MAGNET DESIGNATION A Model for Home Healthcare Practice Nurses at 1 hospital-affiliated home healthcare agency (HHA) found that being a department of a Magnet-accredited hospital had a significant impact on the culture of their HHA. Important lessons were learned in conjunction with the Magnet designation journey. In this article, the authors describe the history of the Magnet recognition program, the components of the Magnet model, and how these are applicable to nursing practice within HHAs.
Introduction Magnet designation may not be a topic near the heart of many home healthcare clinicians, but nursing leaders of one hospital-based home care and hospice agency (HHA) found that being associated with a Magnet-accredited hospital had a significant impact on the culture of their HHA. The Magnet model focuses on structure, process, and outcomes, in a manner similar to many HHAs, and this model provides a framework to enhance the work environment of nurses and improve patient care (Drenkard, 2010). Studies indicate that Magnet-designated facilities have a higher percentage of satisfied registered nurses (RNs), lower RN turnover, improved clinical outcomes, and patient satisfaction, all important issues in HHA settings
Sarah Via Browning, DNP, RN-BC, and Rebecca Culver Clark, PhD, RN
January 2015
Home Healthcare Now
27
Copyright © 2015 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
(Hess et al., 2011; Kelly et al., 2011). This is consistent with the results of a mixed method study by Tullai-McGuinness et al. (2011), which found that effective nurse leadership in HHAs was associated with higher quality of care. Ellenbecker and Cushman (2012) expanded their model of home healthcare nurse retention to include shared governance, supportive managers, and effective teamwork, all components of Magnet designation. Nursing leaders in this HHA learned important lessons in conjunction with the Magnet designation journey of their hospital partner and developed skills that other healthcare organizations will find useful, even if there are no current plans to apply for Magnet status. Much of the literature concerning Magnet designation has centered on the clinical outcomes and environments in acute care facilities. This manuscript describes the history of the Magnet recognition program, the components of the Magnet model, and how these are applicable to nursing practice within HHAs. The Magnet recognition program, developed and administered by the American Nurses Credentialing Center (ANCC), recognizes healthcare organizations for quality patient care, nursing excellence, and innovations in professional nursing practice (ANCC, 2014). This program was initiated in 1993, following a research study that identified the key organization and work components of hospitals that were successful in their strategies to recruit and retain professional nurses (Jenkins & Field, 2011). At that time, healthcare organizations were facing a critical shortage of nurses and the study identified facilities that demonstrated qualities that were associated with an increased ability to attract nurses who expressed satisfaction with their work environment, hence the title “Magnet.” The study described 14 characteristics as the “Forces of Magnetism” and the facilities that demonstrated these were designated “Magnet” hospitals. The forces were categorized into three areas: characteristics of nursing administration, the attributes of the professional nursing staff, and components of the work environment. In 2007, nursing leaders modified the original vision and introduced a new model that organized the 14 Forces of Magnetism into five key components: transformational leadership; structural empowerment; exemplary professional practice; new knowledge, innovations, & improvements; and empirical outcomes (ANCC, 2014). The Magnet Recognition Program supports three primary goals: (1) quality patient outcomes, achieved in a work environment that supports pro-
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fessional nursing practice; (2) excellence in nursing care; and (3) dissemination of best practices in the delivery of nursing (ANCC, 2014). A facility seeking Magnet designation makes a multiyear commitment to demonstrate excellence in leadership, patient outcomes, and a professional work environment. The organization must collect and report empirical data that document achievement of these components (Drenkard, 2011). Approximately 7% of all registered hospitals (351 facilities) in the United States have achieved ANCC Magnet recognition status (ANCC, 2014). This is a dramatic increase from 16 hospitals in 2000 (Frazier, 2003), and illustrates that this designation and recognition of nursing excellence and high-quality patient care is valued by the healthcare community. The HHA discussed here is a department of a not-for-profit health system, anchored by a 700bed, level 1 trauma center located in southwest Virginia. The agency employs more than 50 nurses and serves 15 counties. Nursing leadership of the hospital committed to achieving Magnet recognition for the third time. To meet the Magnet criteria, leaders and frontline staff engaged in a systematic review of nursing care practices, patient outcomes, and work environments, and analyzed the integration of evidence-based practice and the impact on patient care. Practices and outcomes that illustrated nursing excellence were included in a document submitted to the ANCC accreditation commission as exemplars.
