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Could we learn something from the US about nursing excellence?


The Magnet Award is given to hospitals that are judged to have reached excellent standards of nursing care in the US, and it inspires and enthuses the nursing workforce that achieve the accreditation.

Could a similar system work in the UK though or do nurses feel too ignored and downtrodden to believe it could change things?

I was at a conference last week listening to speakers talk about a new way of pushing excellence in UK nursing, when someone sent me a tweet saying that something had to change in nursing because it could not go on the way it is.

I was struck by the truth in that sentence – it is a fact. If we leave nursing be and don’t invest in it, inject resources, new thinking and get the workforce organised differently, the profession will wither on the vine – and patients will suffer as a result.

So what was the conference that I was attending? It was the UK’s first Magnet Conference, which was held last Friday.

“Evidence was presented at the event that by year three they start to realise savings”

For those of you who don’t know, Magnet is a US-originated system that recognises nursing excellence, and the Magnet philosophy is now being spread in healthcare organisations across the globe. It sets a standard for nursing, and compels organisations to respect the value and contribution of the profession, and invest it in appropriately to achieve those results. Hospitals that meet a rigorous set of criteria are awarded Magnet accreditation, and have to work hard to maintain that status.

Far from being a tick box exercise, the Magnet system keeps leaders, managers and nurses focused on best practice, innovation in nursing, and quality experiences for patients and staff. And, although the system has initial set up costs, evidence was presented at the event that by year three they start to realise savings, mainly from better staff recruitment and retention, as well as greater quality outcomes.

The conference was organised by Oxford University Hospitals Trust and Nottingham University Hospitals Trust, who are each vying to become the only Magnet hospital currently in the UK.

Videos were shown of the Magnet Conference in the US, which is a nationwide event hosted at Universal Studios in Orlando, Florida.

By way of contrast, the first UK Magnet event last week was at the National Motorcycle Museum, just off the M6.

“Their sense of empowerment has been nurtured instead of being eroded”

The US version had a cast of thousands of nurses and an awards ceremony with razmataz, and more glitter, pom poms, pink stetsons and feather boas than a West Midlands conference venue can stomach.

But the spirit was arguably the same at both events. There was the same conviction that nursing is the route to improving care and the same pride in the eyes of the delegates. The only difference is that in the US they clearly believe it and live it. Their sense of empowerment has been nurtured instead of being eroded.

Here in the UK, that pride is dwindling. Pushed to the limit by scarce resources and even scarcer pay rises, it feels like nurses’ passion is being worn away. That is why this interest in Magnet – and also Pathways to Excellence, a bridging partner programme, that is being followed by Northampton General Hospital – is a much-needed boost for the profession.

Concerns I have heard about the Magnet programme are that it is overpriced, and unsuitable for these shores, where we fail to hug it out in the workplace. However, even hardened nurse leaders I’ve met have been convinced of the power of Magnet to improve nursing’s morale and make real, tangible differences to the quality of care delivered – without requiring additional funding in the long term.

As Oxford’s Magnet programme director Professor Dickon Weir-Hughes said: “We are really poor at celebrating best practice in this country.” Quite right. Nurses tend to accept and absorb the knocks and criticism, but don’t shout out about the contribution the profession makes. If Magnet changes all that, I for one am prepared to find out more about it.


Readers' comments (13)

  • Most of my nursing practice (last 25 years) was in the States where I did my degree nursing. My previous employment was with one of the first hospitals to achieve Magnet status (University of Colorado). I agree with this article, there is a deciding difference between nursing here and there, not the knowledge and skills but the attitude, the support and the overall professionalism of the art and science of nursing. Nursing is held at a higher standard with the public and the nurses in the US are 'empowered' to excel, are confident in their roles and are 'nurse led' not the handmaiden of the doctor. We all own stethoscopes and use them. We assess, plan, implement and evaluate. We do all the physical care but also are the leaders in discharge planning, prevention and well being. We are pro active, we sit alongside the medical team, partners in care and the patient advocate. And it is a working wage that you do not have to do 'extra shifts' just to pay for food. It is a career, not a job! Anything that the UK can do to empower nurses....I am all for it!!!

