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HealthNovember 10, 2021

Redesignation as Magnet® status — CNO’s perspectives on maintaining the Magnet standards

By: Sarah Handzel, BSN, RN
While most CNOs agree that simply achieving the designation is a difficult task, they also agree that maintaining Magnet® status can be just as challenging.

In a first-of-its-kind study, researchers interviewed 14 CNOs who were part of organizations that had successfully achieved at least one Magnet redesignation. The results were recently published in JONA: Journal of Nursing Administration.

Literature review points to key redesignation factors

In hospitals around the country, efforts to achieve Magnet redesignation focus on several important issues:

  • Implementing programs to develop a culture of safety for improved patient outcomes
  • Leveraging a strategic plan inclusive of nursing leadership, practice, education, research, role clarity, and culture
  • Restructuring nursing leadership teams to promote a culture of professional nursing practice
  • Streamlining the transition of CNOs during Magnet redesignation
  • Using a continuous improvement framework rooted in building positivity

However, to date there have been no published studies focused on what type of hospital infrastructure is needed to achieve Magnet redesignation. For this study, researchers collected data on redesignation through telephone interviews with 14 CNOs representing a variety of hospital systems.

The study participants had an average of 27 years’ experience in nursing leadership. The average number of years as a nurse leader in their current organization was 19.

Interviews identify six themes necessary for Magnet redesignation

Six core themes emerged as being necessary for Magnet redesignation, with many other subthemes identified for each.

1. Keep the Magnet flames burning

CNOs reported it was of primary importance to stay on top of Magnet status by taking steps to be proactive and never stop working toward the designation’s standards. They acknowledged that strong leadership was necessary to keeping Magnet status, and that it was very important to create a culture of continuous learning and growing.

For leaders, it was also important to remain hands-on within the organization. Study participants noted that this could be achieved by keeping lines of communication open and clear with medical staff, executives, and the Board, keeping all nursing staff engaged and a part of conversations, and identifying and addressing gaps in practice leading to innovation and change.

2. Honor the nursing voice

The CNOs unanimously indicated that shared governance was the most important factor in their organization’s initial Magnet designation. This trend continued throughout the redesignation process, with bedside nurses continuously involved in organizational decision-making. Additionally, promoting staff ownership, responsibility, and accountability for Magnet redesignation was flagged as an important component of any redesignation effort.

3. Monitoring and constant vigilance of the environment

Among other issues, awareness of all external regulatory requirements was crucial to Magnet redesignation. This included weeding out older Magnet standards which did not keep up with current recommended practices.

Budget and cost issues and slippage were also identified as chief concerns among CNOs. One CNO mentioned it was important to prevent “shifting quality work to others without adequate knowledge base”. When these actions occur, it points to slippage in enthusiasm for Magnet redesignation.

4. Cultivating teamwork to sustain success

While some CNOs reported multidisciplinary teamwork as an existing component of their organizations, others pointed to efforts undertaken to improve collaboration before redesignation could be possible. These included:

  • Driving practice changes
  • Lifting the entire organization through collaboration
  • Sharing best practices

5. Using the redesignation “secret sauce”

Successful redesignation also depended on two factors related to organizational governance:

  • Ensuring CNS alignment with Magnet strategies
  • Garnering CEO and Board support

Magnet redesignation simply was not possible without the support of top-level leadership.

6. Inspiring and mentoring the Magnet Project Director way

The participating CNOs also pointed to the importance of the organization’s Magnet Project Director (MPD) knowing Magnet standards inside and out. Additionally, reinvigorating the organizational culture and maintaining strong relationships between CNOs and MPDs were viewed as vital to forming a cohesive organization and plan for achieving Magnet redesignation.

All six themes supported the need to focus and maintain an awareness of all the components of Magnet designation, even after the initial designation has been achieved. In the future, it may be necessary to examine the organizational changes and processes that contributed to unsuccessful redesignation as a way to better understand what works and what doesn’t.

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Sarah Handzel, BSN, RN
Freelance Health and Medical Content Writer, Wolters Kluwer Health
Sarah has over nine years’ experience in various clinical areas, including surgery, endocrinology, family practice, and pharmaceuticals. She began writing professionally in 2016 as a way to use her medical knowledge beyond the bedside to help educate and inform healthcare consumers and providers.
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