such as an online learning needs assessment, nursing certification preparation courses, and BSN forecasting tools to project advancements in educational levels was created. In addition, new and innovative tools have been developed to assist hospitals on their journey. One of these tools, the Magnet Metric Report (Supplemental Digital Content 2, http://links.lww.com/JONA/A928), provides quarterly updates to each inpatient and ambulatory setting by category: quality outcomes, patient experience, nursing satisfaction, BSN rates, and certifications on a 1-page report card. The Magnet project analyst, who works with the MPD is responsible for producing this form. The MPD provides the completed metric tool to all nursing leadership, including departmental managers, as a stacking report to rank each department for all categories. The most recent metric tool is accessible to all MPDs in an online location on a shared platform. A color-coding automated system allowed for visual representation of areas of strengths and opportunities. The automated color-coding system displays departmental outperformance as well as opportunities for improvement. Green areas were considered areas of strength and outperformance of the category, and the ones not meeting national benchmarks were left white. Through shared decision-making, the MPD Council voted to use the color white for not successfully outperforming versus the traditional red color to not appear punitive. This tool is available to all hospitals in the system for use and has been successful for tracking areas of focus. The information captured aids the MPDs to identify areas of need and implement tactics to increase or decrease metrics to exceed national benchmarks. The MPD Council facilitates the sharing of interventions to address areas of opportunity and decrease rework by the MPDs. System-wide innovations, such as the Magnet Metric Report, have proven to be a successful tool in building nursing excellence.
Results
The MPD Council has been a source of unifying the team, standardizing the work, avoiding duplication or repetition, and disseminating best practices internally and externally. Annual goals for the system in the system strategic plan align with initiatives and opportunities identified by the MPD Council. Council tactics including consistent data collection methods for national benchmarking quality metrics, reporting templates, dissemination of best practices, and use of prediction models have been implemented. On a larger scale, a process for determining Magnet readiness and pre-site visit preparations has also been developed and implemented. Since the inception of the council in 2010, 27 hospitals have been added to the council, and 20 new MPDs have been oriented to the role. Initially, the hospital system had 2 Magnet-designated hospitals when the MPD Council was created. Today, 10 hospitals within the enterprise are Magnet designated with 7 redesignated at least once. Currently, there are 11 hospitals on the journey to Magnet and 10 seeking designation in ANCC Pathway to Excellence(R).
Conclusion
The development of a centralized MPD Council by larger hospital systems has proven to be an effective way to develop novice MPDs, as well as support increasing the number of Magnet-designated hospitals. Collaborative connections, the development of an MPD residency, and the dissemination of innovative metric reports have provided a solid foundation to develop hospitals and MPDs from novices to experts.1 Experiences shared on the journey to initial Magnet designation or Magnet redesignation facilitate mutual MPD learning and collaboration in other areas as well. The MPDs on the Council have enhanced the knowledge and resources of their hospitals in improving empirical outcomes, as well as supporting a more uniform system-level culture of nursing excellence.
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