When a nationwide center has declared your nursing care among the best of the best, getting even better means clearing a very high bar.

Leslie Robbins and DeShuna Dickens aim to prove Novant Health is doing exactly that. They're co-leaders of a program that has brought the nation's top nursing honor to Novant Health Presbyterian Medical Center in Charlotte and Novant Health Forsyth Medical Center in Winston-Salem.

The two Novant Health hospitals — and by extension, smaller ones under their umbrella — are among fewer than 10% nationwide recognized as Magnet hospitals by the American Nurses Credentialing Center. Just 591 of the nation's 6,093 hospitals have attained Magnet status.

"It's not something that's required of us to do, but it shows that you're invested in your nurses and interdisciplinary care teams that take care of your patients," Robbins said.

Simply put, the designation recognizes innovative nursing practices and outstanding patient care.

With the nationwide demand for nurses outstripping the supply, finding ways to attract and keep the best of the best is harder than ever. And, as Magnet recognition emphasizes, programs that empower nurses, foster their growth and reward clinical excellence are key.

"We have less turnover than other hospitals without these resources," Robbins said.

Among other things, Magnet hospitals must show support for nurses' professional development and their ideas for improving everyday practice. Magnets must surpass nationwide benchmarks for vacancies, turnover rates and the percentage of nurses who are certified and/or holders of advanced nursing degrees. They must also prove their nurses are making a difference outside the hospital, for example by volunteering at health screenings or participating on mission trips. Patient satisfaction scores matter, too.

Adding to the difficulty, Magnet hospitals are expected to get better all the time — always besting their own previous benchmarks.

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Documenting that to satisfy a panel of outside appraisers is a time-consuming task. Renewal is not automatic.

"It's a high bar, but if we're doing the work, we will absolutely see the benefits in terms of nursing turnover, job satisfaction and patient outcomes," Dickens said.

Robbins knows from experience what it takes.

"We used to submit a six- to eight-inch binder full of documents for our appraisers to read," she said. "Now, it's all electronic but it's still the same amount of work."

‘Nurse-driven' change

Programs such as Novant Health's graduate RN residency program, which has helped nearly 3,000 women and men transition from student to professional, represent the kind of innovation Magnet appraisers prize.

Providing support for nurses to do original research and play a part in shared governance is another. Karen Cumbo is among the front-line nurses who have taken advantage of both. She's part of an interdisciplinary team at Forsyth Medical Center that includes nurses, midwives, obstetricians, anesthesiologists and others who care for women during labor and delivery.

Challenged to come up with ways to improve care, the team had an idea: What if women could have a light, nutritious snack during labor? The possible need for anesthesia has traditionally made eating during labor a safety concern.

With help from Novant Health's nurse scientist, Gloria Walters, and leadership from Carol Mayernik, clinical practice specialist at Forsyth's Women's Health Center, a formal study was designed. It found that women deemed at low risk should be offered a low-fat diet during early labor to optimize the birthing experience and increase energy levels. Cumbo was part of a group that recently presented its findings to the Association of Women's Health, Obstetric and Neonatal Nurses.

She described the experience as empowering.

"It was all nurse-driven, and it came out of our unit's shared governance," Cumbo said. "Our co-workers wanted to see it happen, and you like to be part of the solution."

She said the collaboration is just one of many ways Novant Health supports innovative nursing practice.


The Magnet model

To become a Magnet, hospitals must show excellence in five areas:

  1. Transformational leadership: Leaders must have a clear vision for the future and the environment and systems required to achieve it.
  2. Structural empowerment: Strong plans for improving patient outcomes and the health of the communities they serve. Empowering nurses to find the best ways to achieve these outcomes is key.
  3. Exemplary professional practice: Besides outstanding patient care, innovating, documenting what works and sharing successes are aims.
  4. New knowledge, innovation and improvements: Magnet organizations are expected to contribute to new and better models of patient care.
  5. Empirical quality results: Hospitals must show evidence that they've improved care.

‘They’ve been very innovative’

Encouraging nurses to further their education and providing financial support to help them do it is another. A clinical ladder program provides bedside RNs advancement opportunities and rewards professional growth and development.

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All of it — from research projects to financial incentives to sharing best practices with other hospitals — is aimed at boosting what's known as nurse-sensitive indicators. Those are the numbers demonstrating the difference nurses make every day in patients' outcomes — for example, in reducing falls, pressure injuries and infection rates.

Responding to worldwide equipment and supply shortages during the COVID-19 pandemic, Novant Health formed interdisciplinary teams to ensure the safe delivery of basic treatments such as intravenous therapy and tube feedings. The team established safe practices to improve nursing workflows, decrease risk of exposure, conserve personal protective gear and respond quickly to any shortage of necessary equipment.

"They've been very innovative, and we will show that occurring, day-to-day," Robbins said.

Surveys show Novant Health nurses value the opportunity to innovate and collaborate. More than 90% describe their work as meaningful and almost as many say they and their colleagues work well as a team, even in the face of daunting challenges like a worldwide pandemic.

‘Your time to brag’

Once Robbins and Dickens make their case for continued Magnet status in writing to the American Nurses Credentialing Center, appraisers will visit Presbyterian and Forsyth to see for themselves.

"Once we get to that site visit, we tell our nurses, 'It's your time to brag,' " Robbins said.

She predicts nurses will only be too happy to tout their successes. After all, the Magnet Recognition program came about at Novant Health because nurses eager to set a high bar for success pushed for it — and it's that kind of front-line leadership that is paying off on a daily basis.

"Being a Magnet hospital is just one of the many ways we're encouraging nurses to work at the top of their abilities," Dickens said.