Magnet status and the journey The focus of week 5 is on the Magnet status and journey. You are asked to interview a few people and are given a semi-structured interview guide to help structure your interviews. This week’s discussion forum is focused on the 14 forces of magnetism and provides information that will contribute to the successful completion of the Application assignment. To allow time for you to participate fully in the Discussion forum and then apply that knowledge to the Application, your Week 5 Application assignment will not be due until the end of Week 6. Good luck! Jack Carla Kimmons 29 Jan 07 8:06 PM MST Forces of Magnetism-Professional Development Professional Development is one of the Forces of Magnetism that is strong in our organization. We have many resources available to support professional education. A generous reimbursement program is available to all staff involved in continuing their formal education. Our health sciences library offers computer support, research assistance, and a large reference library. During our Magnet certification process, the librarian and I served together in organizing our evidence. Her knowledge of the Forces of Magnetism and the emphasis on Advanced Practice nurses led her to develop specific resources for nurses pursuing advanced degrees. In the clinical area, we have a Clinical Ladder composed of four levels. Each level has specific clinical, educational , professional practice, and leadership requirements. Portfolios, with peer letters of recommendation and interviews, determine qualified applicants. It is an honor to achieve each level. All levels are given special recognition and a higher pay scale. Ongoing inservices and educational workshops are offered free to all employees. We have state-of-the art AV equipment and classroom facilities. All nurses are encouraged and supported to give presentations. In Magnet hospitals, professional development opportunities are a primary indicator of a professional practice environment. (Mason, et.al., 2002, p.331). This is true in our facility. Prior to our first Magnet application process, these educational programs existed. During the application process and successful achievement, our organization has developed a stronger conviction supporting professional development. New policies have been implemented requiring advanced degrees for all manager level positions and staff educators. More important, there has been an increased recognition of the importance of advanced degree nurses at the bedside. Most staff nurses hold BSN or MSN degrees and one or two specialty certifications. Luther Christman stated, "The issues of low pay and low status in nursing is a direct result of the fact that the majority of nurses are less educated than any other healthcare professionals...."(Houser and Player, 2004, p.78.) As we move toward higher level educated nurses at the bedside, overall quality of care, communication, and work environment improves in our hospital. The Magnet program provides a format for Nursing to define and evaluate itself. It is worth the work, and gives us the opportunity to grow as individuals and a profession. Robinson, Carol. (2002). Achieving Excellence in Nursing Practice. In D.J. Mason, J.K. Leavitt, and M.W.Chaffee (Eds), Policy and politics in nursing and health care (4th ed.) (p. 331). St. Louis, MO:Saunders/Elsevier. Houser, B. P. & Player, K. N. (2004). Pivotal Moments in Nursing:Leaders Who Changed the Path of a Profession.(p. 78). Indianapolis, IN: Sigma Theta Tau International Honor Society of Nursing. Date Modified: 29 Jan 07 8:09 PM MST Karen Kelsall 30 Jan 07 3:16 AM MST Carla, Your facility seems to be right on the ball with the Magnet journey. My facility is just starting the process, which makes me a little unsure of the information we are dealing with this week. I was wondering if you could clarify a few things in regard to the Magnet Journey. In your post it is stated that New policies have been implemented requiring advanced degrees for all manager level positions. In my facility the majority of manager positions are only held by an Associates Degree nurse. Some by BSN prepared and only (2) I can think of that hold MSN degrees. Now when you refer to the phrase "new policies" are you speaking of Magnet Organizations in general or are you speaking in regards to your facility? Also is there a "grand fathering" of these managers because they already hold the position prior to magnet status? Through these courses I have learned so much about leadership and communication that it appears that it would only be beneficial for a nurse manager to advance her degree and acquire the tools she needs to be an effective leader. Although I often hear some of the managers stating they are "too old to return to school". I happen to be one to believe that continued learning is a journey we should all be traveling. Thanks for sharing the post and any information in regards to my questions would be helpful. Karen Kelsall PA Kim Zolnier 30 Jan 07 6:19 AM MST For those who say they are too old to return to school I offer my mother-in-law and her sister as examples. Their first goal after returning to school was to obtain an Associate Degree before turning 80. They just made their goal. They are now working on a Bachelors Degree. I agree with you that education continues throughout the lifespan. Respond iconRespond Faith Vaughn 30 Jan 07 8:19 AM MST Kim, That is amazing! Thanks for sharing. My mother is finally going to nursing school or trying to work her way there, after having breast cancer, 4 surgeries, two jobs, and a divorce all in one year. I don't know how she is doing all of that. I am amazed that your mother in law is going back to school late in life. That's wonderful. You are never too old to learn. Faith Vaughn, RN, BSN NC Carla Kimmons 30 Jan 07 7:53 PM MST Karen, our policies are facility specific. Unit managers must have a BSN. This was implemented four years ago, and those without a BSN were given four years to start and complete this degree. Our organization gave tremendous financial and resource support to nurses needing to achieve this goal. This year, when the deadline arrived, two nurse managers had failed to meet the requirement and were relieved of their positions. No one considered this harsh, as the support and means to achieve this requirement were provided. Two years ago, the policy was initiated that Directors and higher Administrators have a minimum of MSN. This year all nurses in a formal staff education position are also required to have, or be working on an MSN. Overall, there is much support and acceptance of this standard. Most staff nurses are now BSN several are working on their MSN. As a lot of nurses engage in the educational journey, there's a lot of sharing and appreciation of the new knowledge base. Advanced degrees are becoming a part of our culture and an expectation. It's taken a long time to get to this point and it's been gradual. Good luck and enjoy the journey!! It is a tremendous amount of work, but the growth that results is worth it! Respond iconRespond Karen Kelsall 30 Jan 07 8:21 PM MST Carla, Thanks for sharing those answers with me. It will be interesting to see as the Magnet journey unfolds in my organization how they handle the lack of higher education by managers and educators. I have been doing some research this week on Magnet in my institution and am amazed at thinks that have already been put in place that I was not aware of. It is exciting to see so many things come into alignment throughout the institution. I have always favored my department for being on the edge of advancement but now I am seeing that it is not just isolated to just one area. I think it is also great that a definitive plan was offered out for them to follow for gaining their higher education and that a financial support system as well as resources were extended to them. It shows that the institution really cares about the individual and not just acquiring something. That goes a long way in my book. If choices were made my those involved not to seek the higher education then at least they know that there were other options for them. As I mentioned in my last note, I hear some say they are too old to return to college. I have to say that increasing ones knowledge base is something we should all be doing on a continual bases. It is encouraging to hear that you have so many BSN and MSN prepared staff nurses. Again kudos to your facility for extending these resources so all can take part in the journey. Karen Kelsall PA Mary Arnold 30 Jan 07 9:15 PM MST Carla & Karen: At a hospital facility that I worked at in Las Vegas, several years ago, it was customary to have those nurses with a BSN be a charge nurse. It was not allowed to have an associate prepared be a charge nurse. That was the norm there and it was not a magnet facility. I think things like this will start becoming more of the norm. Mary Lynn, RN, BSN IL Jack Yensen 30 Jan 07 10:13 AM MST Hi there: as a reminder, this week, in examining the 14 forces of magnetism, you will be reserving one of the following topics: Quality of nursing leadership (Faith) Organizational structure Management style Personnel policies and programs Professional models of care Quality of care Quality improvement Consultation and resources Autonomy Community and hospital Nurses as teachers Image of nursing Interdisciplinary relationships Professional development (Carla) To ensure that all 14 forces of magnetism will be represented