The Value of Attaining Magnet Recognition, Research Paper Example

Problem Identification

Staff shortages, insufficient allocation of nursing staff, and the lack of control over professional development of hospital employees can negatively affect health care delivery.  Recent resource shortage problems have created a great challenge for DNP nurses to redesign health care delivery processes, empower talent, and allocate staff in a way that the quality of care is improved. One of the quality improvement initiatives based on evidence-based practice is Magnet. In order to obtain a Magnet recognition from the American Nurses Credentialing Center, a hospital needs to introduce evidence-based practices focusing on quality and safety, people and service delivery, as well as efficiency (Drenkard, 2010). Further, there are financial benefits associated with implementing reforms that lead to Magnet recognition. In a busy maternity care unit, it is important to implement evidence-based practice and provide professional development opportunities for nurses to fulfill multiple roles and become competent in delivering various health care interventions. The lack of qualified nurses available to carry out regular checks, measurements, immunization, providing advice for mothers for preventing infections can increase the risk of childbirth complications and reduce both service quality and efficiency. By implementing changes to achieve a Magnet recognition, the hospital can improve safety, financial performance, as well as health care delivery efficiency.

The main issues targeted by Magnet implementation in the next five years will be complications during and after childbirth. According to a recent study by the Health Care Cost and Utilization Project (Moore, Witt & Elixhauser, 2014), some of the most prevalent complications in maternity care are Preeclampsia originated from hypertension as a complicating condition, postpartum hemorrhage, and poor fetal growth. By increasing nurses’  competency to identify complicating conditions of expectant women, the risks associated with these health issues can be tackled. This will result in lower cost of care, shorter stay, and better health outcomes. Further, the Magnet implementation project will also focus on educating women about the benefits of natural birth over Cesarian section. According to Moore, Witt & Elixhauser (2014), complicating conditions were more prevalent among women who chose Cesarian section as a delivery option, and this increased their risk of further complication. Further, the study states that the mean hospital cost of vaginal delivery is $3400 per hospital stay, compared with $5,900 for Cesarian section.

Significance of the Issue

Leadership approaches focusing on empowerment of nurses and shared leadership are required to tackle the issue of high complication rates and related increased costs.  According to Barden, Griffin, Donahue & Fitzpatrick  (2011), shared leadership approach can help nursing leaders to contain the costs of health care delivery, retain nursing staff and talent, while improving the quality of patient care. In order to tackle the increasing shortage of qualified nurses, motivating employees and focusing on individual professional and career development goals is essential. Creating a clear mission and vision that is related to Magnet implementation, clearly stating the goals and objectives is also necessary. Further, a transformational leadership approach will be necessary to engage with stakeholders, empower followers, and increase the commitment of staff towards the project. Nurse autonomy and control needs to be maintained in order to build a strong network of collaboration within the unit, according to Weston (2010). This will increase job satisfaction and empower employees to improve their skills and gain further skill-sets necessary for identifying complicating conditions and design evidence based interventions to prevent prolonged stay, reduce risk of childbirth-related complications, and improve patient outcomes.

In order to implement transformational and shared leadership in the hospital’s maternity care unit, it is important to create clear guidelines and create a mission, assigning each task to project teams. Based on individual competencies of nurses, the project teams will be developed to analyze the related evidence-based practices and evaluate their effectiveness on service safety, quality, efficiency, and delivery. The DNP nurse would determine the direction of transformation, identify relevant evidence based practice, assigning each project team with the task of designing an implementation plan. There is also a need for the analysis of the hospital’s own records regarding average length of stay, number of complications, preventable infections, and measures in place that target the early identification of complicating conditions described above. Further, a patient maternity education plan needs to be designed to promote natural childbirth as a primary option among expectant women. As infections were found to be more prevalent among women who opted for Cesarian childbirth, this program could deliver a reduction of complications within the unit, and cost savings as well. This will free up funds for nurses’ further training related to evidence-based practice research, patient-centered care, and methods to identify risks of complications. This, in turn, will result in higher overall efficiency of the entire unit and better patient outcomes. Academic research needs to be implemented in the individual professional development plan of nurses working in the unit, in order to empower them to carry out the evaluation of evidence based practice related literature and design interventions that lead to the unit’s Magnet accreditation in a period of five years. Further, financial planning is also needed in order to ensure that extra training is funded, and the return on investment needs to be calculated. Based on the literature research, a detailed plan can be drawn up for each aspect of health care delivery, risk reduction, and cost containment, with clear goals identified by percentages and figures. The below literature review will focus on identifying some of the measures related to health care delivery improvement that can support Magnet accreditation.

