In one Magnet-recognized tertiary medical center, a medical-surgical telemetry step-down unit has used the lessons learned through the Magnet accreditation process to improve care team collaboration, promote positive patient outcomes, and develop life-saving treatments for those with COVID-19. An article in the December 2021 issue of Nursing Management details how nurses in this unit used Magnet principles to help them navigate through the uncertainty of providing care during the global pandemic.
Magnet culture is characterized by several deeply engrained principles, including:
- Transformational leadership
- Structural empowerment
- Exemplary professional practice
- New knowledge, innovation, and improvements
- Empirical outcomes
Throughout the nursing unit, managers, frontline nurse leaders, and other clinical staff members helped identify these principles in action. Then, they were used to direct the unit’s response to the wave of COVID-19 positive patients.
Transformational leadership
The Magnet model of healthcare designates a transformational leader as one who leads others to where they need to be in order to meet the demands of the future. In response to the pandemic, nurse leaders on the med/surg unit moved to 24/7 operations to ensure leadership availability and visibility at all times. Nurse leaders could immediately respond to any communications from the hospital’s pandemic command center, and, in turn, give feedback to decision makers from nurses directly on the front lines.
These enhanced communication efforts were essential for maintaining the unit’s culture of clinical excellence. It also helped facilitate operations on the unit by focusing on shared decision-making, upholding professional accountability and providing a structure that supported autonomy among nursing staff. This was achieved through the use of huddles, written updates to policies, and transparency in communication regarding the state of the hospital’s COVID-19 response.
Structural empowerment
Leaders on the unit helped nurses become more empowered using a variety of structures and programs. Instead of a one-size-fits-all approach to empowerment, nurse leaders engaged each team member and treated each patient as an individual while also learning about COVID-19. As a result, nurse-to-patient ratios were reduced to 3:1, agency nurses were hired to help when staff were infected with the virus, and care partners were called in to assist with COVID-19 patients in isolation.
During this process, the core nursing team built stronger, more meaningful connections among themselves by participating in daily check-ins. At these meetings, nurses were encouraged to share their thoughts and fears. Additionally, frontline nurse leaders guided staff nurses in choosing which hospital-wide committee to participate in, as mandated by the hospital.
As a result, frontline nurses developed and completed two important initiatives:
- Humanizing care for patients in isolation
- Self-proning and incentive spirometry to reduce hypoxia with COVID-19 pneumonia
Exemplary professional practice
Leaders kept team members focused on exemplary professional practice to ensure the quality of care provided and the safety of the patients remained top priority. To meet these goals, unit leadership ensured each nurse participated in interdisciplinary teams, committees, and activities required for clinical advancement.
New knowledge, innovation, and improvements
The uncertainty of COVID-19, together with supply chain issues and changing recommendations from top healthcare organizations, pushed all members of the medical community to develop new treatments and interventions for patients. As a result, nurse leaders on the COVID-19 unit had to be adaptive, flexible, and resilient.
Additionally, staff nurses on the unit were directly involved in creating nurse-driven proning protocols. They also partnered with research teams to provide emergency use authorization treatments and clinical trials. As a result, the team was able to develop a COVID-19 best practices bundle which included a medical-surgical patient care protocol and a proning protocol.
The unit also adopted the use of virtual family visitation for COVID-19 patients in isolation. Nurses acted as a proxy for family members who wanted to be in contact with hospitalized loved ones. Smartphone and tablet technologies helped family members stay in communication with patients.
Empirical outcomes
Nurse leaders also maintained accountability for patient outcomes throughout the course of the pandemic. They used emerging evidence to adapt professional practices to help manage the spread of COVID-19 on the unit. Senior nursing leaders acted as extended resources and helped other nurses avoid extreme fatigue and burnout to the fullest extent possible.
Strong leadership and shared decision-making fostered team unity and governance on the unit during a particularly stressful time. Thanks to Magnet principles, frontline nurse leaders helped other team members successfully navigate through the uncertainty of the COVID-19 pandemic.
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