Celebrating Magnet® Nursing Excellence: Meet the Recipients of the 2020 National Magnet Nurse of the Year® Awards and ANCC Magnet Prize®.

This month's Magnet® Perspectives column spotlights the recipients of the 2020 American Nurses Credentialing Center (ANCC) Magnet Program® National Magnet Nurse of the Year Awards and the ANCC Magnet Prize®, sponsored by Cerner, who were recognized during the ANCC National Awards virtual event on May 14, 2021.

A Qualitative Exploration of Chief Nursing Officer Perspectives on Maintaining Magnet® Designation.

OBJECTIVE: The purpose of this study was to determine chief nursing officer (CNO) perspectives on how to sustain the infrastructure required for successful American Nurses Credentialing Center (ANCC) Magnet® redesignation. BACKGROUND: American Nurses Credentialing Center Magnet designation is a prestigious achievement reflective of years of dedication, innovation, mentoring, and leadership support. As challenging as the initial attainment of Magnet status can be, sustaining the success and becoming redesignated is considered even more difficult by many CNOs. However, there have been no published reports indicating how to be successful in Magnet redesignation. METHOD: A grounded theory qualitative approach was used, and data were collected through telephone interviews with CNOs who had successfully attained at least 1 redesignation. RESULTS: Fourteen CNOs participated; data were organized into 6 themes and 15 subthemes describing the critical elements for Magnet redesignation. CONCLUSION: Relationships among the 6 themes and subthemes are theorized in the form of a wheel with 6 spokes. When "set in motion," the wheel gathers momentum and all of the model elements become coalesced into the organizational ethos.

An assessment of the online presentation of MIS fellowship information for residents.

INTRODUCTION: Residents often utilize internet resources to evaluate and search for fellowship programs within their desired field. The presence of these resources and the information available through them has the potential to influence applicant decisions. The objective of this study was to analyze the online MIS fellowship information relevant to resident applicants provided by the Fellowship Council Directory (FCD) and institutionally based program webpages. MATERIALS AND METHODS: The programs evaluated were chosen based on their inclusion in the FCD, the accrediting body for MIS fellowships. The FCD provides each program a template through which program directors detail information for applicants. This information is publicly accessible through the directory, with each program having a specific page. These webpages were assessed for the presence or absence of 21 previously established individual content criteria. In addition, the presence or absence of a functional link to an institutionally based, program-specific webpage was determined. These program-specific, institutional webpages were then independently accessed via Google® search and separately assessed for the presence or absence of the same 21 previously established content criteria. RESULTS: In total, the FCD listed 144 programs. Each program had a dedicated page within the directory itself with 104 (72%) having functional links listed. Ninety-six (66.6%) of the FCD links were identified as being specific webpages to the fellowship program, verified through a Google® search. Less than half of the programs fulfilled over 50% of identified criteria through the FCD templated directory, with one-third of programs listed failing to provide any program-specific information via a webpage outside the FCD. CONCLUSION: Information available online for MIS fellowship programs is lacking, with many institutionally supported webpages absent altogether outside of the FCD. Templated formats seem to assist in this deficiency, but should be used cautiously as they also can potentially omit relevant information.

The US Health Provider Workforce: Determinants and Potential Paths to Enhancement.

The health provider workforce is shaped by factors collectively influencing the education, training, licensing, and certification of physicians and allied health professionals, through professional organizations with interlocking and often opaque governance relationships within a state-based licensing system. This system produces a workforce is that is insufficiently responsive to current needs and opportunities, including those created by new technologies. This lack of responsiveness reflects the complex, nontransparent, and cautious nature of the controlling organizations, influenced by the economic interests of the organized professions, which seek protection from competitors both local and international. The first step in addressing this is to comprehensively examine the organizational complexity and conflicted interests within this critical ecosystem. Doing so suggests areas ripe for change, to enhance the health workforce and benefit public health.

Achieving American Nurses Credentialing Center Magnet® Designation With a Virtual Site Visit.

