Select Your Question

   Denotes New or Updated Posting

•   Does the eligibility requirement for Nurse Managers on p.6 in the Manual go into effect at the time of application or submission of written documentation?
•   What is considered an innovation?
•   What certifications can be submitted on the Demographic Information Form (DIF) and represented in SE4EO to meet goals for improvement in professional certification?
•   What is the best way to respond to SE3EO and SE4EO regarding goals for formal education and professional certification?
•   What are the requirements for electronic submission?
•   Can you explain more about the requirement to submit data that outperforms the mean of the national database used?
•   Do outcomes have to be quantitative?
•   How should I present my nurse-sensitive indicator data?
•   What is the best way to display nurse satisfaction data?
•   How often do we need to do the RN satisfaction survey?
•   What is the best way to display patient satisfaction data?
• What is the timeline for document submission after application?
• Should information on the Demographic Information Form (DIF) correspond to the 24 months prior to submission of documentation that we use for our document?
• When collecting information about educational level of RNs, where do I count someone who has a bachelor of arts in nursing?
• There is a definition of nurse leader on p. 4 of the green 2008 manual. Why are clinical nurse specialists not included in the data collection of nurse leader?
• If a nurse manager has a master's degree in nursing but not a baccalaureate in nursing, will that meet the requirements that are outlined on p. 6 in the manual?
• In the section on "Notification of Events", why do organizations need to report sentinel events to the Magnet Program Office?
•   Can you give some guidance about collecting data for Nurse Sensitive Indicators?
• What advice can you give me about choosing a benchmarking database?
• Are the outcomes weighted more in re-designation than in the original application?
• In the organizational overview, does nurse (RN) satisfaction data need to be provided at the unit level?
• Is it required that we collect and benchmark falls and pressure ulcers in all areas?
• We currently collect BSI and VAP data in two areas only. We do not benchmark these. Is it a problem that we aren't benchmarking them?
• In areas where VAP isn't appropriate to collect, is the assumption that we should be collecting and benchmarking other data such as BSI, UTI, etc.?
• During the off years, we do a house-wide employee engagement survey for the entire health system, from which we can isolate results specific to the RN. Would this be acceptable?
• The 2008 Magnet Manual says that beginning in 2010 we need to submit unit-level data on all indicators listed. We won't be able to have the data by then.
• For restraint use, what specific data is being requested? In-house restraints in use, or injuries related to restraints?
• We have 20 hospitals in one state. Would we qualify as large enough to be a comparison benchmark against ourselves?

General Questions

   Does the eligibility requirement for Nurse Managers outlined on p.6 in the Manual go into effect at the time of application or submission of written documentation?
Organizations submitting applications for Magnet recognition or redesignation in 2011, and submitting written documentation in 2011 or 2012, must comply with the current requirement that 75% of nurse managers hold a baccalaureate degree in nursing. However, if an organization applies in 2011 with the intent to submit written documentation in 2013, it must comply with the new requirement that 100% of nurse managers hold a baccalaureate degree in nursing.

• At the time of application, the organization must sign an attestation that they meet the applicable requirement for the baccalaureate degree in nursing for nurse managers.
• At the time of written documentation submission, the applicant organization will submit a table listing all nurse managers, where they work, and earned degrees.
• At the time of the site visit, the assigned appraisers will verify the list. top

  What is considered an innovation?

Innovations:

• Are a novel set of behaviors, work and ways of working
• Are a group of activities that are generated and directed toward improving:
        Health outcomes
        Cost effectiveness
        Users' experience
• Are Implemented by planned and coordinated actions
• Are focused toward positive change, with the intent to make someone or something better
• Cause changes in thinking, products, processes, or organizations

Those who are directly responsible for application of an innovation are often called pioneers. top

   What certifications can be submitted on the Demographic Information Form (DIF) and represented in SE4EO to meet goals for improvement in professional certification??
The following is a list of “core” features that the Magnet Recognition Program® uses to assess whether a specific credential is one that applicants may include on the Demographic Information Form (DIF) and use to represent goals for improvement in professional certification for SE4EO in the 2008 Magnet Manual.

