Via Christi is embarking on a multiyear effort to achieve magnet designation by the American Nurses Credentialing Center, the highest international recognition for nursing excellence, starting in Wichita.
The effort is one component of the health system’s strategic plan. And the focus this year will be to lay the foundation, said Linda Goodwin, chief nursing officer for Via Christi Health.
“The magnet journey is not a nursing journey but an organizational journey, and it’s about all of us working together as a team focusing on those aspects high-quality care, safe care, high-quality service,” Goodwin said.
“The other part of that is it’s a journey for professionalism of nurses. And it is the ability for a nurse to actualize their dream of working in an organization that’s patient-centered.”
Via Christi Health employs more than 2,400 registered nurses in Kansas. About 1,600 of them are in Wichita.
The ultimate goal is to achieve magnet status in Wichita by 2018, Goodwin said.
Over the next two months, Via Christi will have consultants evaluate its five Wichita hospitals to help determine whether each hospital is ready to pursue magnet status, whether it should consider a simpler AANC credentialing program called Pathways to Excellence or whether the hospital isn’t ready for either.
The ANCC’s magnet recognition model includes five components: transformational leadership, structural empowerment, exemplary professional practice, empirical quality outcomes and new knowledge, innovations and improvements.
Via Christi is working on implementing those components into its structure and procedures and will have to document the process as part of its application.
It will also have to collect empirical data on outcomes for two years before it can apply for the credentials.
The ANCC will then send a surveyor to conduct interviews with staff members.
“The purpose is to prove we’re living it and can demonstrate that,” Goodwin said.
The cost of the credentialing for magnet designation varies by hospital size, from $13,750 for a 100-licensed-bed facility to $54,350 for a hospital with 750 to 949 licensed beds. There are also fees for the primary application, documentation review and the onsite visit, according to the AANC website.
Over the next two years, Via Christi wants to expand the model to its hospitals outside Wichita.
“That’s kind of the fun part,” Goodwin said. “You learn from the process, then improve that process as you move on. Every environment has different challenges, so you adapt that process to the environment. What Mercy might need to focus on in Manhattan may be different than St. Teresa (in Wichita).”
According to the ANCC website, Stormont-Vail Healthcare in Topeka and the University of Kansas Hospital in Kansas City are the only two magnet hospitals in the state. There are no Pathway to Excellence organizations in Kansas.
Among the five magnet recognition components is “structural empowerment.”
Last year, Via Christi Hospitals Wichita started implementing “shared decision making” across departments in an effort to involve staff members from all levels in making policy and practice decisions.
The restructuring has led to the creation of several councils that focus on areas such as professional development, operations, quality and safety, nurse practice and informatics.
“A lot of the areas we’ve been working on are improving patient safety and satisfaction,” said Evelyn Mierau, a registered nurse at Via Christi Hospital on Harry’s Neonatal Intensive Care Unit.
“But in our unit, it’s not just patient satisfaction, it’s more family than patient, and sometimes the nurse gets caught in a quandary of what’s best for the baby may not be best for the family,” Mierau said.
“One of the things we’re trying to do as a unit is standardize yet make it individual, but make it so everybody is saying the same things to everybody, which involves some protocols.”
Mierau, who has been practicing in the unit for 23 1/2 years and has been a nurse since 1975, is part of the hospital’s pharmacy and nursing committee and thinks that the pursuit of magnet status will help improve communication.
“One of the feelings nurses have often in the past is that we have things that are important for you to know, but nobody wants to listen,” Mierau said. “And when you work toward a more shared governance model, we’re being listened to. … It’s been a hard transition for a lot of nurses who aren’t sure we’re going to be heard, so you have a lot of people who are reluctant, but then there’s people like me who just jump right in.”
Goodwin says that shared decision making also includes communication with patients and their families, which is demonstrated in hourly rounds with patients. Executives like Goodwin also perform rounds and have been doing that for the past year and a half.
One desired result of the restructuring is empowering nurses in the workplace, Goodwin said.
“Nurses who are engaged like that are engaged in the patient, so there’s more ownership of activities,” Mierau said. “So if I make an error, I have to own up to it.”
The hospitals are also starting to collect data to measure quality improvement over time and will present that data as part of the credentialing process.
Recruitment and retention
One element the ANCC considers in credentialing is turnover, vacancy rates and percentage of nurses working toward higher education, such as getting a bachelor’s degree.
Via Christi was a clinical site for more than 300 Bachelor of Science nursing students in the spring of 2012, according to its nursing annual report. By 2016, Via Christi will require all nursing directors to have master’s degrees and nurses in supervising roles must be in the process of attaining bachelor’s degrees, the report says. Via Christi offers tuition assistance for nurses who want to pursue higher education.
But increasing nursing education requirements could present challenges, Goodwin said.
“As nurses age and baby boomer nurses retire, we’re going to have a nursing shortage. Although our desire is to have the majority of our nurses obtain their bachelor’s degrees, I’m not sure we can ever realistically require that to be the initial presenting degree here because of the shortage.”
Goodwin said hospital officials are in discussions with other entities in Wichita, including schools, about what the Institute of Medicine’s goal of having 80 percent of nurses with bachelor’s degrees would mean for Wichita.
“Our associate degree programs locally produce good nurses,” Goodwin said. “We’re going to continue hiring associate degreed nurses, but we’re looking at whether we should require they get their bachelor’s in X amount of time.”
The magnet designation itself could help with recruitment and retention rates.
“That is why we chose the journey for magnet, because it’s all focused on the end result of benefitting along that journey and attracting and retaining top talent, and that happens when people align with organizations that focus on highly reliable care and high-quality care and very high standards of practice,” Goodwin said.