Obzornik zdravstvene nege, 58(3), pp. 164–167. https://doi.org/10.14528/snr.2024.58.3.3304 As part of the continuous commitment to excellence, organizations pursue certification and designation programs focused on improving the work environment, advancing practice, and attaining a status of distinction and the highest level of recognition. Through these programs, nurses are recognized for their contributions to their work environment and care delivery. This is important for nurses' professional and personal fulfillment, job satisfaction, and retention; such recognition can occur at the individual, unit, or organizational level (Hurley et al., 2021). Some programs are focused on specialty areas such as critical care, medical-surgical, psychiatry and stroke. The American Nurses Credentialing Center (ANCC) established the Magnet Recognition Program® and Pathway to Excellence (AACN, 2024b), two programs which recognize nursing excellence. During the nursing shortage in the 1980s, the American Academy of Nursing conducted a study to identify which hospitals retained nurses better. The study identified the characteristics institutions possessed that led to lower nurse turnover and vacancy rates because of their ability to attract and retain nurses. These hospitals were then described as "Magnet®" hospitals and marked the creation of the Magnet Recognition Program® in the 1990s. Elements that were important to nurses such as autonomy in practice, shared governance, collaboration, and teamwork supported a positive practice environment resulting to better nurse retention and improved outcomes in quality and safety. The ANCC Pathway to Excellence Program (AACN, 2024b) recognizes a health care organization's commitment to creating a positive practice environment that empowers and engages staff. Pathway includes six standards that are essential elements in developing a positive practice environment for nursing across a variety of healthcare settings. These standards include shared decision-making, leadership, safety, quality, wellbeing, and professional development. In the UK, several hospitals were successfully designated as Pathway organizations. The American Association of Critical-Care Nurses (AACN) developed the Beacon Award (AACN, 2024c) to recognize hospital units that exemplify excellence in professional practice, patient care, and outcomes. The AACN Beacon Award recognizes top hospital units that meet standards of excellence in recruitment and retention; education, training and mentoring; research and evidence-based practice; patient outcomes; leadership and organizational ethics; and creation of a healthy work environment. The organization is designated as Gold, Silver, or Bronze, demonstrating their stage in the journey (AACN, 2024c). In 2010, the award was updated to align with Magnet® quality indicators. Examples of other awards or designations that recognize excellence in specialty areas include the American Medical-Surgical Nursing (AMSN) PRISM Award, Emergency Nurses Association (ENA) Lantern Award, Society of Gastroenterology Nurses and Associates (SGNA) Flame Award. Why consider pursuing programs of excellence? In spite of the recent wave of significant nursing turnover, many healthcare organizations pushed to work towards achieving or sustaining designated status. In one Magnet®-designated organization, nurses were asked to reflect on what Magnet® status means to them. A nurse who has seen the hospital's evolution before Magnet® referred to themes of more accountability and autonomy in their practice, along with improved collaboration with other disciplines: "Today, nurses really take much more responsibility for Editorial/Uvodnik Pursuing nursing excellence Doseganje odličnosti v zdravstveni negi Rhoda Redulla1, 2,* 1 NewYork-Presbyterian, 435 E. 70th St., 4K New York, New York 10021, United States of America 2 Yale University School of Nursing, 400 West Campus Drive, Orange, CT 06477, United States of America * Corresponding author/Korespondenčni avtor: rhodaredulla@gmail.com Received/Prejeto: 21. 7. 2024 Accepted/Sprejeto: 18. 8. 2024 Redulla, R., (2024)/Obzornik zdravstvene nege, 58(3), pp. 164–167. 