The History of Magnet™ at CKHS: 15 Years of Evolution and Growth
When the American Nurses Credentialing Center Magnet Recognition Program® was in its infancy in the early 1990s, early forms of shared governance were already in evidence at the hospitals that would become the Crozer-Keystone Health System. Over the past 15 years, each CKHS hospital has implemented the Magnet™ philosophy in a variety of ways and, in doing so, laid a foundation for Crozer-Keystone’s official Journey to Magnet Designation®.
The earliest efforts began at Crozer-Chester Medical Center, where a Nurse Practice Council was established in 1993. In the beginning, it was the only nurse-driven committee with representation from each nursing unit. The council addressed a broad range of issues involving the nursing work environment. As it evolved over time, the council’s focus shifted solely to practice issues faced daily by the nurses and the hospital. More recently David Bullen, RN, and Sue Anne Machemer, RN, led council members in researching the concept of shared governance, sharing their findings with all nursing units and the hospital. Ultimately, the Practice Council’s efforts led to the formation of other key councils: Quality, Education, Executive and Unit Based Councils.
Taylor Hospital began adopting the shared governance concept six years ago under the leadership of Janice Perry, RN, who then served as Assistant Vice President of Patient Services. Shared governance and empowerment were part of the Professional Nursing Model being introduced by national nursing societies at that time. Taylor’s nursing leadership discussed the concept with union leadership and held educational conferences for the nursing staff who were intrigued by the idea of bringing decision making to the unit level.
In 2003, Taylor implemented a Nurse Practice Council as well as self-scheduling committees on each nursing unit. Peer accountability was also brought to the table. “We developed our own internal bylaws for the Nurse Practice Council under the guidance of Janice Perry and Sue Mingis, RN,” says Nancy Politarhos, RN, assistant vice president of Patient Services at Taylor. “Our bylaws turned out to be very similar to the official Magnet guidelines published later.”
In the same year, Taylor’s Emergency Department established the hospital’s first unit council under the leadership of Pat Eckenrode, RN, Emergency Department nurse manager. “The ED has really led our charge and we’ve seen really good results,” notes Politarhos. “Recruitment and retention in the ED has improved, employee satisfaction has been enhanced and we are beginning to see patient satisfaction increase as a result of the staff being at the forefront of decision making and buying into the improvements. The staff is part of the solution.”
The ED’s successful results encouraged nurses in other Taylor units to jump in and start their own unit councils. Once again, their structure and bylaws mimicked many of the formal Forces of Magnetism that were later published.
At Delaware County Memorial Hospital, the nursing leadership began to observe how other hospitals practice shared governance in 2004. “We valued our nurses and felt we had a strong Department of Nursing,” says Jerri LaRocco, RN, MSN, NEA-BC, assistant vice president for Patient Services at DCMH. “When we looked at other healthcare institutions, we felt just as qualified to pursue Magnet.”
Jo-Zetta Shawl, RN, MHA, NEA-BC, director of Nursing and Clinical Support Services at Springfield Hospital, agrees. “In many respects, our nursing staff at Springfield Hospital already possesses the attributes of Magnet,” she says. “Our nurses have always embraced the Magnet philosophy. They see it as a benefit for our patient care as well as the professional practice of nursing.”
In 2005, DCMH decided to explore the Magnet Recognition Program and begin a self-assessment to determine what it would take for DCMH to achieve Magnet status. At the time, DCMH had a nursing group that met every two months to develop a shared governance model. DCMH nurses also participated regularly in Policy and Procedure meetings, conducted by nurse educators. However, these meetings were very top down directed with nursing administrators determining the agenda as well as the best way to implement or update policies and practices.