 The credential is a professional certification* if:

• The examination is nationally available.
• The examination is based on periodic job analysis (role delineation studies and content panel experts)
• A recertification interval is defined.
• The examination tests a professional body of knowledge (i.e., not technical-ACLS, BCLS, ATLS etc.)
• No specific classes are required to be eligible for the examination.

*Although, not a requirement for inclusion, the Magnet Recognition Program® does note whether the certification is accredited by the National Commission for Certifying Agencies (NCCA) and/or the American Board of Nursing Specialties (ABNS). .

Check the Magnet Web site ─ www.nursecredentialing.org ─ for information about the different levels of certification. top

  What is the best way to respond to SE3EO and SE4EO regarding goals for formal education and professional certification?

• In your narrative description, State the goal you have set with your team. For example you might say:
         "Increase BSN rate by 2% overall for 2007-2009 on all units"
         "Improve nurse manager graduate degree obtainment to 100%" Your action plan might then be to provide tuition stipend for two nurse managers to complete MSN program – 2008-2010
         "Increase certification rate by 5% for peri-operative RNs by the end of 2009"
         "Increase hospital's overall certification rate by 2% by the end of 2010 (overall rate currently at 78%)"
• Provide a graph over two years and display the data to show how goal was met.
• Show that all stated goals are met top

  What are the requirements for electronic submission?

• The Magnet Recognition Program Office (MPO) must be notified of the organization's intent to submit documentation in electronic format. It is necessary to inform the MPO of the system requirements to run the electronic documentation no later than two months in advance of submission.
• The electronic documentation submission may be forwarded on a CD-ROM, flash drive, Web-based format or via an FTP site. The submission must be clearly labeled with the name of the organization.
• The Organizational Overview volume may be submitted on the electronic medium in folder/file format.
• A hard copy of the entire documentation submission should be prepared in the event the organization advances to the site visit phase, in which it is required to display the documents for public view.
• The Demographic Information Form should be sent:
         As an attachment via email to the Magnet Analyst
         As hard copy included with documents
• The links to attachments and/or to other documents (either Organization Overview or reference documents) must, when closed, return the reader back to the location of the link in the text where the reader left the narrative.
• Each page of the Organization Overview, the Component narratives, and reference documents must be paginated.
• Electronic documents may be rendered in “read-only” format; however, the format must allow for the selection of text (to copy and paste if necessary). .
• When submitted, each Appraisal Team member and the MPO will receive a CD-ROM/thumb drive or Web log-In/password on the designated documentation submission date.
• If submitting a Web-based application, a copy of the documentation must be submitted to the MPO via CD-ROM, thumb drive or hard copy.
• The Magnet Component volumes and related references (other than the Organizational Overview items) must, when printed in a hard copy version, meet the measurement limit of 15 inches.
• The envelope containing the labeled electronic medium (i.e. CD-ROM, thumb drive, etc.) must include a printed version of the Demographic Information Form (DIF), and glossary (containing defined acronyms and abbreviations used in the documentation) on a color of paper that is easily identified. top

What is the timeline for document submission after application?
Good news! There is no waiting list to submit your documents to the Magnet Recognition Program ®. The cycle dates for submission of written documentation are February 1, April 1, June 1, August 1 and October 1. You can submit your documents up to two years after application. You can apply at any time. As you are preparing to submit your application, it is a good idea to call the Magnet® Program Office, so we can work with you to identify dates for documentation submission that will meet your need.. top

Should information on the Demographic Information Form (DIF) correspond to the 24 months prior to submission of documentation that we use for our document?
As much as possible, you should work to line up the data timelines. However, there is often a time lag in reports being disseminated, and there are also constraints on data collection timelines that the organization cannot control (for example, data submission is required on a certain date). Some organizations use different data collection processes and have different timetables for reports. The data submitted should be from the time period closest to document submission that is consistent with your organization's data systems. top

