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  1. Koestner, Amy MSN, RN

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When one considers the word magnet, descriptors such as energy, force, or pull come to mind. Across the country, nursing is feeling the force of that magnetism through the American Nurses Credentialing Center (ANCC) Magnet Recognition Program (MRP). The MRP is the highest level of recognition, the gold standard for nursing excellence. Trauma nurses are well acquainted with the concept of gold standard as a reflection of trauma excellence.


The concept of Magnet status was developed in the 1980s as hospitals strived to solve some of the nursing challenges before them, including retention and recruitment of nurses during a nursing shortage. The American Academy of Nursing conducted a survey on nursing shortage issue in 150 hospitals, and 41 hospitals stood out as facilities that possessed qualities that enhanced retention and recruitment. In the 1990s, a new interest in the concept emerged as nursing renewed its focus on nursing care quality through outcomes and benchmarking. The ANCC Magnet Recognition Program was created. The MRP outlined 14 forces of magnetism that must be obtained to be designated as a center of nursing excellence.


As of March 2008, the ANCC released a new model configuration for the program to streamline the process, provide clarification, and avoid duplication of information documentation. The 14 forces of Magnetism were configured into 5 model components. These components are as follows:


1. Transformational leadership


2. Structural empowerment


3. Exemplary professional practice


4. New knowledge, innovation, and improvements


5. Empirical quality results



The model is focused on providing a structure that encompasses measuring quality outcomes, with acknowledgement of the global issues faced by nursing and healthcare services. These 14 forces include leadership, organization structure, policy and procedure, professional image and development, education, interdisciplinary relationships, and more.


Many trauma nursing leaders are involved with Magnet activities at some level in their center. As one reviews these 5 components and the forces within, one continues to discover more parallels to the trauma verification process and trauma nurses' contributions that fulfill both. In the 1980s, the American College of Surgeons (ACS) developed the trauma center verification program, with rigorous standards in performance improvement (PI) and patient outcome goals. Since that time, the ACS has continued its efforts in standards of excellence and created trauma systems consultation process.


The trauma verification criteria and components in both the ACS and various state verification processes align itself to the various MRP forces. In looking at the first component-transformational leadership, vision, influence, clinical knowledge, and an expertise in nursing practice are fundamental principles in achieving this goal. These are core concepts in our trauma verification process. Trauma nursing leaders have frequent dialogue with staff nurses on principles of trauma care at the bedside and exposure to new research protocols and guidelines. Nursing staff is included in various aspects of disaster planning in the emergency department, trauma intensive care unit, and surgery.


"Structural empowerment" directs hospitals to embrace a solid foundation of practice that ensures quality patient outcomes that goes beyond the walls of the hospital. This can be reflected through injury prevention activities and safety awareness campaigns with local and state agencies. How do we promote the image of nursing in our community? How are staff nurses involved in these community programs? Is there an opportunity to increase this participation and further professional development? The MRP provides further rationale for trauma leaders to promote and encourage staff nurse involvement at the local, state, and national levels.


The "exemplary professional practice" component is an opportunity to demonstrate what nursing best practice means at the bedside. These activities include family-centered care practices, multidisciplinary rounds, and evidence-based practice guidelines that are not only incorporated in care but also being reevaluated. As a trauma advanced practice nurse, how do you collaborate and mentor staff nurses and encourage them to precept and teach novice staff? Is there an opportunity through a peer review process to involve bedside nurses in the PI process? Is it a nurse-driven protocol for the patient with severe traumatic brain injury in the intensive care unit? Is there an emergency department documentation tool to provide self- or peer review with an educational component in place? Any of these methods are excellent examples of exemplary practice. Are multidisciplinary rounds truly an illustration of a collaborative relationship among the trauma team members or isolated to physician participations only?


Addressing "new knowledge, innovation, and improvements" component can challenge trauma nursing leadership to document how through our leadership best practice initiatives, research and quality improvement projects are embedded in the nursing process. How are staff nurses empowered to be an active part of the process? That they have the resources they need to drive process. As a trauma leader, is there an opportunity to attend unit-based nursing council meetings? Is pertinent trauma PI data shared with the council? There are a multitude of opportunities to weave trauma best practice into every department of the trauma center.


The last of component, "empirical quality results," represents the PI process that verified trauma centers live and breathe every day. Your trauma programs contribution in this arena should be enormous. There are a number of patient outcomes directly related to nursing care that are monitored through the trauma registry and PI process. Though the Performance Improvement and Patient Safety committee, there is an opportunity for staff nurses to be a part of the process and have input in action plans. Through the National Trauma Data Bank and state trauma data systems, there is an opportunity to benchmark a number of clinical aspects of care. The question needs to be asked as to how your program contributes to the MRP at your center? Are you considered an integral part of the MRP or truly not a "player"? How are you sharing your trauma achievements with the Magnet team at your center?


In my last President's Message Achieving Balance, I hopefully challenged you to examine your professional life in terms of self-development and improvement and empowerment of other nurses. The Magnet program sends a powerful message challenging nurses to develop this aspect of your leadership portfolio. What steps have you taken to move out of the silo and contribute from the grass roots up?




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HCPro Inc. HCPro's Handbook for the Healthcare Team on the ANCC Magnet Recognition Program. Marblehead, MA: HCPro Inc; 2007.


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Magner C. Is Your Nursing Staff Ready for Magnet Hospital Status? Reno: Nevada Nurses Association; 2005:5-7.