on the Discussion forum, selections will be made on a first-come, first-served basis. Note: You may not post to a topic that has already been selected until ALL topics have one posting. If you wish to reserve a topic, but are not ready to post yet, simply make an initial response, noting, “Posting to come.” This way your colleagues will know that you have committed to this selection. Since Carla has already posted to Professional Development and Faith has reserved Quality of nursing leadership, you cannot post to either of these (responding is fine) until all topics have one posting. Thank you. Jack Linda Hinnant 30 Jan 07 3:38 PM MST Carla Your post on the Professional Development force was very enlightening. There were several new learning’s for me especially since I have not traveled the magnet road as of yet (but would like to). I value the various resources and educational opportunities that are available right at our fingertips to help us grow as nurses. In my current practice we have similar benefits available, with the exception of an on site library (we only have an online library). However, in spite of these opportunities nurses in my current practice are often resistant when asked to participate in in-services and/or career development opportunities, which may be a problem if we begin the credentialling process. According to Drenkard (2005) the Professional Development, force requires emphasis on “orientation, in-services education, continuing education, formal education, and career development for nurses.” During the magnet application period did the surveyors look at how many nurses utilized their educational benefits? Was it difficult to motivate/encourage staff to take part in professional development? You also mentioned that most of your staff holds either a BSN or MSN and certifications, is this one of the requirements for Magnet status or was it the results of the generous reimbursement program that your company offer? Reference: Drenkard, K. N. (2005). Sustaining magnet keeping the forces alive. Nursing Administration, 29(3), 214-222. Date Modified: 30 Jan 07 3:40 PM MST Carla Kimmons 31 Jan 07 2:15 PM MST Linda, The evidence that is submitted for the process must contain data on educational resources and utilization of those resources. If the evidence and documention is accepted and you progress to the on-site visit, the on-site reviewers will randomly ask staff nurses about the educational resources they have used. Our nurses have been motivated by the reimbursement program and also by the positive patient outcomes we experienced through implementation of evidence-based protocols. Our journey toward a culture more positive in attaining advanced degrees faced the challenge of our hospital-based diploma program and many AD programs in our area. The implementation of evidence-based practice and standard of care protocols validated, to many nurses, the need for continued education. As we experienced positive outcomes such as 0% VAP in our critical care units, from implementation of protocols, nurses became more responsive to research. It is a slow process and it requires unwavering leadership to push through the resistance.Please don't think we are 100% BSN/MSN. We are not. However, we have a significant number who are, and those who do not, are engaged in programs or are being encouraged to do so. Obviously, there will be some who chose not to progress. The requirements of the Magnet recognition program was a big incentive for many of the changes we undertook. Leadership began looking at the Magnet process about 3-5 years before actually beginning the application journey. A lot of planning and preparation occurs. Achieving the recognition is wonderful, but it is not a destination. The journey is ongoing and sustaining the high standards is a challenge. Date Modified: 31 Jan 07 2:20 PM MST Linda Hinnant 2 Feb 07 6:49 PM MST Carla Thanks for your response and the heads up how your organization began looking at the Magnet process about 3-5 years prior to beginning the magnet journey. As I develop my presentation to our leadership I will include this information, knowing that planning/preparation is done over time will help get things organize. I a agree this will take a lot of planning, preparation and eventually a change in culture. Linda Margaret Imbrock 30 Jan 07 7:53 PM MST Carla, You mention that higher levels of education improve your facility's overall quality of care, communication and work environment. Have you read any of the studies done on the impact of higher education on mortality rates? Have you noticed any changes in failure to rescue rates or improvement in mortality statistics? Respond iconRespond Carla Kimmons 1 Feb 07 4:20 PM MST Margaret, In regard to our facility