165 themselves, develop our own standards and policies, have more interaction with other departments and focus more on furthering our education." (Johns Hopkins Nursing, 2024). At another hospital, eight hospital units received support to apply for the Beacon award, including the formation of a collaborative to facilitate the submission and designation process. Frontline nurses became directly involved with the development of the strategic plan, engaged in discussions regarding the healthy work environment standards, and were involved in the Collaborative. Although each unit progressed at its own pace, all eight units were successfully designated the Beacon Award (Hurley et al., 2021). Is pursuing the designation or award worth the investment and process? Achieving recognitions of excellence has unique benefits, including recognition, retention, credibility, and improvement. Nursing teams are able to celebrate their achievements and nurses' contributions in clinical excellence. Because excellence programs exemplify healthy work environments, a benefit of successful designation is improved nurse satisfaction and retention. The US RN turnover rate as published in a March 2024 report by NSI Nursing Solutions was 18.4% (Nursing Solutions, 2024). The most recent data released by the ANCC for Magnet® hospitals as of May 2022 was 12.47% (AACN, 2024a). Apart from improving nurse retention, supporting the work environment of nurses has cumulative benefits. Successful designation has been reported to have a positive effect on quality and safety, including lower mortality rates and healthcare associated infections. Commitment Required The decision to apply for a designation involves strong leadership and commitment by the institution. Support and buy-in from the C-Suite helps ensure a successful designation. The C-Suite plays a pivotal role in aligning the pursuit of a designation with the organization's strategic goals and vision. Their understanding of how the designation fits into the overall strategy helps ensure that resources and efforts are appropriately managed and allocated. A key step is creating the infrastructure to support the journey to designation which includes establishing the team charged to work on the designation. Designation programs require the organization to collect data. For example, the Magnet Recognition Program® requires organizations to collect nurse-sensitive quality indicators and benchmark that data against a database at the highest/broadest level possible, whether at the national, state, regional, or specialty organization level. Nursing-focused designation programs are anchored on a framework that supports lifelong learning and involvement of nurses in interprofessional decision- making. Organizations establish nursing committees led or co-led by frontline nurses to work on goals aligned with the strategic priorities of the hospital. For example, in one hospital, a Nursing Quality and Safety Council created a healthcare-associated infections (HAI) champions program. HAI champions facilitate the implementation of reduction strategies in CLABSI, C-diff and other HAIs. For Magnet®, one of the key requirements is to demonstrate the involvement of nurses in research, where a nurse is the principal investigator or co- investigator. The organization's commitment to Magnet® designation includes establishing the infrastructure, resources, and tools for nursing research to grow and flourish. Magnet® creates an environment where nurses lead clinical inquiry and innovation. For most designation programs, the formal process starts with the submission of an electronic application, followed by the submission of written documents, including qualitative and quantitative evidence regarding patient care and outcomes. To be successful, the organization designates a program leader for oversight of the entire process. Writing teams are formed to organize the narratives, evidence, and data. For some designations or awards, a site visit is part of the process to validate the enculturation of nursing excellence. Call to action While the requirements and criteria (AACN, 2024a) may seem too overwhelming and challenging, organizations can start with small steps and demonstrate success in select areas or at the unit level. Another option is to use the designation's framework (such as Magnet® or Beacon) in conducting a gap analysis and identifying areas of opportunity. By actively pursuing these certification and designation programs, nursing organizations demonstrate their dedication to nurturing a skilled and resilient nursing workforce capable of meeting the evolving challenges in healthcare. This strategic investment not only strengthens individual nurses but also contributes to the overall quality of patient care and organizational effectiveness. Slovenian translation/Prevod v slovenščino V delovnih organizacijah se kot del stalne zavezanosti k doseganju odličnosti izvajajo programi certificiranja in podeljevanja priznanj, namenjeni uvajanju izboljšav v delovno okolje, napredka v praksi ter pridobivanju statusa odličnosti in pohvale na najvišji ravni. Cilj tovrstnih programov je izkazati priznanje zdravstvenemu osebju (tako na ravni posameznika, kot tudi enote ali organizacije) za prispevek k delovnemu okolju in kakovostnemu