Innovation has enabled organizations to highlight and engage during the COVID -19 pandemic. The use of virtual site visits to assess the organizations 's culture and sustainability of the Magnet components during initial designation and redesignation allows for ongoing support of nursing excellence.

Facilitating credentialing and engagement of international physician-migrants during the COVID-19 crisis and beyond.

CONTEXT: Physicians who migrate globally face a daunting series of time-consuming, labor- and resource-intensive procedures to prove their clinical competency before being allowed to practice medicine in a new country. ISSUES: In this commentary, we describe licensing barriers faced by physician-migrants based on the authors' experiences, and reflect also on rapidly implemented measures to address COVID-19 pandemic related workforce shortages. We offer recommendations for potential reductions in bureaucratic regulatory barriers that prohibit mobilization of international medical graduate talent. LESSONS LEARNED: Licensing boards and authorities should strive for standardized, competency-based basic professional recognition. Professional medical societies are well-positioned to guide such competency-based recognition as a more organized, international collaborative effort across specialties. The COVID-19 pandemic facilitated cross-state and international licensing in some regions, highlighting a key opportunity: streamlining professional recognition requirements is achievable.

The evaluation of evidence-informed changes to an internationally educated nurse registration process.

AIM: To evaluate effectiveness of specific policy and practice changes to the process of registration for internationally educated nurses. BACKGROUND: Little research exists to inform registration policy for internationally educated health professionals. INTRODUCTION: Internationally educated nurse employment can help address nursing shortages. Regulators assess competencies for equivalency to Canadian-educated nurses, but differences in health systems, education and practice create challenges. METHODS: The study setting was a Canadian province. We used a mixed methods approach, with a pre-post-quasi-experimental design and a qualitative evaluation. Previous analysis of relationships between applicant variables, registration outcomes and timelines informed changes to our registration process. Implementation of these changes composes the intervention. Comparisons between pre- and post-implementation exemplar subgroups and timeline analyses were conducted using descriptive statistics, univariate analysis and non-parametric tests. Data were collected from complete application files before (n = 426) and after (n = 287) implementation of the intervention. Interviews, focus groups and consultations were completed with various stakeholders. FINDINGS: The time between steps in the process was significantly reduced following implementation. Stakeholders reported an increase in perceived efficiency, transparency and use of evidence. DISCUSSION: Results indicated that initial impacts of the policy changes streamlined the process for applicants and staff. CONCLUSION: Maintaining a consistent and systematic review of an organization's data coupled with implementation of findings to effect policy and practice change may have an important impact on regulatory policy. IMPLICATIONS FOR NURSING POLICY: These findings represent the beginning of an international policy conversation. Policy changes based on organizational data can underlie major process improvement initiatives. Ongoing nursing shortages across the globe and increasing mobility of nurses make it important to have efficient and transparent regulatory policy informed by evidence.

Transformational Impact on Direct Care Nurses' Supporting the Magnet Site Visit.

Exposure to strategic project and workforce preparation for nursing excellence throughout organizational American Nurses Credentialing Center Magnet journeys has been observed as positively impacting the escort nurse's personal goal setting and achievement beyond the site visit. This article describes a project undertaken to capture the characteristics of staff nurses serving as Magnet escorts for hospital site visits. The positive relationship of that experience on goal setting and future workplace volunteerism for projects is presented. An association with nurse confidence through perceived self-efficacy is explored. The results have significance for leader and staff involvement in nursing projects and strategic goal achievement.

The impact of registration of clinical trials units: the UK experience.