specific mortality rates, we are continuing data collection and are seeing a consistant downward trend with in-house deaths and failure to rescue rates. Several contributing factors are present. Standard protocols in place, allowing earlier intervention by nurses, and implementation of our Rapid Response Team, are two significant factors in our improving statistics. The main impact of the Magnet process, for us, was the increased awareness and experience of applying the research-based protocols to our everyday nursing practice. Seeing our patients having improved results validated the importance of Structure, Process, and Outcomes. (Kramer & Schmalenberg, 2005) Kramer, Marlene & Schmalenberg, Claudia E. (2005). Best Quality Patient Care: A Historical Perspective on Magnet Hospitals. Nursing Administrative Quarterly. Vol 29. No. 3. pp. 275-287. Retrieved via Ebscohost February 1, 2007. Respond iconRespond Kimberly Pendrey 3 Feb 07 9:07 AM MST In the clinical area that you discuss, are these the levels used for the basis of hiring or new employment? Are these the levels that they use to determine pay rates? What is the special recognition given to employees that are within the clinical ladder? I think it is a wonderful opportunity for nurses that the organization they work for offers professional development growth and continuing education. The hospital I am employed at is a magnet facility and it offers educational and professional developments. It also offers tuition reimbursement for nurses continuing education programs. The professional development practices are a successful contribution to magnet status. Respond iconRespond Karen Kelsall 30 Jan 07 11:30 AM MST Not exactly sure where to post the notice that I will be doing Autonomy as my force for the Magnet discussion. I placed it under the autonomy section, but will note it here as well. Plan to post by tomorrow. Thanks Karen Kelsall PA Linda Hinnant 30 Jan 07 3:46 PM MST Karen and Class From my understanding your post should be under the particular Magnet force you selected. For example you selected Autonomy--your post should be under the "Autonomy Force", I selected Nurses as Teacher, my completed post can be found under "Nurses as teachers". Hope this helps. Linda Jack Yensen 30 Jan 07 12:45 PM MST Travel Day Hi there: I have responded to the week 4 discussion posts and completed my first pass reading of each of your week 4 applications.Tomorrow (Wednesday) I will be travelling most of the day and therefore it is unlikely that I can respond in real time to either email or discussion posts. However, I will play catch up, first thing on Thursday morning, followed by my feedback on your week 4 applications. I trust this will not inconvenience anyone. Thank you. Jack Krista Winslow 30 Jan 07 1:46 PM MST Management Style: The magnetism force I selected is management style. According to the ANCC website, management style as a magnetism force is described as "Both hospital and nursing administrators use a participative style, encourage and value staff feedback. Nursing leaders are visible, accessible and communicate very effectively with staff" (http://www.nursecredentialing.org/). Grossman & Valiga, 2005, state that the participative management style is part of transformational leadership and "expects employees to be part of the decision-making process" (pg. 70). Is this force evident in my organization? That is a hard question because from my point of view as a staff nurse I don't feel like it is. But I don't know much of what goes on off of my floor. I do think nursing leaders are visible, but I guess I will find out soon if they are "accesible and communicate with staff" while I am interviewing about magnet status for the application. Of course employees are part of the decision-making process, but what employees? My observation is that only those high up in management and very few (if any) who are directly involved in patient care make decisions about what is best for the hospital. One way to move in the direction of being aligned with this magnetism force is to have all kinds of employees be involved in decision making. Upper management, floor nurses, housekeepers, social workers, and others should all have a say in what goes on. Mason, Leavitt, & Chaffee (2002), stated, "ANCC magnet hospital designation is a valid marker of good nursing care. Magnet recognition ensures that patients will get the very best in nursing care available at a facility that is recognized as among the best in the nation" (pg. 327). Although my facility is working on magnet status, more needs to be done before we can say we have "the best nursing care in the nation". Sources: Grossman, S.C. & Valiga, T.M. (2005). The new leadership challenge: Creating the future