The Magnet Model and Home Healthcare The processes and outcomes of this HHA were integral components of the hospital’s successful application. The components of Magnet are described below and are illustrated by associated exemplars from the HHA setting. Transformational Leadership
Nurse leaders demonstrate transformational leadership, working with nurses to identify needs and develop strategic plans to meet these needs. In this manner, leaders serve as advocates for nurses and patients. Transformational leaders focus on developing staff to meet the demands of the future. To accomplish this, leaders establish environments where they listen, challenge, influence, and affirm the dialogue of colleagues and staff as the organization makes its way into the future. This requires that leaders be visionary, willing to change, and supportive of innovative approaches to care delivery.
www.homehealthcarenow.org
Copyright © 2015 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
Exemplar: In today’s healthcare market place, hospitals face significant financial consequences for 30-day readmissions of patients. Home care is an increasingly important partner to prevent readmissions, and as leaders, we asked: how do we provide systematic, evidence-based care to assist our patients to avoid readmission? How do we measure these outcomes to assure that we have met our goals? The HHA practice model for assessing staff and departmental performance did not provide the structure to identify aggregate patient outcomes. Leaders found it challenging to identify areas for improvement. Although each nurse was responsible for managing personal caseload data, reports did not capture trends in outcomes. Leaders determined that to provide meaningful data to address readmissions and related care, the practice model and documentation required major revision. A multidisciplinary team of home care, human resource, and financial leaders worked with a systems engineer and conducted an extensive literature review, benchmarked with other HHAs, and mapped processes for care within the context of the geographical coverage areas. The team developed a “pod” design where staff worked in teams within a geographical area to provide consistent personnel for patients and created a new position, the patient outcome coordinator (POC) to monitor care delivered by each pod. The POC, a RN, meets with members of the pod at least weekly to review progress toward outcomes, hospital readmission data, and future discharge plans. In addition to the weekly meetings, the POC reviews the schedule for appropriateness, monitors outcome reports, and works with team members to address areas of opportunity. This structure promotes interdisciplinary collaboration and allows clinicians to make timely adjustments to the plan of care and ensures careful evaluation of disease management. Currently, leaders are monitoring the parameters of readmissions and outcomes of care. Although it is too soon to evaluate the impact of the revised clinical model, we anticipate that our hospital readmission rates will decrease as a result. Structural Empowerment
In a Magnet-designated facility, the work environment empowers nurses to engage in collaborative decision making regarding patient care and professional development. Nurses in these organizations practice in a shared governance approach where they participate in committees; collaborate
January 2015
The Magnet journey has provided nurses in this home healthcare agency with a framework for practice that enhances their ability to lead, grow, and innovate in nursing practice. with other professionals; and contribute to the implementation of the strategic plan, policies, and nursing practice. The following exemplar details how our home healthcare nurses work within this structure to influence practice and patient outcomes. Exemplar: Home care patients often experience multiple health problems and chronic diseases that may lead them to seek care in the emergency department (ED). Not only does this create a burden for patients and families, it has now become a financial challenge for hospitals because of changes in reimbursement. Our agency worked with hospital leaders to explore disease management for patients with chronic obstructive pulmonary disease (COPD) and to evaluate the impact of a telehealth intervention on unplanned visits to the ED. The goal of this project was to decrease unnecessary ED visits and rehospitalizations, and improve the quality of life of these patients. A group of home healthcare nurses collaborated with physicians to devise a plan of care for patients who did not meet the traditional Medicare homebound criteria, but represented a “nontraditional” patient population that was often working outside the home. The home healthcare nurses participated in committees and engaged in interprofessional collaboration to develop a program that included telehealth monitoring of patients for specific frequencies for a minimum of 90 days. A total of 42 patients with COPD were enrolled in the pilot program conducted over 30 weeks. A home healthcare nurse reviewed results daily and worked collaboratively with the physician to modify the plan of care based on telehealth findings. Real-time reporting resulted in prompt adjustments to the patient’s medication and/or treatment regimen. By the end of the pilot, the patients enrolled demonstrated a 30% reduction in both ED and inpatient encounters as compared to a similar timeframe preimplementation. Home healthcare nurses are indeed empowered to impact change. The nurses were critical in designing, implementing, and evaluating this program.
