Does the MAGNET system work?

forrester · Nov 5, 2009

Don't hospitals pay a lot on the "journey to magnetism"?

They sure do!

Seems they are willing to invest in everything BUT proper staffing levels. Like most politically charged things, we are penny wise and pound foolish.

Better to spend 10 million dollars on computerized communication systems which need constant repair and periodic upgrading than to invest in people who are doing the job. If they had their way, nursing would be done robotically.

lithrlndRN · Nov 11, 2009

I disagree with everyone who thinks magnet is a bunch of BS. When reading this I would hope that you would have an open mind. It is all about how your shared governance works at your hospital (or lack of). My fiance and I are both on the magnet committee and we are going for our designation at our hospital. My fiance is an LPN and one of the most involved nurses in the committee. She is going to go back and finish her RN. Magnet is a recognition of the good care that you do as a nurse everyday at your hospital. It is no different than an award for lab, RT, or any other dept. Don't get me wrong I agree that it makes the hospital look better. If your hospital is not to your standards you should either leave, or fix it. There are a lot of things that need to be changed at my hospital, but there are a lot of amazing things we do everyday. I just don't see why any nurse would not want to be recognized for their hard work. I think what happens is that a hospital starts magnet status for all the right reasons, and then when they get the status they quit their journey to excellence. I know my hospital will never be perfect, but I do know that we will strive for the best pt care possible. Our door to cath time is less than 30 min, we are stroke certified, we have constant observers for patients who are high risk for falls or extremely confused, on our med surg floors we usually only have 4 pt max per nurse, CCU 2 pt per nurse and open hearts are all one on ones. We have rough times, but when there is a problem we try to fix it. I know that most of you reading this think this reply is as much BS as you think magnet is, but I firmly believe in my great care towards my patients. Do you? We have been working on relationship based care (RBC) for the past year and getting ready to role it out to the staff. We all have the choice to have our opinions heard at our hospital. I highly suggest that if your hospital has not fully embraced shared governance or adopted RBC as a model of care then you should make it happen. In our hospitals RBC has involved 14 different dept in our hospital that meet once a week. This is including everyone from dietary to med staff. We want to make sure that every dept has good communication and understands each others needs to give the best pt care possible. I hope that maybe this message has helped at least one of you understand what magnet SHOULD be about. If you have any questions for me on how things are becoming successful at our hospital I would love to share, if you have any suggestions on how to make RBC work well for us I would appreciate it. Also, I am one of those nurses in a lot of committees and I work my full time hours weekly. I am in the committees to help make my work enviroment better, and to give better patient care. I think maybe we forget the real reason we started working for the healthcare system in the first place.

forrester · Nov 11, 2009

The reason I started this post was to try and get information directly from practicing nurses in Magnet designated facilities. It seems that reporting nursing survey data from Magnet facilities to the regulating group is an optional requirement for facilities. The information is certainly not made available to independent nurse researchers.

I am interested in things which are on the table for shared governance, but more importantly, things that are NOT on the table. Staffing ratios seem to be one of those things.

I don't know, and cannot tell, what unit you work on, but the 4:1 ratio for med-surg floors is highly unusual. Most med-surg floors I know of are 6:1 or more...easy. I have heard up to 10:1.

Anecdotally, from friends and some blogging, I started hearing of problems some 10 years ago. I have asked the ANCC repeatedly to do computer based nursing surveys and to make these results open for review. For some reason, they want to keep what information they do have in-house.

Recently, several Magnet facilities were ranked at the bottom of the pile for nursing care in U.S. News and World Report, granted, based on patient reporting systems. The Magnet system has become a big money maker for the ANA, and we know from experience, anytime big money gets involved, ethics and intents go out the window.

So I am glad Magnet is working at your facility, although the 4:1 on med-surg seems a bit unrealistic. Keep up the level of involvement you have and good luck in sustaining these efforts once you get the designation.

ps- If your med-surg floors are 4:1, what are your tele floors? Are you in California????????

phosphorus · Nov 11, 2009

In the city where I am, the Magnet healthcare system has staffing rations of 7:1, and nurses complain of often having 9 patients. They are tethered to phones that patients call directly at all times, and they are written up if they don't answer them (even while with other patients). My hospital is going the magnet route, and all the nurses believe that means lower patient:staff ratios. Management propaganda has been working well.

Shared governance has been used much more extensively in other industries like auto, manufacturing, etc. It was introduced by Japanese and German companies as a means of trying to get workers more invested in the companies, and to break up unions. The problem is that the governance is shared only when it doesn't come into conflict with management. There's nothing which forces management to respect the democratic wishes of employees, and those wishes often contradict the bottom line. This compounded by the fact that the layered committees of shared governance is seen as an opportunity to enter management makes it difficult for real democracy to occur, as representatives has conflicts of interest (job advancement). Rather than shared governance, we need real democracy where hospital workers run hospitals directly. Until we get to that point, we're better off organizing together to have a united voice in making changes in the hospital. It has to be on equal terms though where management can't control, structure, and veto everything on a whim.

At the local public non-magnet hospital, which is union, the staffing ratio is 4:1. I'm just saying....

lithrlndRN · Nov 12, 2009

I don't work for a union. I work in a nice size hospital in a very diverse college town in southern indiana. When I started here at my hopital 3 yrs ago staff pt ratio was 8:1 sometimes without techs. Then we went to team nursing where the LPN passed medications, which was a disaster. Our LPN's are able to do a lot here, pretty much everything but ng and pushing cardiac meds. Our LPN's are strongly encouraged to further their education, and most of them have. Shared Governance works well, in my opinion. Although management does make the final decision, we get a lot of say. If you propose what you want to change, why it needs to be changed, and how it will benefit the hospital it is really hard for management to deny what you have to say. The problem at a lot of hospitals are that people are willing to complain, but do not want to put in the extra hours to fix the problems. Our tele floors like PCU is 3:1 ratio most of the time. I float around the whole hospital and I have observed what is working and what is not. I am telling you that floors with a strong shared governance and managers that listen are the most successful. Of course management plays a huge part in the decision making, but I feel strongly that if you believe in something enough and build a case for change, the majority of the time management will not shoot you down.

forrester · Nov 14, 2009

If your ratios are 4:1 on med-surg and 3:1 on tele floors, you are indeed the exception (except in California of course). I find those ratios anywhere else rather hard to believe.

SheaTab · Nov 18, 2009

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Anecdotally, from friends and some blogging, I started hearing of problems some 10 years ago. I have asked the ANCC repeatedly to do computer based nursing surveys and to make these results open for review. For some reason, they want to keep what information they do have in-house.
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This is suspect. Have you ever gotten a response?

forrester · Nov 18, 2009

This is suspect. Have you ever gotten a response?

Yes, they seem very content with their own analysts. They did, however, question my mental status when I asked them about this. The email that did this was inadvertently sent to me, and I got an apology from ANCC.