of nursing (2nd ed.). Philadelphia: F.A. Davis Company. Mason, D.J., Leavitt, J.K., & Chaffee, M.W. (2002). Policy and politics in nursing and health care (4th ed.). St. Louis, MO: Saunders. American Nurses Credentialing Center. (n.d.). Forces of Magnetism. Retrieved January 29, 2007, from http://www.nursecredentialing.org/ Date Modified: 30 Jan 07 1:47 PM MST Latoya Hagood 2 Feb 07 4:54 PM MST Krista, one way to have all kinds of employees involved in decision making is through a shared governance model. This allows employees at all levels to have their voice heard. Latoya Hagood (SC) Laura Ballance 30 Jan 07 7:44 PM MST Professional Development Posting can be found under number 14 for Professional Development. Thank you. Laura Ballance Karen Kelsall 31 Jan 07 10:21 AM MST Week Five Discussion: Forces of Magnetism ~ Autonomy Posting can be found under force 9 Autonomy of pull down arrow. Thanks Karen Kelsall PA Faith Vaughn 31 Jan 07 7:10 PM MST In today’s health care system it is difficult for nurses to have a “supportive care environment that satisfies nurses and ensures patient safety”(Quality of Nursing Leadership, 2004), because this “requires outstanding nurse leadership”(2004). These days it is difficult to find quality nursing leadership, and only a few hospitals are recognized with Magnet status. In fact, “Approximately 3 percent of the nation's 5,700 hospitals and healthcare organizations have been recognized with Magnet status” (2004). If the nursing leadership team would communicate and focus more on patient and nursing satisfaction, then they would be surprised how loyal nurses would be to the company. Nursing leaders and managers have to work diligently on “continuous quality improvement, strategically manage resources, ensure collaboration, foster lifelong learning, and facilitate empowering care delivery models that raise the level of nursing practice within the organization” (2004). According to the website, the descriptions of a nurse leader are as follows: “innovative, risk-taking, dynamic nurse leaders”, which they say are usually “found at Magnet institutions” (2004). My company is not a hospital, and I do not know if we can obtain Magnet status, but I do know that this company truly listens to the nurses, because they tell us that we are the ones who make a difference in patient’s lives. Faith Vaughn, RN, BSN NC Quality of Nursing Leadership, (2004). Retrieved on January 31, 2007 from http://www.medscape.com/viewarticle/473683_2. Betty Barrow 31 Jan 07 8:04 PM MST Faith, I'm not sure that I agree with your statement that "it is difficult to find quality nursing leadership." You support that by citing that only 3% of hospitals and healthcare organizations have achieved Magnet status. I work at Vanderbilt University Medical Center and we just received Magnet recognition in December of 2006, but we've had wonderful nursing leadership for a lot longer than that and for much longer than the amount of time it took us to take the Magnet journey. I've also worked in lots of other places that had great leadership and they were not Magnet hospitals either. I believe that all Magnet hospital have great leadership, but not all organizations with great leadership have been recognized as Magnet hospitals. In most places where there's competition for nurses, the nurses in the area know which organization is the best to work for, so that organization is a magnetic for the nurses in that community. That magnetism is likely related to pretty decent leadership or nurses wouldn't be as likely to want to work there. Have you not worked in places with quality leadership? Also, keep in mind that Magnet recognition is still a pretty new phenomenon so not all hospitals are at a point that they are eligible to apply or ready to do so. That doesn't mean that they don't have quality nursing leadership. I'm glad you work in an organization that listens to the nurses as that is part of several of the forces of magnetism. Betty Barrow Tennessee Jack Yensen 1 Feb 07 2:24 PM MST Origins of Magnet Ideas Hi there: prompted by Betty's germane observations, I am curious to see if anyone has thought about looking at the origins of Magnet ideas from the original 1980s work by Kramer and Schmalenberg. I was further interested to see a posting by Margaret, who asked some incisive questions in the "so what" category, i.e. does Magnet status make any real differences to patient outcomes? That's a bold question, but one that needs to be asked. Perhaps some of you will have time to do a quick author search on Kramer and Schmalenberg in PubMed and determine if there is any evidence basis for Magnet claims. Jack Carla Kimmons 1 Feb 07 4:35 PM MST As part of our process, we did extensive reading and research into the qualities