May. 8, 2015

Oh the glory of Magnet

 How Magnet, Press-Ganey and Obamacare are Taking the Nurse Out of Nursing

In 1983 the American Academy of Nursing Task Force on Nursing Practice conducted a study in hopes to attempt the identification of hospitals that were able to retain their nurses while providing quality care to their patients. These hospitals were referred to as "Magnet" hospitals.
With nursing shortages continuing to be a growing concern, there was a definite need to help improve both patient satisfaction and staff retention. The program developed into a nationally recognized status for hospitals.
Whether a hospital meets those credentials depends on its capability of meeting five key components: Transformational Leadership; Structural Empowerment; Exemplary Professional Practice; New Knowledge, Innovations, & Improvements; and Empirical Outcomes.

It is a coveted recognition for hospital administrators across the nation. In America's hospitals, the very low percentage that actually meet Magnet standards (close to 7%) are considered to be upper crust and on paper they are, but what does it feel like to be a nurse employed by a Magnet hospital? When you add in Press-Ganey, the survey that random patients receive regarding whether or not they had a "very good" experience while in the hospital and the constant looming threat of Obamacare it all becomes pretty overwhelming. (Please keep in mind that Press-Ganey is the survey to be used by the government to determine a percentage of medicare/medicaid reimbursement that the hospital will receive)

Most nurses say they felt a "calling" into their field. They either had an experience that led them to nursing or have felt as though they wanted to help people from when they were a small child. There is absolutely nothing like the feeling of saving a life, holding the hand of a patient who needs to feel loved, embracing a grieving human during a tragedy, holding a newborn as they take their first breath, the adrenaline rush of caring for a trauma victim knowing that seconds count, administering TPA to a stroke victim and watching neurological deficits disappear... Each of these things are miracles in their own right. Those who chose nursing wanted to make a difference. It was a calling.
The problem is that not all nurses who heed to that calling are actually good at their job. Administrators are forced to create policy to govern the quality of care that we as nurses provide. Policies are merely tools for nurses, doctors and other staff members to help implement the notorious "right thing to do". We should all be completely on board with this, right?

Here is where it gets sticky: Gone are the years of entering a patient room, giving good care and trying to make a difference while applying knowledge and healing hands. The powers-that-be have dictated to us the methodology in which we must do this. We have been transformed into scripted robots who aren't allowed to step outside of our guidelines and tap into our humanity. "Hello, my name is Nurse A. I have been a very good nurse for 10 years at this very good Magnet hospital. My goal is to give you very good care. You shouldn't feel my necessary harried behavior and I cannot nor will not tell you that I have numbers and time frames to meet from the very beginning of your entry to the department. I cannot tell you that studies have been done regarding the amount of time you spend in this department and how they correlate with your satisfaction scores. What I must do is trick you into answering "very good" on the survey you receive in the mail."

The prudent nurse should round on each patient hourly, assess them, document vital signs, offer them a warm blanket, a smile and possibly a hand hold or hug when appropriate. During the in-between times they should be checking orders, administering medications, double-checking that the ordering physician hasn't made a mistake, triaging and assessing new patients, answering call lights for unforeseen necessities like going to the restroom, episodes of nausea or vomiting, anticipating patients that are "crashing", calling the lab to find out when results will be posted, transporting patients to radiology, working on getting patients admitted or discharged, and assisting the other nurses in their area. It's doable, right?

The answer is yes. It actually IS doable. Doable that is until you tell THE REST OF THE STORY. In a Magnet hospital, nurses are expected to lead a committee, sit on a committee, implement projects not only to their department but also to other departments and hold a national certification which warrants an extra 80 hours of Continuing Education to be completed on their own time and often their own dollar. They receive 30 emails a day regarding changes that are being made or new responsibilities they must shoulder. They are held personally responsible for staff retention and also the practice of their peers. (Side note- administration is ultimately responsible for the hiring of nurses who won't and don't stay but it is the STAFF who is HELD responsible for their retention) It is all a bit crazy.
So much emphasis is placed on retention that nurses are fast-tracked into leadership positions that they do not have the experience to handle. In the field of nursing, "baby nurses" are orienting "baby nurses" on how to be nurses just so the retention goals are met. Actually, having said that the reason babies are training babies is two-fold. Experienced nurses do not like the trend in nursing and do not want to be held responsible for the new graduates and the type of nurses they will grow to be, so they are not acting as preceptors. The newer nurses, less than 2 years of experience, are hungry for professional growth and the easiest place to start that growth is in the vacancies of the role of preceptors.

New nurses are being placed in the role of triage nurse or trauma nurse before they should be simply a because the department is trying to retain them and one of the easiest ways to do that is to make them feel important. It's all actually pretty dangerous. Bedside nursing is an art. It takes years to perfect it and even those that have perfected it have days in which they leave feeling inadequate. Gone are the days in which it was glory enough to work in a Level I Trauma Center. Now, every nurse feels the need to be on the top of the totem pole. This does nothing but create chaos and mayhem. The new generation of nurses is part of the generation where everyone, even the losers, received a trophy. The trophy in nursing isn't power. The trophy in nursing is the satisfaction of knowing you made a difference. If this isn't enough, maybe nursing isn't the field for you.

On another note, Lets face it. All of these committees are simply a mind trick to make nurses feel empowered. Administrators still make the decisions. Administrators still make the rules. Committees are a financial burden on hospitals who are drowning in debt. Nurses are an expensive necessity to hospitals. Their time on the clock should be utilized in productivity at the bedside not paying them to sit around a table at a bi-monthly bitch session in which very few problems are resolved. Hospitals could actually staff the departments better if they eliminated these committees because they could afford to do so.

Magnet Hospitals are only hiring nurses that have a Bachelor's Degree in nursing. These are generally nurses who want to become nurse practitioners or administrators of some sort. Why are all Registered Nurses not good enough in the eyes of administrators? Didn't they too pass the state-mandated tests to become a nurse?

Magnet has been twisted and turned until it is no longer a way to measure the best hospitals but instead has become an ugly virus of pointless responsibilities that are exhausting our nurses and reflecting on the care we actually provide for our patients. Sometimes the methodology of the past should be embraced. I would personally rather work in a hospital where the staff is actually happy regardless of whether it is reflected  on paper or not.