When collecting information about educational level of RNs, where do I count someone who has a bachelor of arts in nursing?
The category will read baccalaureate in nursing. If the RN holds a bachelor of science in nursing or a bachelor of arts in nursing, it should be counted in the baccalaureate category. top

There is a definition of nurse leader on p. 4 of the green 2008 manual. Why are clinical nurse specialists not included in the data collection of nurse leader?
The definition of nurse leader has been clarified as a nurse who participates in decision-making bodies and/or has a leadership role. We have reprinted the Manual with the correct definition. See the manual update section on the Web site for these changes. There is a separate data collection category for clinical nurse specialists on the DIF. The DIF is being changed so that information about advanced practice nurses and clinical nurse specialists have categories for data collection. top

If a nurse manager has a master's degree in nursing but not a baccalaureate in nursing, will that meet the requirements that are outlined on p. 6 in the manual?
The requirement is for at least a bachelor's degree in nursing. The Commission on Magnet (COM) believes that it is essential that nurse managers know the theory base for the profession. This theory base is required in curricula for bachelor's, master's, and doctoral degrees in nursing.

The criterion states that effective January 1, 2011, 75% of nurse managers must have at least a baccalaureate in nursing. A higher degree in nursing (a master's or doctorate in nursing), will meet the requirement even if the baccalaureate degree is not in nursing. top

In the section on "Notification of Events”, why do organizations need to report sentinel events to the Magnet Program Office?
An "adverse event" describes any harm (i.e., undesirable clinical outcome) to a patient as a result of medical care. The term "sentinel event" denotes a serious occurrence that signals the need for immediate investigation and response. Research, policies, and action taken to reduce adverse or sentinel events often focus on mistakes and systemic problems with care.

The Centers for Medicare & Medicaid Services (CMS) indicates that reducing the incidence of adverse events in hospitals is a critical component of efforts to ensure patient safety and to provide quality health care.

Various federal and state government agencies and other entities are responsible for addressing adverse events in hospitals. Additionally, hospitals must track and analyze adverse events as a condition of participation in the Medicare and Medicaid programs. Reporting events and suspected causes can help hospitals improve practices to prevent adverse events and ensure accountability for poor care. Hospitals also use reported information to inform affected patients and families, which is thought to boost public trust, and to improve clinical decision- making compliance in treatment.

The Magnet Recognition Program ® goal is to provide patients with a benchmark to measure the quality of care that they can expect to receive by recognizing quality patient care, nursing excellence, and innovations in healthcare services. Therefore, the Magnet program must be cognizant of the current healthcare industry trends—emphasizing quality of care, lower error rates, and non-payment for many adverse and sentinel events. Magnet® designation is an indication to customers not only of a quality nursing program within a healthcare organization, but also a signal that they can expect quality care because of recognized nursing excellence within a designated facility. For those reasons, the Commission on Magnet should track and trend the situations of adverse or sentinel events of organizations that hold the Magnet designation credential.

The reports should remove any identifiable patient health information and names of healthcare professionals involved. top

Questions About Data and Benchmarking

  Can you explain more about the requirement to submit data that outperforms the mean of the national database used?
The 2008 Magnet Manual includes Sources of Evidence that require the submission of outcome measurement data. These data are included as evidence for the Empirical Outcome Sources of Evidence to demonstrate that your organization is in the top half of nationally benchmarked organizations.

Applicant and Magnet-designated organizations are expected to contribute their own data (patient and nurse satisfaction, clinical nurse-sensitive indicators) to a national database that compares the organization's data against cohort groups at the national level and to demonstrate that the majority of the units outperform the national benchmark for majority of the time that data are collected.

It is anticipated that over time, this threshold will be increased as Magnet-designated organizations continue to improve performance.