and statistics associated with the original hospitals in the 1980's studies. We were impressed with the lower mortality rates, shorter patient stays, reduced complications, and increased nurse retention. Honestly, the statistics in the articles were, and are impressive.I must say that real life experience of the Magnet process is a slow transformation and often filled with concerns and doubts in terms of cost, realistic expectations, and long-term benefits. Two years later, we are seeing improved patient outcomes and a higher satisfaction rate with patients, families, and staff. Even with our current lay-offs and work redesign, the communication and coping ability of our organizational "family" is much better than before we experienced the Magnet process. The Magnet process is not the changing agent itself- Each Force of Magnetism is a "mini-course" in developing new processes of achieving specific goals. You have to research, analyze, evaluate, and then perhaps redesign some aspects of your organization. The Magnet process is excellent. I do agree that the expense is out of touch with reality and a huge obstacle for many high quality hospitals. Respond iconRespond Jack Yensen 1 Feb 07 4:49 PM MST Carla: it will not have escaped your attention that the Magnet process and experience (see http://www.nursecredentialing.org/magnet/apply/fees.html) is a huge revenue generator for ANCC (a component of ANA), which along with its accreditation programs provides a rich revenue stream. Just as there is no substantive evidence base for the impact of accreditation on the outcomes of continuing education, there is insufficient evidence that the Magnet designation itself is causally linked with staff and patient outcomes. It would be very interesting to conduct a discriminant analysis on hospitals of excellence to see if one could predict quality outcomes based upon the presence or absence of Magnet designation or experience. Jack Carla Kimmons 2 Feb 07 3:26 PM MST In my opinion, any organization can achieve the same outcomes that the Magnet designation claims. It's the process that Magnet forces the organization to go through, that actually stimulates the culture changes. Human nature seems to require a certain level of pressure to initiate and incorporate change. We tend to want to stay in a comfort area and only expand when forced to. "Magnet" is a marketing dream. They packaged some very challenging professional goals as "Forces", created strategies, and then put a big price ticket on it. One of the issues I had with our original process and now it's being repeated in our re-application process, is the contracting of a Magnet consultant. Talk about a price tag! She comes in during various phases of the process to evaluate, make recommendations, and guide the organization to successful documentation. To me, the organization should initiate and go through the process with it's own personnel. Some of our culture changes have taken root, but others are struggling. Without the internal, "home-grown" effort, any change or recognition is empty. The principles organized under the Magnet umbrella are the gold standards for any effective health care organization. The Magnet process was effective in our setting due to the administrations "good ole boys club". The Glitz of Magnet recognition appealed to them and so we were able to initiate changes that otherwise would not have occurred. If they had understood the transformation that would take place, they would not have been so supportive. Laura Gasparis makes a valid point in stating that if Magnet designation has the effect of improving patient care, it should be mandatory rather than voluntary. (RN, May 2006) Magnet is another example of the struggle we face in our healthcare profession. In order to achieve recognition, we must create an expensive package to assign value to what we do. I do support the the criteria/processes emphasized in this program. The program itself is not the source of successful outcomes. Gasparas, Laura. Get Real! Does Magnet Have Merit?. RN Magazine. May 2006. Vol. 69. No.5. Mary Arnold 2 Feb 07 7:08 PM MST Carla: You make an interesting point. I do agree that "Magnet" is becoming a marketing dream, and that they have packaged very challenging professional goals. They are good goals, but I feel that if all the staff are not initiators of the forces, they may not be obtainable goals for the facility, and therefore only struggle to achieve such recognition. Mary Lynn, RN, BSN IL Margaret Imbrock 2 Feb 07 8:36 PM MST Betty and Faith, In regards to the quality of nursing leadership force, have you read the ANA Scope and Standards for Nurse Administrators? This is a document I am just beginning to digest. ANA (2003) ascribes responsibility and