In 2008, it became clear to the Magnet(R) Commission that the next generation of the Magnet model had to focus on outcomes. Although structure and process were necessary elements of nursing excellence, the link to evidence-based practice (EBP) and outcomes was increasingly becoming essential to nursing practice. The Magnet model component of new knowledge, innovation, and improvements challenges organizations and their leadership to develop a culture encouraging inquiry, question the status quo, and focus on finding solutions to questions and problems. The sources of evidence for this component are organized in 3 elements: research, EBP, and innovation. These requirements serve as a foundation for advancing the practice of nursing and delivery of healthcare in all settings. They are also among the most challenging sources of evidence to integrate into nursing practice.
Differentiating among research, quality improvement, and EBP is often a puzzle for clinical nurses who may or may not have been formally educated in their prelicensure programs about nursing research and theory. It is incumbent on the nursing leadership team to ensure that the whole organization understands the vision for moving to an EBP environment. The leadership has an obligation to help each clinician understand his/her unique and vital role in transforming the practice environment, engaging the nurses to practice at the highest level possible. Evidence-based practice is the "conscious use of and integration of the best research evidence with clinical expertise and patient preferences in nursing practice."1(p76) Knowing what questions to ask and where to find the answers and translating the findings to clinical care are integral to professional nursing. Organizational leaders must begin the cultural transformation by encouraging nurses at all levels to ask the questions of what and why about their clinical practice. By encouraging nurses to ask those 2 questions, the culture supports the process of exploring the foundation of decisions, policies, procedures, and nursing practices. The culture develops a science-to-service model of engagement, enhances the use of critical thinking, and applies research-based evidence to deliver quality and cost-effective care.1(p76) Taking those first steps toward inquiry means that nurse leaders need to create the spaces for the questions to be generated. Providing the resources, from librarians to advanced practice nurse consultants, is a key responsibility of the nursing leadership team.
Creating new knowledge is also a responsibility of professional nurses in the practice arena. This can be such an exciting process! Research, the second element of the Magnet model component new knowledge, innovation, and improvements, is defined as "a systematic inquiry that uses disciplined methods to answer questions to solve problems."1(p76) The ultimate goal of nursing research is to develop, refine, and expand the body of nursing knowledge. Although many nursing practice questions can be answered through systematic review of the current literature, there are often gaps in the science and formal research is necessary. There are research activities in every hospital that all nurses can participate in. As the organizations' nursing research infrastructure is being built, it is important to incorporate advanced practice nurses and educators. Their educational preparation and roles are suited to assist in the development and participation in research and EBP. It is important to actively encourage staff nurses to become involved in the research process, beyond the data collection phase. Strategies such as unit-based journal clubs, research conferences on site, inservice, and continuing education about the research process all help to engage nurses. These activities help to expand the clinical nurses' knowledge and encourage the development of future research questions. Staff nurses can also be included in discussions about research design, methods of outcomes evaluation, and how to appropriately read research articles. Sharing the results of the studies that they participated in is essential so that they can see the results of their participation and their role in creating new knowledge. Knowledge obtained though performing nursing research should be shared with others in the nursing community, through presentations, posters, and publications. Magnet organizations serve to improve the quality of care provided in all organizations by sharing best practices and new knowledge.
The Magnet roadmap is based on a fundamental belief in new and creative ways of doing things, solving problems, and planning for the future. Innovation is the final element of this model component. Organizations that encourage innovation stimulate the exploration of new and creative ideas, encouraging nurses at all levels to challenge the status quo. Innovative thinking is directed at improving outcomes, efficiency, and cost effectiveness. Intentionally involving nurses at all levels of the organization in the process of innovation develops a culture focused on shaping the future of healthcare. An innovative culture is willing to take calculated risks, knowing that not all ideas will be 100% successful. To assist organizations in developing a culture of innovation, a number of tools and resources are available from the Magnet Learning Communities Web site (http://www.magnetlearningcommunity.org), an Internet-based collaboration for nurses engaged in improving patient care outcomes and excellence in nursing practice. It includes discussions and learning through the sharing of exemplars and outcomes from Magnet-designated facilities, moderated discussions with industry experts, webinars, and current research findings.
The future of healthcare delivery is being designed and tested today. Magnet organizations are leading the efforts, seeking evidence to base their practice and using research as part of standard problem-solving methodologies. Innovations in patient care, nursing, and the practice environment are the hallmark of organizations receiving Magnet recognition. Being innovative and willing to change is not always comfortable, but it is invigorating and makes the work so rewarding. Establishing new ways of achieving high-quality, effective, and efficient care is the outcome of transformational leadership, empowering structures and processes, and exemplary professional practice in nursing.
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