So, for example, for unit level data presentation, if an organization had nine patient care units, at least five of them have to outperform the mid-point more than half the time. top

  Do outcomes have to be quantitative?
Outcomes are results, impacts or consequences of actions. For any of the outcome Sources of Evidence there must be documentation that describes a beginning and end, cause and effect, of what is being presented. When responding to the outcome sources include the following information in your response:

• Describe the purpose and the background
• Describe how the work was done
• Discuss who was involved and what units participated
• Describe the measurement used to evaluate the outcomes and the impact (show results and significance of results)

In addition to responding to the bullets described above, use graphs and charts to illustrate outcomes. top

  Can you give some guidance about collecting data for nurse-sensitive Indicators?
The intent is to collect data that is applicable and value-added for the particular unit and organization. Organizations must contribute their own data (patient and nurse satisfaction, clinical nurse-sensitive indicators) to a national database that compares the organization's data against cohort groups at the national level.

When a national database is available, it must be used. If a national database is not available for unique clinical areas/subjects, an organization can choose another appropriate way to benchmark. An organization can choose another benchmarking measure or database as long as the organization can justify the reason for choosing that measure or database. Benchmarking should be done at the highest level possible (national, state, specialty-specific) to have meaning and value. Appraisers will ask: Why are you using it? What did you use to determine measure? What else did you look at?

Example: Many specialty pediatric hospitals across the country formed a cohort and benchmarked against each other. top

What advice can you give me about choosing a benchmarking database?
There is no Magnet-required process for approving databases or benchmarking choices. Organizations have the latitude to choose the tools that are most beneficial to them. The guidance is to choose the highest quality tool that is statistically significant, at the broadest level nationally available, with the largest cohort to get the greatest comparative value. In addition, review of the requirements in the Organizational Overview will provide applicants with the data elements that they need to make sure they are collecting, and also requires that some data be displayed at the unit level. top

Are the outcomes weighted more in re-designation than in the original application?
The requirements for redesignation require that all of the outcomes Sources of Evidence delineated in the manual as EO (Empirical Outcome) are addressed. Since there are fewer overall Sources of Evidence to address in re-designation (64), and all of the outcome sources (19) need to be addressed, the "weight" of the outcomes sources will be emphasized in redesignation. top

In the organizational overview, does nurse (RN) satisfaction data need to be provided at the unit level?
Yes, you need to submit unit-based nationally benchmarked data. top

Is it required that we collect and benchmark falls and pressure ulcers in all areas?
It is required to collect falls and pressure ulcers on the units where this is an applicable data indicator, plus two other indicators from the list provided on page 21or 40 of the 2008 Magnet Manual. If your unit does not have falls or pressure ulcers as applicable indicator, then you only need to collect two of the indicators on the list. As a result, some units may be collecting two, three or four indicators to meet the intent of this requirement. At a minimum, each unit must collect at least two indicators, but no more than four are required. top

We currently collect BSI and VAP data in two areas only. We do not benchmark these. Is it a problem that we aren't benchmarking them?
BSI and VAP data can and must be benchmarked to address Magnet Sources of Evidence. We suggest you participate in a comparative database (such as those that are publicly available on the Center for Disease Control's National Healthcare Safety Network data set) to benchmark these indicators. If a national database is available, it should be used. But an organization can choose another appropriate way to benchmark for clinical areas/subjects not covered by a national database. An organization can choose another benchmarking measure as long as the facility can justify the reason for choosing that measure or database. Benchmarking should be done at the highest level possible to have meaning and value. Appraisers will ask: Why are you using it? What did you use to determine the measure? What else did you look at? top

In areas where VAP isn't appropriate to collect, is the assumption that we should be collecting and benchmarking other data such as BSI, UTI, etc.?
It is required to collect falls and pressure ulcer data on the units where applicable, plus two other indicators from the list provided on page 21 or 40 of the 2008 Magnet Manual. If your unit does not have falls or pressure ulcers as an applicable indicator, then you only need to collect two of the indicators on the list. top

Questions about data collection for Nurse Sensitive Clinical Outcome Measures, RN Satisfaction, and Patient Satisfaction
(OO23/EP32EO, OO12/EP3EO &, OO26/EP35EO)

  How should I present my nurse-sensitive indicator data?

