Kristin Fowler   	 1 Feb 07  12:28 AM MST
	Management Style

The Magnet program was developed to recognize hospitals and other healthcare organizations the provide "the very best" nursing care. Several standards have been developed, also called "forces of magnetism," that lay out how the organization should function in order to achieve magnet status. One such force is managerial style.
The management style is a transformational style that allows for effective communication between managers and staff due to a shared vision of excellence. Managers are to involve the staff at all levels, communicate directly with the staff and allow staff to provide appropriate feedback.
When analyzing the hospital I work for, I was looking at the managerial style of the organization as a whole, not just my department. I started with the Vice President of Nursing, through the nursing supervisors and then to the department managers. The framework of the hospital is to allow staff members to be involved in various councils and committees. The practice council, quality assurance council are both groups that meet monthly to discuss policies and practices throughout the hospital. The group includes staff nurses from all departments and various department heads as well as upper management.
Although these councils are used and some policy changes are directly generated from these councils, I feel though that the majority of the policy and practice changes occur without discussion, usually due to some sentinel event that occurred within the hospital. For example, we recently had a policy change that only a respiratory therapist can bag an intubated patient during transport. That policy change came about when a nursing aide inadvertently removed and ET tube when bagging an intubated patient during transport to another unit.
I also feel that there should be more input from the nurses in regards to the required education and competencies for each unit. The development of an educational council would be great. Now, there are hospital wide competencies and educational classes. Unit specific classes would be a benefit as well as input into skills and topics that the staff nurses would find beneficial to there practice. In order to achieve such a council, a proposal for its generation would have to be submitted to the Vice President and include a list of enough interested staff to fill the committee.


Margaret Imbrock 	2 Feb 07  10:00 PM MST
	Kristin,
In response to the your statement about nurse aide bagging an intubated patient, Was the previous practice / policy of allowing a nursing assistant to manually ventilate a patient during transport in agreement with your nurse practice act. In recent years I have not seen that responsibility delegated to a unlicensed assistive personnel during transport. Is this a function that should be delegated? Where was the nurse? I have had nursing assistants help me bag a patient while I was suctioning, but I had a hold of the tube while they squeezed the bag.


Kristin Fowler 	3 Feb 07    2:11 AM MST
	Margaret,

The aide was not intubating the patient which would totally be out of their scope of practice. Bagging a patient whether intubated or not does fit in their practice.
The point I was trying to make is that a whole new policy was developed and initiated because of this one incident without any education or communication from the staff that was affected by the change. According to the managerial style under the rules of magnetism, a two-way communication should exist between staff and management, and not new policies being implemented at will by management.

Kristin


Kimberly Pendrey 	3 Feb 07    9:46 AM MST
	Is the facility that you work for a magnet facility? I think it is a good concept that the organization has councils and committees that allow staff members to be involved. However, it is true that more of the policy and practice changes do need to include more staff input and feedback before a change is made. This would allow everyone to be a part of the change and it may be tolerated more efficiently.


Krista Winslow 	1 Feb 07    2:16 PM MST
	Review of forces of magnetism
This week I have heard of many different hospitals, some which are already magnet status, some that are getting close, and some that still have a long way to go. I have been thinking about a hospital I worked at before that was magnet and comparing it to the hospital I work at now. Even though they are both under the same organization (Intermountain Healthcare), there are vast differences. The truth is where I work now, I don't know if they will ever be good enough to be magnet status. They are lacking in a lot of areas. I hope we can someday get there though. Its good that a lot of hospitals and organizations are trying to get magnet status because that means they have to work harder and do everything right. At this point, I think hospitals that are currently magnet deserve it. I hope magnet doesn't get out of control and pretty soon everyone is magnet, because then it wouldn't mean much if everyone was magnet. I have realized that the next time I am looking for a job, a magnet hospital will definetely be a good choice.


Christine Higbie 	1 Feb 07    7:04 PM MST
	Response to Krista:
Krista, I am wondering about how your hospital's management fits in with the magnet vision. Do you have a shared governance system or is there a more traditional form of governance? How does your unit manager and hospital deal with problems?

I agree with you that if every hospital becomes Magnet distinction it may not mean as much. However, would it be bad that all hospitals try to provide excellent care, encourage their nursing staff to become better, and include staff in hospital decisions. I think that that would be very positive for everyone in the healthcare system.

Chris


Mary Arnold 	2 Feb 07    8:09 PM MST
	Krista & Christine:

I agree that if Magnet status was easily achieved and every hospital became a Magnet hospital, then it would definitely loose its distinction. However, I do feel that regardless of the status of the hospital status, the nursing staff should be providing the best possible patient care possible.

Mary Lynn, RN, BSN
IL


Kristin Fowler 	3 Feb 07    2:22 AM MST
	Mary,

I agree with you that Magnet status should be difficult to obtain, but I do not agree with the application and appraisal fees associated with the program, as well as the costs to bring in the appraiser for the three day site visit. I feel that this unfairly limits some smaller, financially constrained hospitals from attempting to achieve Magnet status. It is stated in the literature that healthcare organizations that achieve Magnet status have advantages in the competitive market, but I feel that it was though competitive advantages that allowed the hospital to achieve Magnet status in the first place.

Kristin