When Nancy Bucher, RN, MSN, NEA-BC, was named Vice President and Chief Nursing Officer for Crozer-Keystone in 2004, she recognized that there was a high level of nurse dissatisfaction with the old paradigm of top-down driven nursing practice. Bucher is a strong believer in the concept that job satisfaction among nurses translates into good patient care and positive outcomes. She was also strongly influenced by two of Jim Collins’ books, Built to Last and Good to Great. Both books demonstrate that engaged employees make successful organizations. Bucher was also energized by listening to other chief nurses who spoke of implementing shared governance and the positive impact it had on both patient care and nurse satisfaction. “It all comes down to professional nurses being engaged in the work they do, buying into the mission and having some decision making capability. People want to be the masters of their own fate when it comes to their profession.”
Bucher was also impressed by the way the CKHS medical staff functioned. “They do everything collaboratively with administration, but basically govern themselves,” she notes. “I wanted to pursue some level of that for nursing because I thought it would be a real positive for the nurses.”
Bucher met with the nurse executives from each CKHS hospital to discuss the idea of pursuing Magnet designation. They, in turn, introduced the idea to their respective practice councils and provided education about it. At Crozer, Bucher also spoke with Frank Glatts, RN, chief shop steward for the nurses’ union.
“Frank became very interested in Magnet, researched it and wrote an article about what’s in it for the nurses, which appeared in the union newsletter,” she relates. “His article really helped the nurses understand that this is a positive change that will bring them real advantages.”
Early in 2006, nurse leaders from all CKHS hospitals attended a Magnet conference conducted by Lancaster General Hospital, whose nursing staff had already achieved Magnet Recognition. “We learned how they had developed their unit councils and turned specific functions over to their staff very successfully,” recalls LaRocco. “The success of Lancaster’s unit councils motivated us, and served as a real impetus to move forward with our Magnet efforts. It didn’t happen overnight and it didn’t happen in all units right away, but unit councils began to form at DCMH.”
“The Magnet conference presented by Lancaster General was a real fire starter for the whole system,” adds Politarhos. “Even though we had already embraced the concept of shared governance, this was a great motivator to keep pushing forward.”
After the conference, each hospital started a quality council and education council as well as unit councils. All councils began transferring leadership to staff nurses. “We provided them with courses on meeting development, project management, professional writing – all the things they would need to lead a group of people to reach a common goal,” relates Bucher. Each of the practice councils then elected a leader from their ranks to serve as chair, and the nurse manager stepped into the background as a facilitator.
Springfield Hospital found it beneficial to partner with Crozer’s Practice, Quality and Education councils, but started their own unit councils to address the unique nursing management issues they face as a smaller hospital with a different structure. In addition, Springfield nurses joined their CKHS colleagues in participating at Magnet conferences held in 2007 and 2008.
Crozer-Keystone nurse leaders also developed a system-wide nursing research committee. “This enabled us to begin self educating about research, decide what studies to conduct and mentor people to do the work,” says Bucher. Support was provided by several professors at Widener University, including Janice Reilly, RN. Betty Mariani, RN, PhD, and John Harper, RN, MSN, also helped move the research committee forward. Michelle Ciafre, RN, a Crozer staff nurse with a clinical research background, became co-chair of the committee which now has subcommittees in each hospital.
At the same time, CKHS began a gap analysis related to the 14 Forces of Magnetism which will be completed by the end of this fiscal year.
In 2007, Executive Councils were created composed of key nursing leaders and staff nurses who were serving as chairs of each council. The CKHS Center for Nursing Excellence was opened and Zanet Lester, RN, BSN, MSHA, was appointed coordinator.
Pursuing Magnet Recognition®
In January of 2008 a Nursing Leadership Retreat was held with system wide nursing leadership, including all nursing council chairs in attendance. The nursing councils have written or reviewed their bylaws, reviewed policies and standards of care and engaged in many new initiatives. The Nurse Practice Council chairs from across the system are working with CKHS senior nursing leadership to develop one standardized Nursing Practice Manual to be used by all system hospitals, an initiative that will enhance patient safety. The system-wide RN practice survey has been conducted, and the process of assembling Magnet documents has begun with the expectation of submitting the final application in 2010.
“Pursing Magnet Recognition as a system will enhance nursing at all Crozer-Keystone hospitals as we share our resources and best practices,” says Bucher. “We all benefit by supporting each other as we pursue this vital goal together.”