For OO23 Organizational Overview Requirement
Provide unit-based, nationally benchmarked nurse-sensitive clinical indicator data related to patient outcomes for the most recent two-year period. Provide quarterly data for every unit for which all patient falls and all nosocomial pressure ulcer incidence and/or prevalence are applicable. If available, include the levels of statistical significance as compared to the benchmark.

Additionally, for each unit, display data for two (2) other applicable nurse-sensitive clinical indicators selected from the list below:

• Blood stream infections
• Urinary tract infections
• Ventilator-associated pneumonia
• Restraint use
• Pediatric IV infiltrations
• Other specialty-specific nationally benchmarked indicators

Include a graphic display and a table of the data that clearly identify:

• The database to which the data was contributed
• The mean or median of the national benchmark (select one cohort such as hospitals, bed size, Magnet hospitals, etc.)
• Labels for each axis
• Whether a data point is 'no data submitted' or 'zero' top

For EP32EO Requirement
Submit data for the most recent eight quarters of data for fou r nurse-sensitive clinical indicators and include the mean or median of the national database used. This data can be displayed at the single unit level (such as ICU, CCU, SICU); or by clinical groups of multiple like-units ( such as critical care, medical, surgical, medical-surgical, rehabilitation, and ambulatory); or at the organizational level. Data must be statistically valid and provided by the vendor. Keep in mind that t he majority of the data must outperform the mean or median the majority of the time.

Two (2) of the indicators must be all patient falls and all nosocomial pressure ulcer incidence and/or prevalence if applicable.

Two (2) other indicators must be selected from the list below:

• Blood stream infections
• Urinary tract infections
• Ventilator-associated pneumonia
• Restraint use
• Pediatric IV infiltrations
• Other specialty-specific nationally benchmarked indicators

Exceptions:

• Obstetric areas present a unique situation related to nursing sensitive indicators. Hospital-acquired pressure ulcers and pediatric IV infiltrates do not apply and OB patients rarely have blood stream infections, urinary tract infections, ventilator- associated pneumonia, or restraints. It would be appropriate for them to choose two of the "other specialty specific indicators."
• In ambulatory care areas, hospital-acquired pressure ulcers and pediatric IV infiltrates may not apply, nor do blood stream infections, urinary tract infections, ventilator- associated pneumonia, or restraints, in most situations. It would be appropriate for them to choose two of the "other specialty specific indicators."
• In any areas where the number of RNs is small, with only one or two RNs, one indicator may be appropriate and reasonable, as organizations attempt to balance productivity with performance improvement. Just be sure to explain why an area does not have two indicators, as the expectation is that nurses are critically examining their practice for opportunities for improvement wherever they practice.

The narrative must include:

• Analysis, and evaluation of the data
• The database to which the data was contributed

Include a graphic display and a table of the data that clearly identify:

• All data from the most recent eight quarters.
• The benchmark mean or median for each quarter, for the selected cohort (select one cohort such as hospitals, bed size, Magnet hospitals, etc.)
• Labels for each axis
• Whether a data point is ‘no data submitted' or ‘zero'

NOTE: Do not include internally benchmarked data top

  What is the best way to display nurse satisfaction data?

For OO12 Organizational Overview requirement
Provide the two (2) most recent unit-based, nationally benchmarked nurse satisfaction or engagement surveys. The preference is that the same tool be used for both surveys. Provide data for each unit. If the measurement tool has subscales, data should be displayed at the sub-scale level. If available, include the levels of statistical significance as compared to the benchmark.

Include a graphic display and a table of the data that clearly identify:

• The database to which the data was contributed
• The mean or median of the national benchmark (select one cohort such as hospitals, bed size, Magnet hospitals, etc.)
• Labels for each axis

For EP3EO requirement
Submit data for the most recent annual or bi-annual nurse satisfaction or engagement survey and include the mean or median of the national database used. This data can be displayed at the single unit level (such as ICU, CCU, SICU); or by clinical groups of multiple like-units ( such as critical care, medical, surgical, medical-surgical, rehabilitation, and ambulatory); or at the organizational level. Data must be statistically valid and provided by the vendor. Keep in mind that t he majority of the data must outperform the mean or median the majority of the time.