Literature Review

Hughes & Lundmark (2008) reviewed the impact of Magnet environments on nursing practices. According to the authors (Hughes & Lundmark, 2008. p. 3-69), apart from preventing illnesses and caring for the ill, nurses also need to “maintain and manage the environment surrounding the delivery of care, which has increasingly involved coordinating the care activities provided by other health care providers”. Therefore, organization is thought to be one of the most effective ways of improving health care system delivery. Activities related to maternity care and infant health should be coordinated in a manner that they are promoting patient-centered care. One important characteristic of Magnet hospitals, according to Hughes & Lundmark (2008) is a high retention rate of professionally trained nurses. Even during nursing shortages, Magnet hospitals seem to be attracting and retaining talent. In maternity care, high retention rate could positively influence the overall knowledge pool of nurses, and patient outcomes, while reducing the cost associated with training and development. The authors also mention the Keeping Patients Safe program that could be implemented in the selected practice. According to the guidelines detailed in the program outline, the environment should be adjusted in order to implement a successful change in service delivery while reducing patients’ risks.

Another issue highlighted by Barden et al. (2011) is the impact of nurses’ empowerment on the overall performance of the organization and the individual nursing unit. The main challenges that this approach can tackle are identified by the authors as “earlier discharge of patients, downsizing of the professional workforce, changes in staff mixes, restructuring of services, and decreased support services for patient care” (Barden et al., 2011, p. 212). Shared governance was found to have a positive impact on employee engagement, empowerment, skills development, and retention rates. According to the study, there is a direct positive correlation between nurses’ perception of shared governance and their level of empowerment. Further, it has also been found that there is a clear relationship between nurses’ empowerment and their access to information, training, development opportunities, and support. A DNP-designed intervention to increase employee satisfaction and involve nurses in the development of the program to make maternity care safer, more effective can, therefore, lead to a Magnet qualification. The main recommendation of the authors (Barden et al., 2011, p. 217) is that “Nursing leaders must continue to identify and sustain new strategies to empower nurses so that nurses can continue to be an integral component in the health care delivery team”.

The value of Magnet recognition in relation with service efficiency and patient outcomes was examined by Drenkard (2010). One of the most relevant findings of the author’s review is related to safety levels of hospitals. As Drenkard (2010, p. 50) confirms, quoting related statistics, “Magnet hospitals, on average, experience 7.1% fewer safety-related incidents and accidents than the industry norm”. Magnet facilities also had fewer complications following interventions, lower rates of mortality, and shorter stays. As it has been stated above, fewer complications and shorter stays can result not only in better patient outcomes, but also reduced costs of health care delivery. Magnet hospitals can save money in more than one way. First of all, improved nursing staff retention rates will translate to lower human resource related costs. Further, absenteeism is reduced as a result of higher employee engagement, and this also saves money for the hospital.

Winter’s  (2015) DNP dissertation, published this year provides a comprehensive overview of evidence based practice implementation methods. The author states that stakeholder engagement and partnership with patients is necessary to supplement research information when designing an evidence based intervention. For the maternity unit the author of the current study is focusing on, the health care delivery system needs to be reviewed in order to ensure that necessary checks are in place for identifying risks and intervening in time to prevent complications. Further, related to the issue of building a partnership with patients, it is important to note that a patient education plan focusing on promoting natural (vaginal) childbirth has to take into consideration the needs of patients and nurses’ experiences. This is the main reason why a shared leadership model needs to be applied. Without the experience of nurses providing care for patients and having direct contact with recipients of the service, as well as family members, the evidence-based practice will not be tailored to the needs of the population served, and will be plainly based on assumptions and research findings.

For empowering nurses to take part in the leadership, design evidence based, patient centered processes, and support the successful implementation of the initiatives, there is, however, a need for supporting their professional development and increasing their competencies. The author (Winter, 2015) highlights the importance of using the competency self-assessment model to identify gaps in current nurses’ knowledge and skills. This would help designing a training and professional development plan based on individual needs. By tailoring the training plan to individual needs, the leader would also be able to increase job satisfaction and employee engagement. By finding skills gaps, the DNP is able to design a plan that would serve the overall mission of the change project, and have a positive impact on the results.