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  • Never going to happen with tory government in charge

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  • I was fortunate to have been a Nurse Executive at a hospital in Riyadh during our Magnet journey. Having started out with a huge dose of British scepticism, I became a convert. Through empowering our Nurses, skilling them up, dealing with poor performers, improving the quality of collaborating with other disciplines, increasing our focus on research and evidence-based practice and encouraging innovation at the bedside we began to see measurable benefits. These included in patient safety, in nursing practice and in the perception and experience of nursing amongst non-nursing colleagues. Nurses on my units knew their quality data and could readily speak to their areas of excellence as well as those for improvement. We also used our patient satisfaction and staff satisfaction data to make meaningful changes in the way that we delivered care and worked with our staff. I am sure that there were sceptics. However, we had enough of a critical mass of engaged staff and the results spoke for themselves. We achieved our Magnet Hospital Accreditation in 2015. I have now moved to a new organisation and I am embedding the Magnet practice standards from day 1 so that it is what we do every day and not a special initiative. We will definitely be starting our Magnet journey as early as possible. There will be genuine concerns about cost from some organisations but the return on investment is worth it.

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  • no I don't like this idea, I have seen so many nurses with high standards becoming disillusioned because of being devalued and seeing their pay ever decreasing.
    An award seems futile.

    I loved nursing for what I did , my patient care, my own striving for excellence,

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  • Nursing has been effected by tick boxes and and trying to place,
    Patients in. Category.Learnt with nursing process and used individual patient care.
    Nurses in England now have developed American style nursing.
    More time on computer less with patients .Not always respected for experience.Feel check list is more to do with being sued then patient care.

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  • To note we have here perspectives not necessarily from floor level nurses. Some critique explores all show but no sense of go show. Some how input drops as soon as creditation given. Others maybe performance is for actors and subjective. I'm sure California Nurses Association and the Massachusetts Nurses Association may have something different to say and a different perspective.

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  • I'd like to know if any journalist is going to get wise to how much public money has been wasted sending NHS management to america learning stuff like this. Or the other way round if american hospitals paying for.NHS management to visit and the right to know who in the NHS has been okaying it.

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  • How much does this cost to implement? What are the identifiable and measurable benefits over any existing local less costly (?) systems? Where in the UK has it been piloted and evaluated? One essential component of nursing excellence is knowing how to express yourself in written English. What on earth does " where we fail to hug it out in the workplace" mean? What is "upskilling of nurses" ? What is such rubbish supposed to mean?

    By whom - exactly - is this wonderful system "accredited" Magnet itself? American Health Maintenance organisations {in the context of a profit making health system based on health insurance)? Nurses have enough to do already without introducing additional form -filling for no other reason than their employers have been dazzled and seduced by something of unproven and/ or questionable benefit.

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  • I have 2 separate points to make, firstly like Kathy above I was working on the floor in a hospital in Riyadh as it began its magnet journey. Myself and many of my colleagues similarly believed that it was just a process we had to go through and it wouldn't change anything, but it did start to change things. Nurses became empowered to speak out and use the skills and knowledge they already posses and build on evidence based practice to improve the quality of care provided to patients and to improve the safety of patients. It does, however, need a cultural shift in the way the hospital/trust acts and thinks and requires everyone to embrace the change that is happening.

    My second point is from a friend who recently had a baby who was in NICU in Oxford who was then transferred to a more local NICU when a bed became available. Her comments (without knowing anything about the magnet process) was that although the care received in both places was of a high standard, they were very close to requesting a transfer back to Oxford even though it would mean more travel because the attitude of all staff from cleaners to the consultants was completely different in Oxford where everybody seemed to be working together and listening to each other as equals. I think this speaks volumes as to why a Magnet Journey and the cultural shift in thinking so very important. Especially given the pressures facing the NHS when we need to work collaboratively more than ever.

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  • I was saddened when I read some of the commentary offered above because it seems to suggest that Directors of Nursing and CNOs want different things from Nurses in practice. Far from being interested in ticking boxes to look good (who has the time?), my reality is that we all want the same things; greater nursing empowerment to effect having the right RN to patient ratios, significant reductions in falls, pressure ulcers, hospital acquired infections, better pain management for patents etc. Failure to tackle these issues of course, adds cost into an already cost-constrained the system related to amongst sickness-absence of fatigued and over-worked staff and increased lengths of stay due to pressure ulcers, UTIs, falls and other untoward incidents.
    Magnet accreditation does not have to be everyone's aspiration but using best practices to improve patient care, certainly must be.

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