The narrative must include:

• Participation rates
• Analysis, and evaluation of the data
• The database to which the data was contributed

Include a graphic display and a table of the data that clearly identify:

• All data from the most recent survey cycle within the last two (2) years.
• The benchmark mean or median for the selected cohort (select one cohort such as hospitals, bed size, Magnet hospitals, etc.)
• Labels for each axis

NOTE: Do not include internally benchmarked data. top

  How often do we need to do the RN satisfaction survey?
The nursing satisfaction surveys do not need to be done annually. Whether those are annual or every two years is up to your organization. top

  What is the best way to display patient satisfaction data?

For OO26 Organizational Overview Requirement
Provide u nit-based, nationally benchmarked data for patient satisfaction with nursing for the most recent two-year period. Provide quarterly data for every unit for four of the measures listed below. If available, include the levels of statistical significance as compared to the benchmark.

• Pain
• Education
• Courtesy and respect from nurses
• Careful listening by nurses
• Response time

Include a graphic display and a table of the data that clearly identify:

• The database to which the data was contributed
• The mean, median, or other benchmark statistic of the national database used (select one cohort such as hospitals, bed size, Magnet hospitals, etc.)
• Labels for each axis

For EP35EO Requirement
Submit data for the most recent eight quarters of data for four measures related to patient satisfaction with nursing (listed below) and include the mean or median of the national database used. This data can be displayed at the single unit level (such as ICU, CCU, SICU); or by clinical groups of multiple like-units ( such as critical care, medical, surgical, medical-surgical, rehabilitation, and ambulatory); or at the organizational level. Data must be statistically valid and provided by the vendor. Keep in mind that t he majority of the data must outperform the mean or median the majority of the time.

• Pain
• Education
• Courtesy and respect from nurses
• Careful listening by nurses
• Response time

The narrative must include:

• Analysis, and evaluation of the data and resultant action plans
• The database to which the data was contributed

Include a graphic display and a table of the data that clearly identify:

• All data from the most recent eight quarters
• The benchmark mean, median, or other benchmark statistic for the database used for each quarter, for the selected cohort (select one cohort such as hospitals, bed size, Magnet hospitals, etc.)
• Labels for each axis 

NOTE: Do not include internally benchmarked data. top

During the off years, we do a house-wide employee engagement survey for the entire health system, from which we can isolate results specific to the RN. Would this be acceptable?
One thing to consider is the comparability of the indicator set. You must have two data points from the same survey tool to compare results. You must assure that it is benchmarked as part of a nationally representative sample. In addition, data needs to be available for RNs by unit, even in the house-wide survey. As long as those conditions are met, you may use whatever survey instrument you wish.

If special circumstances prevent your organization from comparing two data points from the same survey tool, a detailed explanation must be included in the written documents. Every effort needs to be made to compare results between similar concepts for nurse satisfaction over time. top

The 2008 Magnet Manual says that beginning in 2010 we need to submit unit-level data on all indicators listed. We won't be able to have the data by then.
The Magnet program is moving the requirement to 2012 because of the lag in reporting benchmarking data. This should give organizations time to catch up. The requirement will be to submit data on all indicators, so you should be collecting now in order to have two years' worth of data to submit by 2012. top

For restraint use, what specific data is being requested? In-house restraints in use, or injuries related to restraints?
It depends on the database being used and how restraints are defined. Submit the restraint indicators that have benchmark data. top

We have 20 hospitals in one state. Would we qualify as large enough to be a comparison benchmark against ourselves?
The requirement is to benchmark against a nationally representative sample. The larger the comparative cohort, the more valuable the data set on which to base your improvement efforts. While it is always helpful to compare yourself to other hospitals in your state, 20 hospitals in one state would not qualify as a nationally representative sample for comparison benchmark for Magnet. If you have questions, or are unsure, it is always a good idea to call the Magnet Program Office and talk to your analyst. top