When it comes to nurses, a magnet can indeed be a powerful attraction. Only about 263 hospitals nationwide have earned recognition for nursing excellence by achieving designation as a magnet hospital. These facilities use their magnet status as a powerful nurse recruiting tool.
Although the magnet program does not explicitly require that hospitals use information technology, many of the organizations that have achieved magnet status are making extensive use of I.T., especially electronic charting for nurses.
The magnet designation from the American Nurses Credentialing Center, a unit of the American Nurses Association, recognizes quality patient care, nursing excellence and innovations in professional nursing practices. But the program stops short of requiring that hospitals use information technology because “we don’t want to lock out some smaller hospitals that lack funding to support technology,” says Cynthia Hagstrom, an outcomes analyst with the Magnet Recognition Program.
The program’s 2008 manual, however, makes it clear that I.T. can play a vital role in improving the quality of care and facilitating interdisciplinary collaboration, she stresses. “We don’t specify that a hospital needs an electronic health record, but to achieve what the program requires, we expect many hospitals will use an EHR,” she adds.
“A large organization would be immensely hampered by not having good I.T. support” when seeking magnet status, says Sabrina Downs, R.N., director of the magnet recognition program for Vanderbilt University Medical Center, Nashville. Some smaller hospitals, however, might be able to provide the necessary documentation on paper, she acknowledges.
“The underlying philosophy of the magnet culture is that if you provide the right environment for nursing, nurses will perform exceptionally well and you’ll have positive patient outcomes,” Downs says. “Nurses have to be well supported. There are many factors in the magnet world that I.T. supports.”
In addition to academic medical centers, however, many smaller community hospitals realize the power of information technology to support nurses.
“I.T. really facilitates practicing at a higher level of excellence,” says Cathy Duquette, R.N., PhD., vice president of nursing and patient services and chief nursing officer at 148-bed Newport (R.I.) Hospital. The hospital, which has implemented an advanced electronic health records system, achieved magnet status in 2004.
Key Technologies
In addition to electronic health records, other key technologies magnet hospitals are using include: bar coding and other medication administration systems; computerized physician or provider order entry; automated nurse scheduling; and mobile hardware and wireless networks that provide access to clinical data at the point of care.
Many magnet hospitals also have created the position of director of nursing informatics and taken other steps toward involving nurses in all I.T. decisions. Some, like Vanderbilt, have taken the extraordinary step of appointing a point-person to lead the effort to achieve and then maintain magnet status.
Vanderbilt has capitalized on a wide variety of information technologies to support its nurses. The academic medical center, which includes three hospitals with a total of about 528 beds, self-developed an order entry system that’s now marketed by McKesson Corp., San Francisco, and also developed its own electronic health records system. It supplements those with a number of other applications from McKesson.
All medical disciplines, including physicians, nurses, therapists and pharmacists, use the CPOE system, which has decision support built in. For example, the system provides nurses with reminders about steps to take to prevent pressure ulcers among inpatients.
Other technologies supporting nurses include electronic scheduling, automated performance appraisals and online education. The Vanderbilt hospitals have shifted from distributing paper-based patient care pathways to using a document repository Web site, where nurses can print the documents as needed. “Something as simple as that has really changed the way we do business,” says Karen Hughart, R.N., director of systems support service and nursing informatics. Vanderbilt plans to eventually incorporate the clinical pathways into its electronic records system.
The academic medical center is phasing in a McKesson bar coding system for medication administration. Nurses scan bar codes on patients’ wristbands and the medication to help avoid medication errors. “It creates a culture of nurses doing their jobs safely and practicing in as safe an environment as we can provide,” Downs says. “One of the underlining principals of the magnet program is to create a safe environment.”
Highly Evolved EHR
In addition to holding the distinction of being a magnet hospital, Newport Hospital is one of only a handful of organizations recognized as having a Stage 6 electronic health record. HIMSS Analytics, a branch of the Healthcare Information and Management Systems Society, has created a model that shows seven levels of development of electronic records. In 2007, it determined that only .3 percent of U.S. hospitals had reached Stage 6, a highly advanced stage. None had reached Stage 7.
Newport Hospital uses clinical software from Siemens Medical Solutions, Malvern, Pa., which it heavily customized to provide caregivers with the data they need, Duquette says. For example, nurses’ initial assessment forms contain a scale for indicating a patient’s risk of pressure ulcers, she explains. The records system also provides direct access to diagnostic images.
Physicians and nurses also use CPOE for all orders. The records system is available primarily via computers mounted on mobile carts, mainly from Stinger Medical LLC, Murfreesboro, Tenn. The carts also carry bar coding equipment from Siemens used for medication administration. The bar coding system “has identified a whole host of issues we didn’t even know about,” Duquette says. For example, the system can catch if a medication was given too early or too late relative to a schedule outlined in the medical record.
The mid-size community hospital receives financial support for clinical I.T. from its parent company, LifeSpan, a delivery system that owns four Rhode Island hospitals. “We would not be where we are today if we were a stand-alone hospital,” Duquette says.
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