A study carried out in the United Kingdom, created by Thomas and Dixon (2012) reviewed various strategies designed to increase patient safety in maternity care. The Safer Births project was found to improve training, leadership, service delivery, staffing, and included tools that supported nursing staff in identifying risks and potential complications. The majority of upskill training materials were delivered through computer-based courses, and this significantly reduced the cost associated with personal and professional development. Some of the most important tools introduced by the British study could easily be implemented in American hospitals’ maternity unit to reduce risks and improve patient outcomes. Early identification of complicating conditions and the creation of a framework focusing on relevant interventions could also improve the quality of care. As an example, the Continuous cardiotocography provided for patients who are at risk could ensure timely intervention. Providing nurses with a related course (PROMPT in Great Britain) could improve nursing staff’s preparedness to emergencies. Further, the distribution of maternity newsletters could create awareness of health risks and help promoting natural (vaginal) childbirth. Nurses could also be provided with an equipment checklist to make service delivery more effective. The Modified Early Obstetric Score (MEOWS in Great Britain) could help monitoring patients’ condition and identifying risks. The above recommendations based on the study by Thomas and Dixon (2012) could potentially improve both patient outcomes, health care delivery, and staff competency levels.

Role of DNP to Address the Problem

As a DNP, the leader needs to create a mission for introducing evidence-based and patient centered care and share it with the team. The mission needs to be based on shared values and missions, therefore, collaboration is necessary. In order to introduce shared leadership and transformational leadership approaches, the DNP will need to assign related tasks to multidisciplinary teams. The first step would be to review the current service delivery system and practices. A team would work on a service delivery framework improvement based on evidence obtained from research. The second step would be to evaluate the skills of nursing staff and identify knowledge gaps, as well as individual training needs. For this, the leader would initiate the creation of a competency assessment questionnaire. Nurses would be required to fill out the questionnaire and reflect on their own performance, as well as their competencies. The results of the research carried out in the unit would be used to create a comprehensive general training plan, as well as personalized professional development plans. A separate team would be assigned to carry out research for identifying relevant training, based on the initial recommendation and research of the DNP. Once the training needs are identified, individual schedules would be drawn up for each team member. A separate team would analyze the main risk areas and sources of prolonged stay, complications, and infections. Evidence from related research would be collected to choose relevant intervention methods to be implemented within the hospital.

The main leadership challenges related to the implementation of the project are related to human resources and finance. The financing of training and essential tools for improving patient monitoring and risk identification needs to be carefully planned and justified with return on investment analysis. While patient-nursing staff ratios can be maintained while introducing training in the team, it is also important to ensure that training is provided when sufficient cover is available. Further, resistance to change is likely to occur among older members of staff who believe that they are competent enough and have the relevant experience to deal with daily duties. Therefore, it is important to openly communicate the mission of the project and create a shared vision for implementation. For this, individual assessments and group collaborative projects are needed.  Low engagement with the goals would hinder the impact of the quality improvement project, therefore, it is necessary to distribute and share leadership. The four I-s of transformational leadership could also be applied to overcome resistance:  individualized consideration, intellectual stimulation, inspirational motivation, and idealized influence (Bass &Bass, 2008). Individualized consideration would help aligning the hospital’s goals (Magnet accreditation in five years, patient safety and service quality improvement) with the individual’s personal goals, such as professional development, career progression, or leadership opportunities. Intellectual stimulation would be delivered through training programs and training provided by nursing leaders based on the recommendations of the DNP. Further, participation in project teams would help team members identify their strengths and development areas. Inspirational motivation would be based on the shared vision communicated by the DNP towards the nursing team leader, and the members of the team. Sharing the vision is important for allowing followers to fully understand the different phases of change and their purpose. Idealized influence, on the other hand, would be creating a positive, supportive culture that is based on sharing knowledge, expertise, and experience, improving the overall performance of the entire team.

The main leadership skills needed to implement changes in the maternity care unit will be: empathy, strategic thinking, communication, collaboration, and analytical skills. In order to carry out a situational analysis within the hospital and identify the development areas, the DNP will need to use hospital health care systems to retrieve and analyze statistical data. Before setting targets for reducing the number of complications and prolonged stay, a snapshot of the current situation needs to be created. For this, the DNP will need to have relevant competency in health care systems and technology. In order to successfully plan and introduce a change strategy, the review of the current service delivery framework is needed, and this requires strategic thinking. To draw evidence from nurses’ experiences, communication and collaboration is necessary. To share the vision with followers, the DNP needs to have advanced communication skills. Finally, to understand the preferences of the main stakeholders (patients), the DNP will need to display a high level of empathy.