Home Healthcare Now
29
Copyright © 2015 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
Exemplary Professional Practice
Empirical Outcomes
Formal education, certifications, and career development are important characteristics of nurses in Magnet-designated organizations. This reflects a commitment to lifelong learning and ongoing integration of new knowledge into clinical practice. Exemplar: Chronic disease management in the home care setting can be challenging for patients, families, and nurses. All nurses who provide care in our HHA are required to obtain national certification in the management of chronic disease. Over 200 nurses in our HHA have achieved chronic disease management certification. With the evidence-based knowledge demonstrated through certification, nurses assist patients to develop healthy lifestyles and recognize changes in health status that might necessitate early interventions. Our nurses demonstrate exemplary professional practice and empower patients and family members to be partners in care as they work together to apply evidence-based interventions, promoting healthy choices and avoiding readmissions to the hospital.
Industry and regulatory changes require HHAs to evaluate and improve processes on a continual basis. Outcome and Assessment Information Set in home healthcare and the new hospice information set requirements serve as a means to compare outcomes across providers. Magnet provides a philosophy for guiding agency leaders in thoughtful and methodical outcomes analysis. The exemplars described above illustrate how empirical data are collected and analyzed to improve nursing practice and patient outcomes.
New Knowledge, Innovations, and Improvements
Nurses in Magnet organizations contribute to nursing knowledge, innovate, and improve care through application of evidence-based best practices. This requires that nurses continually evaluate empirical outcomes of care and seek evidence-based strategies to improve care. Exemplar: A nurse in our agency noted that there was a wide variation in infection control reporting policies and little literature existed to support standardized definitions for reporting infections in the home. Infections were reported, or not reported, based on nurses’ opinions rather than on actual definitions of reportable infections. This lack of structure and standardization resulted in infection control data variations with little meaning. Following an extensive literature review, the nurse developed evidence-based policies containing standardized definitions for infection reporting. This process led to new policies, standardized definitions, and comparable results. As an innovation in practice, this work was disseminated through the shared governance of the organization and in a manuscript submitted for publication. This initiative illustrates multiple components of the Magnet model including exemplary professional practice, structural empowerment and new knowledge, innovations, and improvements.
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Summary The Magnet journey has provided nurses in this HHA with a framework for practice that enhances their ability to lead, grow, and innovate in nursing practice. Although not all HHAs may be interested in pursuing Magnet designation, the concepts of transformational leadership, exemplary professional practice, structural empowerment and new knowledge, innovation, and improvements helped shift our focus to process and outcomes, important aspects in today’s dynamic healthcare environment. Sarah Via Browning, DNP, RN-BC, is the Director, Systems Operations and Support, Carilion Clinic Home Care, Carilion Clinic Hospice, Roanoke, Virginia. Rebecca Culver Clark, PhD, RN, is a Clinical Consultant–Nursing Research/Grant Writing, Carilion Roanoke Memorial Hospital, Belleview at Jefferson Street, Roanoke, Virginia. The authors declare no conflicts of interest. Address for correspondence: Sarah Via Browning, DNP, RN-BC, Carilion Clinic Home Care, 1615 Franklin Rd., Roanoke, VA 24016 ([email protected]). DOI: 10.1097/NHH.0000000000000168
REFERENCES American Nurses Credentialing Center. (2014). Magnet program overview. Retrieved from http://www.nursecredentialing.org/ Magnet/ProgramOverview Drenkard, K. (2010). Going for the gold: The value of Magnet recognition. American Nurse Today, 5(3), 50-52. Ellenbecker, C. H., & Cushman, M. (2012). Home healthcare nurse retention and patient outcome model: Discussion and model development. Journal of Advanced Nursing, 68(8), 1881-1893. Frazier, S. C. (2003). Magnet home care agencies: A professional way to impact quality and retention. Home Healthcare Nurse, 21(9), 603-610. Hess, R., Desroches, C., Donelan, K., Norman, L., & Buerhaus, P. I. (2011). Perceptions of nurses in Magnet hospitals, non-Magnet hospitals, and hospitals pursuing Magnet status. Journal of Nursing Administration, 41(7-8), 315-323. Jenkins, M., & Field, B. (2011). Pursuing Magnet designation as a system or as individual entities: What is the right decision? Journal of Nursing Administration, 41(4), 172-288. Kelly, L. A., McHugh, M. D., & Aiken, L. H. (2011). Nurse outcomes in Magnet and non-Magnet hospitals. Journal of Nursing Administration, 41(10), 428-433. Tullai-McGuinness, S., Riggs, J. S., & Farag, A. A. (2011). Work environment characteristics of high-quality home health agencies. Western Journal of Nursing Research, 33(6), 767-785.
