The Magnet Recognition Program(R) provides a foundation for nursing excellence by creating a road map for healthcare organizations. The standards within each component of the Magnet(R) Model1 guide the development of the structures and processes that are critical to achieve positive outcomes for patients, nurses, and the organization. Excellence cannot be measured by a single snapshot in time but by sustained results created by enculturation of the tenets of Magnet throughout a healthcare organization.
For Magnet purposes, enculturation is "the process by which an individual learns the traditional content of a culture and assimilates its practices and values."2 This includes the process by which the values of Magnet are disseminated throughout the depth and breadth of a healthcare organization. Enculturation is demonstrated by the ability of every nurse at every level to function autonomously within the interprofessional care team.
The written documentation that organizations submit as part of the appraisal process provides Magnet appraisers a narrative detailing how the sources of evidence (SOEs) are "present and fully operational within the healthcare organization."1 The Magnet site visit occurs once it is determined by Magnet appraisers that the written documentation meets the required threshold. It is during the site visit phase that organizations have the opportunity to demonstrate the enculturation of Magnet. Although the verification of enculturation is objective, specific to the examples provided in the documentation, it is not unusual to hear the appraisers making statements referencing the "feeling of excellence" as being palpable during the visit. This observation is the result of an environment that empowers nurses to contribute to improving structures and processes that result in improved outcomes. These structures include nurse participation in unit based councils, interprofessional committees at the unit and organizational level, nursing research, and quality initiatives, among others.
During the site visit, the appraisers visit settings where nursing is practiced. In addition, there are meetings with randomly selected clinical nurse participants. These meetings provide a venue for transparent discussions including how nurses interact with their leaders, how nurses have a voice in care they provide, and how they are supported in professional development. The meetings are limited to clinical nurses and are representative of all care settings. Both unit visits and meetings provide appraisers with opportunities to develop an appreciation of the organizational culture.
The enculturation of Magnet excellence is not limited to the appraisal period. It is about the fundamental principles of Magnet being lived in the organization every day through the period of designation as a Magnet recognized organization. These fundamental principles are found in the 5 components of the Magnet Model1: transformational leadership; structural empowerment; exemplary professional practice; new knowledge, innovations, and improvements; and empirical outcomes. These components provide the road map for excellence; however, the leadership provides the vision.
One way to ensure that these principles are woven into the organization's cultural fabric is through the work of transformational leaders. Transformational nursing leaders are present at all levels of the organization and demonstrate advocacy and support for nurses. They facilitate regular nursing assessments as a critical step both on the Journey to Magnet and after designation. Are there enough resources dedicated to the conduct of nursing research? Have we sufficiently resourced our shared decision-making models? What structures are in place to sustain a culture of inquiry where all nurses have continuous access to existing evidence and the infrastructure to add to the growing body of literature? Enculturation expands beyond the walls of the traditional acute care setting. Ambulatory care nurses must have autonomy and ability to influence their practice. The 2019 Magnet Application Manual1 introduces 9 SOEs that require examples from the ambulatory setting. To ensure readiness for Magnet, nurse satisfaction, patient satisfaction, and nurse sensitive indicators must be submitted to a benchmarking vendor and evaluated with the same rigor and attention as the inpatient setting. In addition, examples of mentoring and succession planning, participation in an organization-level interprofessional group, opportunities for continuing education, a professional practice model, and the ability to influence the selection of technology and work environment and to implement evidence-based change, are required in ambulatory examples. Nurses in ambulatory care settings are vital to patients through the continuum of care and need equal access to leaders, resources, innovative practices, peer feedback, and shared decision-making.
A Magnet culture cannot be achieved or maintained without enculturation of these principles throughout the organization. The objective is not only merely attaining Magnet recognition but also, and more importantly, creating and sustaining a culture that drives nursing excellence in all care settings. As healthcare evolves, so do the requirements for each component. A Magnet culture is about "raising the bar." Healthcare organizations must be at the forefront on quality and safety initiatives. Leadership must be nimble, adjusting to the demands that are placed on the healthcare team and establishing the framework for enculturation of Magnet principles.
References