Key Stakeholder Identification

The key stakeholders of the hospital are identified as patients, staff, researchers, contractors, government agencies and regulators, and communities served. Patients’ perceptions and preferences can provide the leadership with relevant information for developing patient-centered care. Therefore, surveying patients and distributing health care satisfaction surveys would be recommended. Patient advocacy groups should also be involved in the process of introducing more effective interventions that result in better outcomes. Further, collaborating with patients and advocacy groups would help communicating the vision and building channels of sharing ideas related to risk prevention, health education, and other issues.

No hospital is able to function without highly trained, professional, and committed staff. The impact of implementing quality improvement programs and obtaining a Magnet recognition on staff retention and commitment to projects has already been discussed earlier in the current study. The main goal of the project teams created by the DNP is to increase employee commitment and engagement in order to improve the success rate of the intervention. Without implementing distributed leadership in the practice, staff could believe that decisions are made without them, and they would not fully understand why the changes are necessary. This would hinder nurses’ commitment to the change project.

Collaborating with researchers is also important, as they can provide support for selecting the most relevant interventions and analyzing data. Further, researchers’ involvement in change projects could help the DNP determine the performance measures and evaluate the results of the evidence based practice implementation. Collaboration with government agencies would also help the DNP nurse to identify priority areas defined by the CDC and the Health Agencies related to maternity care and diversity of patients. Community engagement is important to improve patient groups’ health competency and educate individuals about healthy lifestyle. This will result in lower rates of complicating conditions when patients are admitted to the hospital, and consequently better health outcomes. Finally, collaboration with contractors would help aligning values and visions and ensure efficient service delivery, reduction of supply shortages and delivery delays.

Development of Outcome Measures

In order to develop outcome measures to evaluate the results of the patient safety and health care delivery quality program, initial development areas need to be identified. The main focus of the improvement project will be reducing the number of complications, increasing the proportion of natural (vaginal) births, and reducing the risks of infections. Therefore, the outcome measures will be based around these main goals and targets. However, it is also important to note that staff training and development will be a crucial part of the project, and it will also be required for obtaining the Magnet accreditation, which is the end goal of the project that stretches over the next five year period. Therefore, after determining the short-term (12 months) and long-term (5 year) targets for the change project, a monitoring team needs to be created to record the progress based on the measures. The measures identified and discussed with researchers are as follows:

1. average length of stay per admission
2. number of complications per 100 patients
3. number of early interventions to prevent complications by identifying risk based on pre-existing conditions
4. percentage of natural births
5. staff competency based on self report and official assessments
6. costs associated with service delivery
7. staff retention rate
8. patient satisfaction survey results

The monitoring team would review statistical records within the hospital and create a report for the DNP quality improvement manager, who would assess the progress and initiate changes based on the results. The change initiatives will be passed to the implementation team that would redesign the service delivery framework to make the system more effective, delivering improved health outcomes for patients.

References

Barden, A. M., Griffin, M. T. Q., Donahue, M., & Fitzpatrick, J. J. (2011). Shared governance and empowerment in registered nurses working in a hospital setting. Nursing Administration Quarterly, 35(3), 212-218.

Drenkard, K. (2010). Going for the gold: The value of attaining Magnet recognition. American Nurse Today,5(3), 50-52.

Hughes, R. G., & Lundmark, V. A. (2008). Magnet environments for professional nursing practice. Retrieved from http://www.ncbi.nlm.nih.gov/books/NBK2667/

Moore, J. E., Witt, W. P., & Elixhauser, A. (2006:2011). Complicating conditions associated with childbirth, by delivery method and payer, 2011: Statistical Brief# 173.

Thomas, V. & Dixon, A. (2012) Improving safety in maternity services. A toolkit for teams. The King’s Fund. Retrieved from http://www.nhsla.com/safety

Weston, M. J. (2010). Strategies for enhancing autonomy and control over nursing practice. OJIN: The Online Journal of Issues in Nursing, 15(1), 13-19.

Winter, Peggi B., “Using a Strategic Model for Professional Development: The Importance of   Evidence-Based Competencies as a Foundation for Professional Practice.” (2015). Doctor of Nursing Practice (DNP) Projects. Paper 55.