Evidence Based Nursing: The Magnet Hospital Model

Evidence-Base practice (EBP) is defined as: “based on problem identified from the practitioner’s area of practice; a combining of best evidence and professional expertise and an integration of this into current practice; about ensuring patients receive quality care, being part of quality improvement processes; about collaboration and requiring a team approach” (French, 1999). Scott and Mcsherry (2008) supported the French’s assertion, proposing the key elements of EBP are that it is a theory-driven process, which involves the use, evaluation and application of research; identification of best evidence; evaluation of care; problem solving; decision-making; clinical expertise; and requires patient involvement. Evidence-based practice is made of evidence, clinical expertise, patient preference, the context of care (Barker, 2013). In brief, evidence-based practice is the parameter in the nursing practice that it requires that the nurses gather and use clinical evidence to make decision for the patients so that in the nursing process they can deliver the quality of care for the patients (Ellis, 2013). In the other words, in the nursing practice all the nursing procedures performed by the clinical evidence supported.

As a provider of care, professional nurses depend on research, theories, and evidence based practice to guide the care they provide to patients. Nurses deliver care to their patients based on information they have learned through many years of school and training. Training for nurses and other providers of care is founded on theories, research, and evidence based practice in the healthcare field. Theories, research, and evidence based practice are all important for providing care to patients and each can be used in a different manner depending on the situation. Clinicians often use research based evidence to design and implement care that is high-quality and cost effective for patients. Evidence based practice can be used to provide care to patients in a steadily changing clinical environment. (PDF page 8-9). Nursing theories are frequently used as frameworks for establishing nursing care interventions and assessing

Evidence based practice is an integral part of nursing care. According to the Academy of Medical-Surgical Nurses, evidence based practice is defined as, “the conscientious use of current best evidence in making decisions about patient care.” (AMSN) The use of evidence based practice has drastically improved patient outcomes, increased quality and safety of healthcare, and reduced costs for facilities. (Melnyk, 2016) In this paper I will provide the history of evidence based practice, how it has already been incorporated and impacted healthcare, and why it is important to nursing and healthcare as a whole.

Evidenced Based Practice (EBP) is essential to enable all nurses to provide the most current up to date practises for their patients. This process involves research, systematic review of current practises, critical thinking skills, evaluation and application to the clinical setting. In addition to this, the nurse must take into account the patients’ preferences. For nurses to have professional autonomy they must be able to justify their actions and demonstrate an understanding of why they perform the tasks they do. This defines them as unique professionals judged by their knowledge and not simply by their hands on skills.

Magnet asks healthcare organizations to define their philosophy because it is the leading resource for establishing effective and efficient nursing practices. (Magnet Monday, n.d.). This magnet is a landmark behind the success of certain hospitals with low turnover rates, better quality of care, decreased length of stay, and improved outcomes. (Magnet Monday, n.d.). American Nurses Credentialing Center for Magnet status is a prestigious award that not all hospitals attain. Those who are Magnet status have higher nurse retention and satisfaction, improved quality of care, less nurse burnout, and lower mortality rates

There is no one definition for philosophy of nursing, there are many that can help illustrate its meaning. According to Cherry and Jacob (2010) philosophy is the set of values and beliefs that guide the actions of the organization and serves as the basis of all planning (p. 344). All nurses should be mindful of the mission and philosophy of their employing organization as well as recognizing the connection between their own intimate values and the organizations. Schrock (1981a) “points out that philosophy of nursing is often mistakenly construed to refer to an ideology of nursing” (p. 1089). Schrock also states some examples like nurses are born, not made and nursing is an art based on common sense (Schrock, 1981a, p. 11). As nurses, understanding our profession helps us to focus more on the care of the patient and improving how we approach different situations.

Itroduction: Evidence-based practice is an approach to medicine that uses scientific evidence to determine the best practice (Beyea & Slattery, 2006). As nurses perform their daily tasks they must continually ask themselves, “What is the evidence for this intervention?”. Nurses are well positioned to question current nursing practices and use evidence to make care more effective. In order to improve patients’ outcomes it is the responsibility of the nurse to transition evidence-based practice into the norm, through application of daily practice (Flynn Makic, Rauen, Watson & Will Poteet, 2014). Continual evaluation of current practice must be performed to ensure the use of evidence-based practice opposed to practice based upon tradition. The implementation of evidence-based practice standardizes healthcare practices and diminishes groundless variations within care. These variations lead to the production of uncertain health outcomes (Stevens, 2013).

Within this essay Evidence based Practice will be identified and the significant effect it has on the nursing profession, barriers will also be explored in the implementation of Evidence Based Practice.