izvajanju zdravstvene nege, kar je izrednega pomena v smislu poklicne in osebne Redulla, R., (2024)/Obzornik zdravstvene nege, 58(3), pp. 164–167.166 izpolnitve medicinskih sester, njihovega zadovoljstva pri delu in ohranjanja zaposlitve (Hurley et al., 2021). Nekateri od omenjenih programov se osredotočajo na specializirana področja, kot so intenzivna nega, zdravstvena nega na kirurškem področju, zdravstvena nega v psihiatriji ali internistična zdravstvena nega. Za priznanje odličnosti v zdravstveni negi je organizacija American Nurses Credentialing Center (ANCC) vzpostavil programa Magnet Recognition Program® in Pathway to Excellence (AACN, 2024b). V obdobju pomanjkanja medicinskih sester v 80-ih letih prejšnjega stoletja je American Academy of Nursing (AAN) izvedla raziskavo, namen katere je bil izpostaviti bolnišnice, ki so bile najuspešnejše pri zadrževanju medicinskih sester. Raziskava je opredelila dejavnike, s katerimi so bile bolnišnice sposobne pritegniti in zadržati medicinske sestre, kar je botrovalo k nižji fluktuaciji osebja in nižjemu številu prostih delovnih mest. Te bolnišnice so pridobile naziv »Magnet®«, s čimer se je v 90-ih pravzaprav uvedel program certificiranja Magnet®. Izsledki raziskave kažejo, da zdravstvenemu osebju najpomembnejši vidiki, kot so avtonomija v praksi, skupno upravljanje, sodelovanje in timsko delo, ustvarjajo pozitivno delovno okolje, kar pa po drugi strani prispeva k višji stopnji zadržanja medicinskih sester na delovnih mestih ter boljšim rezultatom na področju kakovosti in varnosti. Program ANCC Pathway to Excellence (AACN, 2024b) podeljuje priznanje za zavezanost zdravstvene organizacije k ustvarjanju pozitivnega delovnega okolja, ki temelji na opolnomočenju in vključitvi osebja. Naziv »Pathway«, ki je bil podeljen že številnim bolnišnicam v Združenem kraljestvu, obsega nabor šestih standardov, ki so bistveni za razvoj pozitivnega delovnega okolja v zdravstvenih ustanovah. Ti standardi vključujejo skupno odločanje, vodenje, varnost, kakovost, dobro počutje in strokovni razvoj. S priznanjem »Beacon« združenje American Association of Critical-Care Nurses (AACN) nagrajuje bolnišnične oddelke, ki so zgled odličnosti v strokovni praksi, oskrbi pacientov in rezultatih zdravstvene nege. Priznanje se podeljuje bolnišničnim oddelkom, ki izpolnjujejo standarde odličnosti na področju ustvarjanja zdravega delovnega okolja, zaposlovanja in ohranjanja kadrov, izobraževanja, usposabljanja in mentorstva, raziskovanja ter na dokazih temelječe prakse, izidov zdravljenja ter etike v organizaciji in vodenju. Glede na dosežen uspeh se lahko podeli zlato, srebrno ali bronasto priznanje (AACN, 2024c). S posodobitvijo programa se je leta 2010 priznanje uskladilo s kazalniki kakovosti Magnet®. Primeri drugih priznanj ali certifikatov odličnosti na specializiranih področjih so: priznanje »PRISM« strokovne zveze American Medical-Surgical Nursing (AMSN), priznanje »Lantern« združenja Emergency Nurses Association (ENA) ter priznanje »Flame« združenja Society of Gastroenterology Nurses and Associates (SGNA). Smisel prizadevanj za pridobitev certifikata odličnosti Številne zdravstvene organizacije si kljub nedavnemu valu odhajanja medicinskih sester prizadevajo pridobiti ali obdržati podeljeni certifikat. V eni izmed organizacij s statusom Magnet® so medicinske sestre prosili, naj razmislijo o tem, kaj jim status Magnet® pomeni. Ena od zaposlenih, ki je bila priča razvoju bolnišnice pred pridobitvijo statusa Magnet®, je omenila večjo odgovornost in samostojnost pri svojem delu, prav tako pa tudi boljše sodelovanje s strokovnjaki drugih disciplin. Dejala je, da medicinske sestre danes prevzemajo veliko več odgovornosti zase, razvijajo lastne standarde in politike, tesneje sodelujejo z drugimi oddelki in se bolj intenzivno osredotočajo na nadaljnje izobraževanje (Johns Hopkins Nursing, 2024). Osem bolnišničnih oddelkov druge bolnišnice je prejelo podporo za prijavo na certifikat »Beacon«, vključno z oblikovanjem delovne skupine za olajšanje postopka prijave in akreditacije, v kateri so bile najbolj izpostavljene medicinske sestre neposredno vključene v pripravo strateškega načrta in razprave o standardih zdravega delovnega okolja. Čeprav je vsak oddelek napredoval po svojih zmožnostih, je vseh osem prejelo priznanje »Beacon« (Hurley et al., 2021). Ali je torej prizadevanje za pridobitev certifikata vredno naložbe v izvedbo potrebnih postopkov? Pridobivanje certifikatov odličnosti ima edinstvene koristi, med katerimi lahko izpostavimo priznavanje kakovosti, ohranjanje delovne sile, verodostojnost in nenehno izpopolnjevanje. Zdravstveni timi lahko z njimi proslavijo svoje dosežke in prispevke h klinični odličnosti. Programi odličnosti in podeljeno priznanje