www.homehealthcarenow.org
Copyright © 2015 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
Introduction Magnet designation may not be a topic near the heart of many home healthcare clinicians, but nursing leaders of one hospital-based home care and hospice agency (HHA) found that being associated with a Magnet-accredited hospital had a significant impact on the culture of their HHA. The Magnet model focuses on structure, process, and outcomes, in a manner similar to many HHAs, and this model provides a framework to enhance the work environment of nurses and improve patient care (Drenkard, 2010). Studies indicate that Magnet-designated facilities have a higher percentage of satisfied registered nurses (RNs), lower RN turnover, improved clinical outcomes, and patient satisfaction, all important issues in HHA settings
Sarah Via Browning, DNP, RN-BC, and Rebecca Culver Clark, PhD, RN
January 2015
Home Healthcare Now
27
Copyright © 2015 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
(Hess et al., 2011; Kelly et al., 2011). This is consistent with the results of a mixed method study by Tullai-McGuinness et al. (2011), which found that effective nurse leadership in HHAs was associated with higher quality of care. Ellenbecker and Cushman (2012) expanded their model of home healthcare nurse retention to include shared governance, supportive managers, and effective teamwork, all components of Magnet designation. Nursing leaders in this HHA learned important lessons in conjunction with the Magnet designation journey of their hospital partner and developed skills that other healthcare organizations will find useful, even if there are no current plans to apply for Magnet status. Much of the literature concerning Magnet designation has centered on the clinical outcomes and environments in acute care facilities. This manuscript describes the history of the Magnet recognition program, the components of the Magnet model, and how these are applicable to nursing practice within HHAs. The Magnet recognition program, developed and administered by the American Nurses Credentialing Center (ANCC), recognizes healthcare organizations for quality patient care, nursing excellence, and innovations in professional nursing practice (ANCC, 2014). This program was initiated in 1993, following a research study that identified the key organization and work components of hospitals that were successful in their strategies to recruit and retain professional nurses (Jenkins & Field, 2011). At that time, healthcare organizations were facing a critical shortage of nurses and the study identified facilities that demonstrated qualities that were associated with an increased ability to attract nurses who expressed satisfaction with their work environment, hence the title “Magnet.” The study described 14 characteristics as the “Forces of Magnetism” and the facilities that demonstrated these were designated “Magnet” hospitals. The forces were categorized into three areas: characteristics of nursing administration, the attributes of the professional nursing staff, and components of the work environment. In 2007, nursing leaders modified the original vision and introduced a new model that organized the 14 Forces of Magnetism into five key components: transformational leadership; structural empowerment; exemplary professional practice; new knowledge, innovations, & improvements; and empirical outcomes (ANCC, 2014). The Magnet Recognition Program supports three primary goals: (1) quality patient outcomes, achieved in a work environment that supports pro-
28
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|
Number 1
fessional nursing practice; (2) excellence in nursing care; and (3) dissemination of best practices in the delivery of nursing (ANCC, 2014). A facility seeking Magnet designation makes a multiyear commitment to demonstrate excellence in leadership, patient outcomes, and a professional work environment. The organization must collect and report empirical data that document achievement of these components (Drenkard, 2011). Approximately 7% of all registered hospitals (351 facilities) in the United States have achieved ANCC Magnet recognition status (ANCC, 2014). This is a dramatic increase from 16 hospitals in 2000 (Frazier, 2003), and illustrates that this designation and recognition of nursing excellence and high-quality patient care is valued by the healthcare community. The HHA discussed here is a department of a not-for-profit health system, anchored by a 700bed, level 1 trauma center located in southwest Virginia. The agency employs more than 50 nurses and serves 15 counties. Nursing leadership of the hospital committed to achieving Magnet recognition for the third time. To meet the Magnet criteria, leaders and frontline staff engaged in a systematic review of nursing care practices, patient outcomes, and work environments, and analyzed the integration of evidence-based practice and the impact on patient care. Practices and outcomes that illustrated nursing excellence were included in a document submitted to the ANCC accreditation commission as exemplars.
