Magnet Hospitals: It’s About the Process, Not the DesignationJanuary 23, 2012
When I had a recent medical emergency, I went to the local community hospital near my home in northern New Jersey. I had been there before for outpatient testing or to the ER with a child and found the care attentive and efficient and the staff friendly and professional. Besides, it was a Magnet-designated hospital, so I was confident that I’d receive good care.
The ancillary staff was wonderful, but I found myself disappointed with the nurses on the acute med/surg unit where I was located. There was no rounding that I was aware of, and they seemed to only show up when it was time to administer meds. Only a few nurses introduced themselves, and only two nurses over three days really engaged me in any conversation. Nurses seemed to respond to call lights only for those patients to whom they were assigned. The unit clerk who promptly answered the call light intercom would say, “I’ll let your nurse know and she’ll be in soon”—when I asked for pain medication, she told me “your nurse is giving report; I’ll let her know when she’s finished.” I waited uncomfortably for more than half an hour.
There were whiteboards, but often the information—especially regarding the date and the name of the nurse—was unchanged from day to day and no longer accurate. (This was annoying, in that they kept asking me what date it was and I kept getting it wrong!)
The worst, though, was the noise level at night. I’ve worked nights, and I know it’s easy to forget to keep conversations hushed. But this unit was a good example of those that are as “noisy as chainsaws” (see our recent post on this). I was two doors down from the nurses’ station and I could hear every conversation, people singing holiday carols, detailed discussions of patients (forget HIPAA!). Requests that they reduce the noise made no difference. One night, I learned every detail about one nurse’s vacation plans while she and a colleague spoke in normal, conversational tones, occasionally laughing, while providing care to the elderly woman in the bed next to me at 2:30 am.
When I asked if they could speak a bit more quietly, one of the nurses angrily pulled back the curtain and told me that I had to understand that they needed to take care of the woman and would be done shortly. She then resumed talking about her vacation. I barely slept at all the three days I was there. It was exhausting, and I was happy to get home.
A few days later, I was admitted to a large teaching medical center in Manhattan, where I stayed for 10 days. The contrast was startling. The ICU nurses were incredibly attentive and supportive; they made me and my family feel that I was safe and in excellent hands. On the med/surg unit, the nurse manager introduced herself when I arrived. My assigned nurse for each shift would introduce herself and ask me if I needed anything; she came by frequently, even if only to poke her head in the room and say, “Everything OK?” Nursing assistants likewise introduced themselves and would inquire if I needed anything.
Yes, one or two nurses seemed to wish they were elsewhere, but by and large, the nurses at this hospital were engaged and patient focused. I saw and felt the presence of nurses at all times, and it made me feel safe. And blessedly, noise levels were low. This facility, while not designated a Magnet hospital, clearly held their nurses to a high standard of practice comparable to Magnet principles. (This is why we must be careful in comparing outcomes from “Magnet” versus “non-Magnet” facilities.)
Perhaps the unit I was on in the local community hospital had a poor nurse manager and didn’t hold staff accountable to a high standard of care. I wonder if the nurse manager there ever made rounds to see how patients were faring, or asked patients if they knew who their nurses were. I never saw him or her.
I want to be clear that I support the Magnet program, but appraisers—and nurse executives and managers at Magnet-designated facilities—must be vigilant in assuring that their organizations do not become complacent once they have achieved Magnet designation. Otherwise, it will have no meaning.