A Cleveland Clinic Hospital on What It Takes To Earn Magnet Recognition

Cleveland Clinic Lutheran Hospital is on the journey

When Janet Schuster, DNP, MBA, RN, NEA-BC, CPHQ, HACP, Chief Nursing Officer at Cleveland Clinic Lutheran Hospital, learned in December 2018 that her staff was applying for Magnet® status, she was both excited and apprehensive.

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Only about 10% of hospitals in the United States have Magnet status awarded by the American Nurses Credentialing Center (ANCC). The credential is a sign of nursing excellence and requires that hospitals satisfy a set of criteria designed to measure the strength and quality of their nursing program.

“It’s a big undertaking,” says Schuster. “We’re a small hospital. We have 100 inpatient psychiatric beds and 100 medical-surgical beds.” Hospitals that earn the Magnet credential are superior in that they have a culture of safety and high quality that translates into better outcomes. For example, in a 2010 study, Magnet-designated hospitals had a 10.3% lower fall rate than non-Magnet hospitals. Since each patient fall costs hospitals an estimated $35,000, in this example, lower fall rates were associated with costs savings. In the same study, authors found Magnet hospitals had significantly better outcomes for patient mortality, nurse safety, nurse burnout and patient satisfaction.1

The process

Applying for Magnet status takes a team of nurses months of hard work that requires evidence of excellence in nurse satisfaction, patient satisfaction and clinical outcomes, such as two years of data showing low rates of patient falls and hospital-acquired pressure ulcers.

The process begins with the submission of an electronic application. Next, the applicant submits written documentation that demonstrates qualitative and quantitative evidence regarding patient care and outcomes. If scores from the written documentation fall within a range of excellence, ANCC representatives schedule an on-site visit to thoroughly assess the applicant. After this rigorous review, the Commission on Magnet analyzes the completed appraisal report and votes to determine whether Magnet recognition will be granted.

Having good outcomes alone is not enough, says Sheila Miller, DNP, MBA, RN, NEA-BC, Chief Nursing Officer for Cleveland Clinic Akron General. Until recently, Miller was the Chief Nursing Officer for Cleveland Clinic South Pointe Hospital, which received its first Magnet designation a little more than a year ago.

“As you work through the process of achieving Magnet status, you’re looking at having the right environment and the right outcomes,” she says. “Everyone does a gap analysis to see if they are not meeting certain standards, but it’s really so much more. You need to have a professional nursing practice that demonstrates good outcomes.”

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Stories of excellence

Documentation for the Magnet process is broken down into four categories: transformational leadership, structural empowerment, exemplary professional practice, and new knowledge, innovation and improvements. Within those categories, the team must include a description of the organization, the settings in which registered nurses practice, actions taken by nurses to support patient care, research projects, and the CNO’s job description and resume.

At Lutheran Hospital, in order to illustrate exemplary professional practice, Schuster and her team will include a recently created narrative describing how nurses developed a multidisciplinary treatment plan for a psychiatric patient with acuphagia — a rare disorder that causes the sufferer to eat sharp objects.

To illustrate transformational leadership, they’ll describe how a nursing director came up with the idea of having a nursing caregiver go to each unit to support coverage so that the nursing staff could take lunch and other breaks. They will also explain how the nursing units gave up a portion of their budgeted direct hours in small increments to pay for this additional position.

And to illustrate structural empowerment, they’ll write about the hospital’s shared governance committee, where nurses are involved in decision-making and feel comfortable bringing forth ideas to improve care.

“We have teams that are very active in writing these stories or in reminding the writing team of the many activities and outcomes previously achieved,” says Schuster. “I have a Magnet ambassador for each area. That’s how we’re building excitement for this from the top down.”

Greater emphasis on research

In its most recent evaluation of Cleveland Clinic main campus, ANCC officials noted it will be elevating nursing-led research as a necessary component of Magnet to promote new knowledge, innovation and improvements. “The idea is to get nurses at all levels of the organization involved in research for the betterment of patient care,” says K. Kelly Hancock, DNP, RN, NE-BC, Executive Chief Nursing Officer for Cleveland Clinic health system, and Chief Nursing Officer for Cleveland Clinic main campus.

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Cleveland Clinic already has a robust nursing-led research program. Five nurse scientists with PhDs serve as mentors to nurses interested in research, and the mentor team is supported by resources that include a budget for educating nurses, statistical analysis, internal grants for literature review of current evidence, nurse-led research and writing for publication.

“Typically nurses come to us with an idea or a clinical problem,” says Sandra Siedlecki, PhD, RN, CNS, senior nurse scientist, Office of Nursing Research and Innovation. “We help them understand the issue and brainstorm with them to arrive at a focused question that can be addressed through research.”

The team at Lutheran Hospital found that the area of research was lacking and contacted the Office of Nursing Research and Innovation. Soon they had two studies in the works — one on psychiatric patient acuity, measuring the intensity of nursing care required by a psychiatric patient, and a second examining the effect of postoperative laxatives on constipation.

“With that piece of the puzzle in place,” Schuster says, “I’m confident that we’ll have the application in by October 2020.”

1Lake ET, Shang J, Klaus S, Dunton NE. Patient falls: Association with hospital Magnet status and nursing unit staffing. Res Nurs Health. 2010;33(5):413-25. doi: 10.1002/nur.20399.