The Magnet Model and Home Healthcare The processes and outcomes of this HHA were integral components of the hospital’s successful application. The components of Magnet are described below and are illustrated by associated exemplars from the HHA setting. Transformational Leadership
Nurse leaders demonstrate transformational leadership, working with nurses to identify needs and develop strategic plans to meet these needs. In this manner, leaders serve as advocates for nurses and patients. Transformational leaders focus on developing staff to meet the demands of the future. To accomplish this, leaders establish environments where they listen, challenge, influence, and affirm the dialogue of colleagues and staff as the organization makes its way into the future. This requires that leaders be visionary, willing to change, and supportive of innovative approaches to care delivery.
www.homehealthcarenow.org
Copyright © 2015 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
Exemplar: In today’s healthcare market place, hospitals face significant financial consequences for 30-day readmissions of patients. Home care is an increasingly important partner to prevent readmissions, and as leaders, we asked: how do we provide systematic, evidence-based care to assist our patients to avoid readmission? How do we measure these outcomes to assure that we have met our goals? The HHA practice model for assessing staff and departmental performance did not provide the structure to identify aggregate patient outcomes. Leaders found it challenging to identify areas for improvement. Although each nurse was responsible for managing personal caseload data, reports did not capture trends in outcomes. Leaders determined that to provide meaningful data to address readmissions and related care, the practice model and documentation required major revision. A multidisciplinary team of home care, human resource, and financial leaders worked with a systems engineer and conducted an extensive literature review, benchmarked with other HHAs, and mapped processes for care within the context of the geographical coverage areas. The team developed a “pod” design where staff worked in teams within a geographical area to provide consistent personnel for patients and created a new position, the patient outcome coordinator (POC) to monitor care delivered by each pod. The POC, a RN, meets with members of the pod at least weekly to review progress toward outcomes, hospital readmission data, and future discharge plans. In addition to the weekly meetings, the POC reviews the schedule for appropriateness, monitors outcome reports, and works with team members to address areas of opportunity. This structure promotes interdisciplinary collaboration and allows clinicians to make timely adjustments to the plan of care and ensures careful evaluation of disease management. Currently, leaders are monitoring the parameters of readmissions and outcomes of care. Although it is too soon to evaluate the impact of the revised clinical model, we anticipate that our hospital readmission rates will decrease as a result. Structural Empowerment
In a Magnet-designated facility, the work environment empowers nurses to engage in collaborative decision making regarding patient care and professional development. Nurses in these organizations practice in a shared governance approach where they participate in committees; collaborate
January 2015
The Magnet journey has provided nurses in this home healthcare agency with a framework for practice that enhances their ability to lead, grow, and innovate in nursing practice. with other professionals; and contribute to the implementation of the strategic plan, policies, and nursing practice. The following exemplar details how our home healthcare nurses work within this structure to influence practice and patient outcomes. Exemplar: Home care patients often experience multiple health problems and chronic diseases that may lead them to seek care in the emergency department (ED). Not only does this create a burden for patients and families, it has now become a financial challenge for hospitals because of changes in reimbursement. Our agency worked with hospital leaders to explore disease management for patients with chronic obstructive pulmonary disease (COPD) and to evaluate the impact of a telehealth intervention on unplanned visits to the ED. The goal of this project was to decrease unnecessary ED visits and rehospitalizations, and improve the quality of life of these patients. A group of home healthcare nurses collaborated with physicians to devise a plan of care for patients who did not meet the traditional Medicare homebound criteria, but represented a “nontraditional” patient population that was often working outside the home. The home healthcare nurses participated in committees and engaged in interprofessional collaboration to develop a program that included telehealth monitoring of patients for specific frequencies for a minimum of 90 days. A total of 42 patients with COPD were enrolled in the pilot program conducted over 30 weeks. A home healthcare nurse reviewed results daily and worked collaboratively with the physician to modify the plan of care based on telehealth findings. Real-time reporting resulted in prompt adjustments to the patient’s medication and/or treatment regimen. By the end of the pilot, the patients enrolled demonstrated a 30% reduction in both ED and inpatient encounters as compared to a similar timeframe preimplementation. Home healthcare nurses are indeed empowered to impact change. The nurses were critical in designing, implementing, and evaluating this program.
