1. Curto, Christine MS, BSN, RN, IBCLC
  2. Martin, Deborah Maust DNP, MBA, RN, NE-BC, FACHE


The coronavirus disease (COVID-19) pandemic has been a source of disruption, unexpected illness, stress, and adversity for people, worldwide. As the reality of the COVID-19 pandemic unfolded in early 2020, many healthcare organizations found themselves in the midst of their Magnet(R) appraisals-just short of the 3rd appraisal phase, the Site Visit Phase. In response, the Magnet Recognition Program(R) devised strategies to maintain the integrity of the appraisal process, despite the turbulence associated with the unexpected changes that healthcare organizations were confronting while contending with the impact of COVID-19. In this month's Magnet(R) Perspectives column, we explore how the virtual site visit has provided healthcare organizations with the opportunity to complete this phase of their appraisal process while addressing the safety and well-being of the organization's staff as well as that of the Magnet appraisers.


Article Content

The Magnet(R) site visit is the 3rd of 4 phases of an organization's Magnet Recognition Program(R) appraisal. The Magnet site visit is designed to validate, verify, and amplify the written documentation, as well as confirm compliance and enculturation of the Magnet Model components within the organization seeking designation or redesignation.1 This 3rd phase occurs only when a peer review team of Magnet appraisers establishes that an organization's documentation meets the threshold of excellence. During the site visit, the Magnet appraisers also consider feedback acquired from public and staff comment. Following the site visit, the appraiser team prepares summary reports of findings and submits these reports to the Commission on Magnet Recognition for final deliberation.1


The Magnet Model provides the foundation for building nurse resilience, with the expectation that the nurse leaders in Magnet-designated organizations support lifetime learning, access to opportunities for formal education, and meaningful recognition and that they establish healthy work environments in order to sustain the nurse workforce.2 The culture of nursing excellence, leadership, structural empowerment, exemplary professional practice, and innovation in a Magnet-designated healthcare organization provides the foundation for resiliency in the face of adversity.


In March 2020, as the coronavirus disease (COVID-19) pandemic unfolded, healthcare organizations were offered 2 site visit options by the Magnet Recognition Program to ensure the safety of the nurses, patients, and the Magnet appraisers-a virtual site visit (VSV) on the same days already scheduled or the option to extend their onsite site visit to a later date. By summer 2020, after evaluating the impact from the COVID-19 cases and a review of the World Health Organization, Centers for Disease Control and Prevention, federal, and state guidelines for travel and public gathering, the Magnet Recognition Program announced the decision to conduct all site visits, virtually, until further notice.


The Magnet(R) Virtual Site Visit

Magnet site visits have been conducted, virtually, for organizations experiencing extreme extenuating circumstances, since 2014. Until the COVID-19 pandemic arrived in the United States, only international organizations experienced circumstances requiring a VSV to complete the site visit phase. Nurse resilience has been behind the changes necessary to successfully implement the Magnet VSV in the context of COVID-19. The VSV does not change any of the Magnet Program site visit requirements depicted on the agenda, and organizations continue to experience the capability to showcase nursing excellence via the extended use of audio/video (A/V) conferencing technology in order to validate, verify, and amplify compliance and enculturation of the Magnet Components within their organizations.


Site visit logistics associated with hosting a Magnet site visit now include the choice of an A/V conferencing platform for use during a VSV. The platform selected by organizations needs to be capable of supporting the multiple virtual sessions occurring simultaneously to accommodate the site visit agenda. These A/V platforms typically already exist within the organization, and the nursing staff are familiar with their use. In fact, the VSV has strengthened nursing's partnership with the information technology departments within their organizations as they come together well in advance of the VSV to confirm screen sharing capability and assess Wi-Fi connectivity in the various conference rooms, meeting spaces, and the inpatient and outpatient clinical units where the appraisers will visit via the use of various mobile devices (eg, laptops, smart phones, and tablets) placed on portable carts or wheels. For the appraiser team leader who is in touch with the organization chief nursing officer and Magnet project director, the key change has been scheduling presite visit sessions with the appraiser team to serve as "rehearsals" or "dry runs" affording time to troubleshoot A/V issues that could arise such as loss of connectivity, as well as reduced visual and/or sound clarity in advance of the VSV.


Nurse resilience, the capacity to accurately perceive and respond well to stressful situations, is a learned skill that is honed with experience.3 What has become evident since March 2020 is that nurse resilience, in the context of the Magnet Model and culture, has been essential to planning for and conducting a VSV, enhancing the experience for organizations and appraiser teams alike. The following comments from organizations demonstrate this nicely:


* "We had an amazing VSV[horizontal ellipsis] Our staff shared that this was the "beacon of hope," [and] in light of this terrible pandemic, this was everything to the staff. Thank you for the opportunity to have the VSV."


* "We recently had a VSV, which we found to be very positive[horizontal ellipsis] the virtual experience was still able to provide a proud and exciting atmosphere overall."


* "The VSVs went smoothly, and the energy and enthusiasm are great. The appraisers are friendly and let the nurses feel at ease and motivated to speak up."





1. 2019 Magnet(R) Application Manual. Silver Spring, MD: American Nurses Credentialing Center; 2019. [Context Link]


2. Kester K, Wei H. Building nurse resilience. Nurs Manage. 2018;49(6):42-45. doi:. [Context Link]


3. Diane Seig. 7 Habits of highly resilient nurses; reflections on nursing leadership; Sigma Global Nursing Excellence; Sigma Theta Tau International Honor Society of Nursing. 2020. Accessed August 3, 2020. [Context Link]