In the early 1980s it came to light that while the supply of nurses had reached a record high, only 80% of hospitals nationwide had adequate nurse staffing levels (American Nurse Credentialing Center, 2011, p. 8). To address this issue a taskforce was formed within the American Academy of Nursing (AAN). Through an initial study of 165 hospitals, the AAN determined the characteristics of healthcare organizations that were magnetically attracting and retaining nurses as employees (American Nurse Credentialing Center, p. 9). In this study the AAN found “Forces of Magnetism” that contributed to the high level of job satisfaction amongst nurses, superior quality of care, low job turnover, and high level of nurse involvement in leadership, decision-making, and research. In the early 1990s, catapulted by the findings of this initial study, the American Nurses Credentialing Center (ANCC) developed the Magnet Recognition Program. The intention of the ANCC’s Magnet Recognition Program was threefold: To reward hospitals that demonstrated “excellence in the delivery of nursing services to patients;” to encourage quality in the nursing work environment to support practicing professional nurses; and to guide navigation for the dissemination of evidenced-based clinical nursing practice (American Nurse Credentialing Center, 2011, p. 14).

The American Nurses Credentialing Center (ACNN) sponsors the Magnet Recognition Program, which focuses on the development of nursing practices and evaluates the environment where nursing is practiced. This program is well recognized by organizations throughout the country, as the Magnet Journey and is considered to be one of the highest achievements that organizations can obtain (Broom, & Tilbury, 2007). Organizations that strive to achieve the Magnet designation, acknowledge the link between a healthy work environment and the development of an organization of nursing excellence. Hospitals utilizing the Magnet concept demonstrate the following characteristics; (a) authentic leadership, (b) skilled communication, (c) effective decision making, (d) quality patient care processes, (e) collaboration and teamwork among all healthcare workers, (f) professional growth and accountability, (g) clinically competent staff and (h) adequate staffing levels (Shirey, 2006). All the above components

Magnet hospitals are named for their potential to attract and retain qualified nurses. Magnet hospitals are facilities that have been certified by the American Nurses Credentialing Center for promoting positive patient outcomes through best practices in nursing (Upenieks, 2003). The Magnet environment fosters autonomy and professional nursing practice. Research shows that Magnet hospitals have better work environments, a more highly educated nursing workforce, superior nurse-to-patient staffing ratios, and higher nurse satisfaction than non-Magnet hospitals (Aiken, Kelly, & McHugh, 2011). Implementation of that environment requires the ability to create trust, accountability, and open communication in changing times.

The researchers surveyed 3186 nurses on staff at 56 hospitals; 52 academic hospitals and 4 non-academic hospitals. The researchers compared the results of the nurses’ surveys with information about the location of the hospital (rural or urban), the hospital environment (managerial support, good relationships among team members, the nurses’ involvement in decision-making), the nurses’ educational levels, and the staffing (nurse:patient ratio). The researchers also interviewed nurse managers and leaders to evaluate their input on nurse retention and nursing shortages in a qualitative portion of the study. In the article “Effective strategies for nurse retention in acute hospitals: A mixed method study”, the researchers state “the results show that nurse staffing and the quality of the nurse practice environment (i.e. managerial support of nursing care, good relations between doctors and nurses, nurse participation in decision-making and organizational priorities on quality of care) are significantly associated with intention-to-leave the hospital” (Van den Heede et al., 2013, p. 192). This association is related with increase nurse satisfaction with environment and staffing is related to decreased intention to leave the hospital, or an inverse relationship. These researchers also shed light on the fact that Magnet hospitals have far better nurse retention and nurse satisfaction. Thus, focusing on and achieving a Magnet status can be an effective

In the early 1980s there was a significant nursing shortage and high turnover at hospitals. Research by the American Academy of Nursing recognized forty-one hospitals that attracted nurses to work at their location because of their more collaborative and supportive work environments. These hospitals were more effective with filling nursing job vacancies compared with similar hospitals. The American Nurse’s Credentialing Center (ANCC), an organization of American Nurses Association developed a voluntary recognition program to formally credential Magnet hospitals, and the first Magnet hospital was credentialed in 1994 (Kelly, 2011). ANCC review certain criteria that are design to measure the quality and strength of nursing practice at the hospital. Nurses who work at these Magnet hospitals have higher job satisfaction and reports that they have better communication between the nurses and other healthcare team. Most importantly, Magnet hospitals have high quality nursing care, better patient outcomes, and high patient satisfaction.

In nursing, evidence-based practice relates to the preferential usage of interventions for which qualitative and empiric research has rendered evidence of substantial efficacy for certain issues in nursing care. The collection, analysis, and integration of crucial, relevant, and pertinent research-driven, patient-reported, and nurse-observed evidences are promoted by evidence-based practice. Another instance or illustration of evidence-based practice is the systematic study of care theories and their implementation to patients. Hence, these attempts act upon against rationalizing of nursing practice on shaky knowledge—solely on the basis of other nurses’ experience—devoid of scientific evidence on which nursing practice can be established.

Evidence-based practice (EBP) in nursing means making decisions about patient care on the basis of best, current, standardized practice and guidelines. According to an article, written by Dr. Kathleen Stevens, the development of evidence-based practice (EBP) is fueled by the increasing public and professional demand for accountability in safety and quality improvement in health care (Stevens, 2013). The author also mentioned in her article that the intended effect of EBP is to standardize healthcare practices to science and best evidence and to reduce illogical variation in care,