Home Healthcare Now
29
Copyright © 2015 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
Exemplary Professional Practice
Empirical Outcomes
Formal education, certifications, and career development are important characteristics of nurses in Magnet-designated organizations. This reflects a commitment to lifelong learning and ongoing integration of new knowledge into clinical practice. Exemplar: Chronic disease management in the home care setting can be challenging for patients, families, and nurses. All nurses who provide care in our HHA are required to obtain national certification in the management of chronic disease. Over 200 nurses in our HHA have achieved chronic disease management certification. With the evidence-based knowledge demonstrated through certification, nurses assist patients to develop healthy lifestyles and recognize changes in health status that might necessitate early interventions. Our nurses demonstrate exemplary professional practice and empower patients and family members to be partners in care as they work together to apply evidence-based interventions, promoting healthy choices and avoiding readmissions to the hospital.
Industry and regulatory changes require HHAs to evaluate and improve processes on a continual basis. Outcome and Assessment Information Set in home healthcare and the new hospice information set requirements serve as a means to compare outcomes across providers. Magnet provides a philosophy for guiding agency leaders in thoughtful and methodical outcomes analysis. The exemplars described above illustrate how empirical data are collected and analyzed to improve nursing practice and patient outcomes.
New Knowledge, Innovations, and Improvements
Nurses in Magnet organizations contribute to nursing knowledge, innovate, and improve care through application of evidence-based best practices. This requires that nurses continually evaluate empirical outcomes of care and seek evidence-based strategies to improve care. Exemplar: A nurse in our agency noted that there was a wide variation in infection control reporting policies and little literature existed to support standardized definitions for reporting infections in the home. Infections were reported, or not reported, based on nurses’ opinions rather than on actual definitions of reportable infections. This lack of structure and standardization resulted in infection control data variations with little meaning. Following an extensive literature review, the nurse developed evidence-based policies containing standardized definitions for infection reporting. This process led to new policies, standardized definitions, and comparable results. As an innovation in practice, this work was disseminated through the shared governance of the organization and in a manuscript submitted for publication. This initiative illustrates multiple components of the Magnet model including exemplary professional practice, structural empowerment and new knowledge, innovations, and improvements.
30
Volume 33
|
Number 1
Summary The Magnet journey has provided nurses in this HHA with a framework for practice that enhances their ability to lead, grow, and innovate in nursing practice. Although not all HHAs may be interested in pursuing Magnet designation, the concepts of transformational leadership, exemplary professional practice, structural empowerment and new knowledge, innovation, and improvements helped shift our focus to process and outcomes, important aspects in today’s dynamic healthcare environment. Sarah Via Browning, DNP, RN-BC, is the Director, Systems Operations and Support, Carilion Clinic Home Care, Carilion Clinic Hospice, Roanoke, Virginia. Rebecca Culver Clark, PhD, RN, is a Clinical Consultant–Nursing Research/Grant Writing, Carilion Roanoke Memorial Hospital, Belleview at Jefferson Street, Roanoke, Virginia. The authors declare no conflicts of interest. Address for correspondence: Sarah Via Browning, DNP, RN-BC, Carilion Clinic Home Care, 1615 Franklin Rd., Roanoke, VA 24016 ([email protected]). DOI: 10.1097/NHH.0000000000000168
REFERENCES American Nurses Credentialing Center. (2014). Magnet program overview. Retrieved from http://www.nursecredentialing.org/ Magnet/ProgramOverview Drenkard, K. (2010). Going for the gold: The value of Magnet recognition. American Nurse Today, 5(3), 50-52. Ellenbecker, C. H., & Cushman, M. (2012). Home healthcare nurse retention and patient outcome model: Discussion and model development. Journal of Advanced Nursing, 68(8), 1881-1893. Frazier, S. C. (2003). Magnet home care agencies: A professional way to impact quality and retention. Home Healthcare Nurse, 21(9), 603-610. Hess, R., Desroches, C., Donelan, K., Norman, L., & Buerhaus, P. I. (2011). Perceptions of nurses in Magnet hospitals, non-Magnet hospitals, and hospitals pursuing Magnet status. Journal of Nursing Administration, 41(7-8), 315-323. Jenkins, M., & Field, B. (2011). Pursuing Magnet designation as a system or as individual entities: What is the right decision? Journal of Nursing Administration, 41(4), 172-288. Kelly, L. A., McHugh, M. D., & Aiken, L. H. (2011). Nurse outcomes in Magnet and non-Magnet hospitals. Journal of Nursing Administration, 41(10), 428-433. Tullai-McGuinness, S., Riggs, J. S., & Farag, A. A. (2011). Work environment characteristics of high-quality home health agencies. Western Journal of Nursing Research, 33(6), 767-785.
www.homehealthcarenow.org
Copyright © 2015 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