accountability for the overall management of nursing practice, nursing education and professional development, nursing research, nursing administration, and nursing services. The policies, programs, and services are to be evidence-based and consistent with professional standards and values. The Chief Nurse Executive must have a bachelor's degree and MSN as well as an active registered nurse license. ANA would also like to see a doctoral degree and a nationally recognized certification (ANA, 2003). The nurse executive is also responsible for a system wide budget, needs to be visionary, acts as a change agent and practice innovator, assures nurse participation in decision-making, and directs system wide nursing quality initiatives. The CNE also acquires resources for nursing to continue operations. The CNE needs to be visible to the staff and lead by example. This person represents and negotiates for the profession of nursing at the executive level. Until about 12-16 years ago I could not say that my CNE fulfilled these characteristics. It has only been about 16 years that our CNE became a member of the hospital's executive team. Prior to that time she had to report to a VP and did not have direct responsibility for the nursing budget. We have progressed. I cannot say that she had a "bad" leadership style, it was the time in nursing. Today is different, we are looking to advance the profession of nursing. Our current CNE has encouraged and provided the initiative and support to attain the magnet designation. Reference: American Nurses Association, (2003). Scope and Standards for Nurse Administrators (2nd ed.), pp.1-11. ANA: Washington, DC. Date Modified: 2 Feb 07 8:38 PM MST Faith Vaughn 2 Feb 07 9:11 PM MST Betty, I have worked in hospitals with very bad leadership, and it just so happened to be one reason that I was so burnt out from the floors that I worked on. Not one manager was very supportive of my decisions, and they did not listen to the nurses. I know that the last hospital I worked for was trying for magnet status last year, and I thought it was a world reknowned hospital, but I can tell you one thing, the floor that I was working on really needed new leadership. I don't want to say the name of the hospital in case someone in here gets offended. I am glad that you have been influenced by good leaders, but for me they have been few and far between. I worked on mostly Medical/Surgical floors, but I have found great leadership now that I work in an office setting. Most of the leaders are great, but a couple of them could use a little more experience and training in a managerial role. Faith Vaughn, RN, BSN NC Betty Barrow 2 Feb 07 11:59 PM MST Faith, I guess I have been fortunate. I, too, spent most of my career in med-surg and was even a manager of a med surg unit at one time. I sure hope no one saw me as a bad leader. Betty Latoya Hagood 2 Feb 07 4:59 PM MST Faith, my organization has not reached magnet status do far. Actually, there is only one organization in South Carolina that has reached magnet. Magnet is our goal, and each year we take steps and make changes that will move us closer to becoming magnet. Latoya Hagood (SC) Faith Vaughn 2 Feb 07 9:31 PM MST Latoya, Are you taking part in your organization to reach magnet status? If so what are you doing, and if not, do you an increase in patient and nurse satisfaction in your hospital? Faith Vaughn, RN, BSN NC Latoya Hagood 3 Feb 07 11:02 AM MST I am currently participating in a new shared governance program. We also do daily patient rounding and discharge phone calls to increase our patient satisfaction. We also have just received a grant that will go towards a new meal program for our patients. I really believe my organization can do more to increase nurse satisfaction. Right now we allow our nursing staff to do self scheduling. This gives them more flexibility and increases satisfaction because they know that no one else does their schedule. We also have tuition imbursement. Previously we had tuition reimbursement, but many employees did not have the cash to put up front towards tuition. Because of suggestions from employees, human resources has changed the program to tuition imbursement. Latoya Hagood (SC) Jack Yensen 2 Feb 07 3:43 PM MST Confusion with 14 discussion areas Hi there: it seems as though there may be some confusion about where to post on your given magnetism attribute. Unfortunately, we are too far advanced in the week to rectify any logistics. Some of you have posted in the "main" area (which is actually for Quality of Nursing Leadership) and others in their respective areas. Please be assured that I will find and read all posts, no matter where they are posted, as your contributions are important to me. Thank you. Jack