pomenijo zgled zdravega delovnega okolja, s čimer organizacije izkazujejo tudi višjo stopnjo zadovoljstva in zadržanja medicinskih sester. Poročilo NSI Nursing Solutions iz marca 2024 navaja 18,4 % stopnjo fluktuacije medicinskih sester v Združenih državah Amerike (Nursing Solutions, 2024). Po najnovejših podatkih, ki jih je objavil ANCC za bolnišnice s certifikatom Magnet®, je maja 2022 ta stopnja znašala 12,47 % (AACN, 2024a). Poleg učinkovitejšega zadržanja medicinskih sester ima podpora delovnemu okolju medicinskih sester tudi kumulativne koristi. Pridobitev certifikata pozitivno vpliva na kakovost in varnost, vključno z nižjo stopnjo umrljivosti in okužb, povezanih z zdravstveno oskrbo. Pomen zavezanosti Odločitev za prijavo na certificiranje je odvisna od učinkovitosti vodenja in stopnje zavezanosti same ustanove, torej od podpore in sodelovanja vodstva, saj ima le-to ključno vlogo pri usklajevanju prizadevanj za pridobitev naziva s strateškimi cilji in vizijo organizacije. Viri in prizadevanja se lahko ustrezno Redulla, R., (2024)/Obzornik zdravstvene nege, 58(3), pp. 164–167. 167 upravljajo in dodeljujejo le, v kolikor vodstvo razume, kako se pridobitev naziva vključuje v splošno strategijo ustanove. Pri tem je ključni korak na poti do pridobitve naziva vzpostavitev ustrezne infrastrukture, ki vključuje imenovanje delovne skupine v tem procesu. Programi podeljevanja priznanj od organizacije zahtevajo zbiranje podatkov. Program Magnet® na primer od organizacij zahteva zbiranje kazalnikov kakovosti, ki se tičejo medicinskih sester, in te podatke primerja s podatkovno bazo na najvišji/najširši možni ravni, bodisi na nacionalni, državni, regionalni ali ravni specializirane organizacije. Programi podeljevanja priznanj, usmerjeni v zdravstveno nego, temeljijo na okviru vseživljenjskega učenja in vključevanja medicinskih sester v medpoklicno odločanje. Organizacije ustanovijo odbore za zdravstveno nego, ki jih v prizadevanju za dosego ciljev, usklajenih s strateškimi prednostnimi nalogami bolnišnice, upravljajo ali soupravljajo najbolj izpostavljene medicinske sestre. V eni od obravnavanih bolnišnic je na primer svet za kakovost in varnost zdravstvene nege oblikoval program prvakov na področju okužb, povezanih z zdravstveno oskrbo. Ta program omogoča izvajanje strategij za zmanjšanje števila bolnišničnih okužb. Ena od ključnih zahtev za pridobitev statusa Magnet® je dokazati vključenost medicinskih sester v raziskave, pri katerih ima medicinska sestra vlogo vodilnega raziskovalca ali so-raziskovalca. Zavezanost organizacije k programu Magnet® vključuje vzpostavitev infrastrukture, virov in orodij za razvoj in razcvet raziskav zdravstvene nege. Magnet® tako ustvarja okolje, v katerem medicinske sestre vodijo klinične raziskave in inovacije. Formalni postopek večine programov pridobivanja priznanj se prične z oddajo elektronske vloge, ki ji sledi predložitev pisnih dokumentov, vključno s kvalitativnimi in kvantitativnimi dokazi v zvezi z zdravstveno oskrbo pacientov in rezultati zdravljenja. Organizacija imenuje vodjo programa, ki nadzoruje celoten postopek, ter formira skupine za oblikovanje potrebnih besedil (pripovedi, dokazov in podatkov). Del nekaterih postopkov je tudi obisk lokacije, da se potrdi uvedbo dejavnikov odličnosti zdravstvene nege. Poziv k ukrepanju Čeprav se zahteve in merila morda zdijo preobsežni in zahtevni, lahko organizacije pričnejo z majhnimi koraki in dokažejo uspeh na izbranih področjih ali na ravni oddelkov. Druga možnost je, da pri analizi vrzeli in ugotavljanju priložnosti uporabijo okvir certificiranja (na primer Magnet® ali Beacon). Zdravstvene organizacije z aktivno izvedbo omenjenih programov dokazujejo svojo predanost vzgoji usposobljene in odporne delovne sile, ki se je sposobna soočati z novimi izzivi v zdravstvu. Tovrstna strateška naložba ne krepi le posameznih zdravstvenih delavcev, temveč prispeva k višji kakovosti zdravstvene nege in učinkovitosti organizacije. Conflict of interest/Nasprotje interesov The author confirms that there are no conflict of interest./Avtorica izjavlja, da ni nasprotja interestov. Literature American Nurses Credentialing Center (AACN). (2024a). 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The Meaning of Magnet: Nurses ponder the significance of the nation’s most coveted nursing award. https://www.hopkinsmedicine.org/nursing/about/magnet NSI Nursing Solutions. (2024, March). 2024 NSI National Health Care Retention & RN Staffing Report. https://www.nsinursingsolutions.com/Documents/Library/ NSI_National_Health_Care_Retention_Report.pdf Cite as/Citirajte kot: Redulla, R. (2024). Pursuing nursing excellence. Obzornik zdravstvene nege, 58(3), 164–167. https://doi.org/10.14528/snr.2024.58.3.3304