This article draws significantly on writing by the Hutt Valley Health team involved in leading the Magnet application.  We acknowledge Annie Vekony, RN, MN (Applied), Michele Halford, RN, BN, PG Dip (Applied), Theresa Fowler, RN, ADN, BHSc (Nsg.), Debbie Poutoa, RN, PG Cert, Toni Dal Din, RN, MA (Applied) Nursing, PG Cert Forensic Psychiatric Care, Brian Phillips, RN, PhD, Colette Breton, RN, MN (Clinical) from the original.

Hutt Valley District Health Board (HVDHB) has recently been accredited as the first Magnet Hospital in NZ. The College of Nurses warmly congratulates Director of Nursing Toni Dal Din and the whole multidisciplinary team at Hutt Valley District Health Board. We also acknowledge the efforts of Rhondda Knox the former Director of Nursing there.
Magnet recognition is a status granted by the credentialing arm of the American Nurses Association – the ANCC.  It is awarded to healthcare organisations that achieve excellence in nursing services and validates an organisation’s ongoing commitment to quality care. The purpose of Magnet recognition is to promote nursing settings that support quality professional practice; to identify excellence delivery of nursing services to people receiving nursing care; and provide a mechanism for the dissemination of best practice in nursing services.

Background
In the 1980s the American Academy of Nursing (AAN) conducted a study of US hospitals to identify the organisational attributes of hospitals that were successful in recruiting and retaining nurses during a severe national nursing shortage. They found that the hospitals subsequently labelled as  “Magnet hospitals” shared certain organisational features that served to promote and sustain professional nursing practice. These features included a culture that understood and recognised nursing as the cornerstone to good patient care and fostered excellent communication between administration and nursing. In particular unit-based decision making was decentralised to the unit level, giving nurses on each unit as much discretion as possible for organising care and staffing in a manner most appropriate to the needs of their patients

Magnet hospitals had influential nursing executives – the nurse executive was a formal member of the highest decision-making body in the hospital, which signified the high priority that hospital administrators placed on nursing. There were significant investments in the education and expertise of nurses, good communication existed between nurses and physicians and patient satisfaction was high. Of particular significance was the very low turnover of registered nursing staff.

The evidence base

Since the 1980s international teams of researchers led by Professor Linda Aiken from the University of Pennsylvania have conducted extensive international research with several aims

1. To better understand the attributes of “magnetism”
2. To explore the impact on nursing
3. To explore the impact on patient outcomes

More recently they have extended the work to include a focus on the cost effectiveness of running a hospital designated Magnet.

The characteristics of Magnetism first identified have since been developed into the 14 Forces of Magnetism shown in Table 1 below.
The Forces of Magnetism may be thought of as attributes or outcomes that collectively exemplify excellence in nursing. Full expression of the 14 Forces of Magnetism, are essential for a health organisation to achieve Magnet recognition. 
Table 1. The forces of magnetism

Hutt Valley's application

The process for Magnet recognition at HVDHB occurred in several phases over a number of years beginning with the  early preparation/planning and building the project team.  Raising awareness and collating data occurred next followed by writing and submitting our application and then hosting the appraiser's visit in March 2007. Each phase had different challenges and revealed different aspects of nursing in our organisation.
“Champions” of the project were crucial to the effort of promoting an understanding of Magnet throughout the different layers of the DHB; in particular, to those nurses providing direct-care. Champions worked collectively and individually to disseminate information and to generate awareness of the issues in their units.
A core writing team was formed to collect an enormous amount of information that accurately described the state of nursing services at HVDHB against the criteria for Magnet. The data collection process confirmed the interdisciplinary context of nursing.  Hutt Valley reports that
“There were many stories that allied and medical staff told about individual nurses, particular groups of nurses, or wards/departments that consistently spoke of the integral role of nurses to successful patient outcomes. The overall message was that allied and medical staff held nurses at HVDHB in high regard for their high level of professionalism, skill, autonomy and ability to communicate effectively. Similarly, nurses’ stories told of their collaborative working relationships with other disciplines. So, while Magnet is unambiguously nursing-centred, it is not exclusionary, and is dependent on good collaborative relationships in which there is a high level of mutual respect.”
Compiling the documentation was seen as the most demanding of all aspects of the application. Ultimately, Hutt Valley DHB submitted a 14-chapter, four-volume narrative against the required criteria and delivered it to the US on time.
The goal for submission of documentation is to obtain a visit by ANCC-appointed appraisers. Approximately 40% of organisations who submit do not reach this point. . The meetings held during the visit sought to  “verify, clarify and amplify” the submitted evidence for all 14 Forces of magnetism. These meetings brought the appraisers together with nurses from all shifts, medical staff, allied health, primary and community representatives, tertiary representatives, Nursing Council, executive management groups, patients and their families.  In this way, all staff had every possible opportunity to have their say and appraisers could document their opinion of how nursing excellence is embedded in the systems and culture of HVDHB. 
Hutt Valley District Health Board, following notification of their success, know that “going for Magnet” provides an organisational learning experience that is valuable beyond the award of Magnet recognition.
“By undertaking an extraordinarily rigorous, in-depth, and systemic scrutiny of the state of our nursing service we now have insights and knowledge that measure us against world-class standards.”

References