1. Zimmermann, Deborah Tansey DNP, RN, NEA-BC, FAAN


Deborah Zimmermann, DNP, RN, Chair of the Commission on Magnet(R) Recognition, provides reflections regarding her 8 years on the Commission. Dr Zimmermann discusses how the standards have changed and how they have positively impacted nursing practice and patient outcomes.


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A privilege beyond compare best describes my 2 terms on the Commission on Magnet(R) Recognition. It has been an honor to serve with colleagues from around the world who, without ego, volunteer their time and generously share their expertise for the purpose of setting standards, driving excellence, and recognizing organizations that embody the Magnet vision. As my 8-year term comes to a close this month, I have reflected on not only the incredible experience this role has afforded me but also its impact on patient care and the practice of nursing globally.

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When I first joined the Commission, we were thrilled that 100 organizations had achieved Magnet designation, and enthusiasm for the program was growing. At the same time, there were critics. The Forces of Magnetism encompassed predominantly process and structure standards. In an emerging era of metric-driven, accountable care, there were no quantitative outcome requirements in the Magnet standards to ensure the presence of core excellence. Likewise, there was a dearth of benchmark data for comparative purposes. Thought leaders asked the Commission to quantify the contributions of nursing through performance metrics and create sources of evidence that measured the impact of nursing on the patient experience, the health of the practice environment, and clinical practice processes and outcomes.


Inspired by this challenge, in the summer of 2006, the Commission gathered for 2 days of intense work and, with the genius of Gail Wolf, PhD, RN, FAAN, outlined the framework for the current Magnet Model(R), which simplified the original 14 Forces of Magnetism into 5 components. In the 2008 Magnet Application Manual, performance measures were introduced with 25% of the sources of evidence requiring measurable outcomes. The standards were not perfect, but directionally, they were on course. Six years later, in 2014, the bar was once again raised, with 50% of the standards calling for measurable outcomes.


The Institute of Medicine's landmark report, The Future of Nursing: Leading Change, Advancing Health,1 propelled several new sources of evidence in the Magnet standards. Asking managers and directors to lead by example, the Commission required that 100% of nurse leaders hold a minimum of baccalaureate education in nursing and, in June 2013, required all organizations to devise an action plan with targets that demonstrate progression toward an 80% baccalaureate-prepared workforce by 2020.2 Leaders in Magnet organizations have risen to this challenge and embraced their role as change agents. The work on seamless academic progression in healthcare organizations and schools of nursing is well underway with new education models and partnerships flourishing throughout the country, evidenced by the rising number of nurses returning to school and completing a baccalaureate nursing degree.3


Since the nursing profession's inception, nurses have practiced in teams. Despite this common experience, only recently have nurses begun to quantify the impact of teamwork on patient safety and clinical outcomes. A growing body of evidence links team-based interprofessional care, in which nurses increasingly serve as team conveners, with better patient outcomes.4 Care delivery models that were traditionally limited to the domain of nursing have expanded and become models for entire organizations. Increasingly, chief executive officers share with Magnet appraisers that their health systems have theoretical frameworks such as relationship-based care5 for organizational priority setting and care delivery. Accordingly, the 2014 Magnet standards reflect the evolution and emergence of nurses as designers of high-quality, effective, patient-centric teams.


Strong leadership is required for reformation, and more than ever before, clinical nurses in Magnet organizations are transforming healthcare by leading policy change that improves care delivery and its outcomes. For example, in Baltimore, Debra Holbrook, BSN, RN, changed how victims of sexual violence are cared for in the United States. Her advocacy led the Federal Government to mandate national forensic care standards. At the same time, Elizabeth Bradshaw-Mikula, MSN, RN, enhanced outcomes for newborns with critical congenital heart disease (CCHD) internationally. Her groundbreaking research demonstrated the feasibility of newborn CCHD screening. In response, 32 states have passed legislation requiring universal CCHD screening for newborns. Nurses such as Holbrook and Bradshaw-Mikula possess the know-how to serve as experts and would be of great value on healthcare organization boards and other high-level decision-making bodies.


Nursing must remain at the center of defining safe, timely, effective, efficient, patient-centered, equitable care. Earlier this year, the American Nurses Credentialing Center(R), the American Nurses Association, and the Magnet Commission convened 2 summits: 1 on ambulatory measures and a 2nd on skin integrity. Nurse experts, researchers, physicians, therapists, national policymakers, and payors came together with the objective of gaining consensus on priorities, communicating best practice, and refining standard outcome measures. The summits were so successful, the Magnet Commission will expand the work that was launched this year. The Commission will sponsor forums for the continued development of tools, processes, and metrics that will move us to the next level of care.


I have had a breathtaking view of excellence. Great progress is underway in academic progression, interprofessional collaboration, the institution of new patient-centered care models, and outcome transparency. Nurses' unprecedented access to literature has cultivated a spirit of inquiry that has fueled innovation and research. When answers to questions do not exist, nurses find those answers generating evidence that is redefining state-of-the-art practice at an exponential pace. Yet, there remain a gap and an opportunity to recognize nurses as full partners in national healthcare policymaking and increase their appointments to governing boards.


The future of healthcare is in competent hands. The talented leaders and clinicians who compose our workforce will challenge us to create a health system that exceeds expectations. Thank you for this glorious ride. It has been pure joy.




1. Institute of Medicine. The Future of Nursing: Leading Change, Advancing Health. Washington, DC: The National Academies Press; 2011. [Context Link]


2. American Nurses Credentialing Center. Magnet Application Manual. Silver Spring, MD: American Nurses Credentialing Center; 2014. [Context Link]


3. Zimmermann D. An essential next step for nursing. J Nurs Adm. 2013; 43( 7/8): 371-372. [Context Link]


4. Landman N, Aannestad LK, Smoldt RK. Teamwork in healthcare. Nurs Adm Q. 2014; 38( 3): 198-205. [Context Link]


5. Koloroutis M. Relationship-Based Care: A Model for Transforming Practice. Minnetonka, MN: Creative Healthcare Management; 2004. [Context Link]