BACKGROUND: Over the last decade, the United Kingdom has invested significant resources in its clinical trial infrastructure. Clinical research networks have been formed, and some general oversight functions for clinical research have been centralised. One of the initiatives is a registration programme for Clinical Trials Units involved in the coordination of clinical trials. An international review panel of experts in clinical trials has been convened for three reviews over time, reviewing applications from Clinical Trials Units in the United Kingdom. The process benefited from earlier work by the National Cancer Research Institute that developed accreditation procedures for trials units involved in cancer trials. This article describes the experience with the three reviews of UK Clinical Trials Units which submitted applications. PURPOSE: This article describes the evolution and impact of this registration process from the perspective of the current international review panel members, some of whom have served on all reviews, including two done by the National Cancer Research Institute. PROCESS: Applications for registration were invited from all active, non-commercial Clinical Trials Units in the United Kingdom. The invitations were issued in 2007, 2009 and 2012, and applicants were asked to describe their expertise and staffing levels in specific areas. To ensure that the reviews were as objective as possible, a description of expected core competencies was developed and applicants were asked to document their compliance with meeting these. The review panel assessed each Clinical Trials Unit against the competencies. The Clinical Trials Unit registration process has evolved over time with each successive review benefiting from what was learned in earlier ones. RESULTS: The review panel has seen positive changes over time, including an increase in the number of units applying, a greater awareness on the part of host institutions about the trials activity within their organisations, more widespread development of Standard Operating Procedures in key areas and improvements in information technology systems used to host clinical trials databases. Key funders are awarding funds only to registered units, and host institutions are implementing procedures and structures to ensure improved communication between all parties involved in trials within their organisation. CONCLUSION: The registration process developed in the United Kingdom has helped to ensure that trials units in the United Kingdom are compliant with regulatory standards and can meet acceptable standards of quality in their conduct of clinical trials. There is an increased awareness among funders, host institutions and Clinical Trials Units themselves of the required competencies, and communication between all those involved in trials has increased. The registration process is an effective and financially viable way of ensuring that objective standards are met at a national level.

Quality and impact of appraisal for revalidation: the perceptions of London's responsible officers and their appraisers.

BACKGROUND: To evaluate NHS England London region's approach to the revalidation appraisal of responsible officers in London, exploring perceptions of the quality and impact of the appraisal process. Revalidation is the process which aims to ensure doctors in the UK are up-to-date and fit to practice medicine thus improving the quality of patient care. Revalidation recommendations are largely premised on the documentation included in annual appraisals, which includes the professional development a doctor has undertaken and supporting information about their practice. METHODS: A pan-London qualitative study exploring the views of responsible officers and their appraisers about the revalidation appraisal process. The study aimed to gain an in-depth understanding of the experiences and perceptions of the participants. Responsible officers were purposefully sampled to represent the broadest range of designated bodies. Data analysis generated themes pertaining to quality and impact of appraisal for revalidation with the potential to feed into and shape the evolving system under investigation. RESULTS: The central importance of highly skilled appraisers was highlighted. Both groups reported educational opportunities embedded within the appraisal process. Independent appraisers, not matched by clinical speciality or place of work, were considered to take a more objective view of a responsible officer's practice by providing an 'outsider perspective'. However, covering the breadth of roles, in sufficient depth, was challenging. Participants reported a bias favouring the appraisal of the responsible officer role above others including clinical work. Appraisal and revalidation was perceived to have the potential to improve the healthcare standards and support both personal development and institutional quality improvement. CONCLUSIONS: Responsible officers play a central role in the revalidation process. Getting responsible officer appraisal right is central to supporting those individuals to in turn support doctors and healthcare organisations in continuous quality improvement. The complexity and importance of the role of responsible officer may make achieving an appraisal of all roles of such individuals problematic. This evaluation suggests responsible officer appraisal was perceived as educational and effective.

Doctor of nursing practice by 2015: an examination of nursing schools' decisions to offer a doctor of nursing practice degree.

OBJECTIVES: The American Association of Colleges of Nursing recommends that nursing schools transition their advanced practice registered nurse (APRN) programs to doctor of nursing practice (DNP) programs by 2015. However, most schools have not yet made this full transition. The purpose of this study was to understand schools' decisions regarding the full transition to the DNP. METHODS: Key informant interviews and an online survey of nursing school deans and program directors were performed. DISCUSSION: The vast majority of schools value the DNP in preparing APRNs for the future of the health care system. However, other important factors influence many schools to fully transition or not to the postbaccalaureate DNP, including perceived student and employer demand, issues concerning accreditation and certification, and resource constraints. CONCLUSION: Multiple pathways to becoming an APRN are likely to remain until various factors (e.g., student and employer demand, certification and accreditation issues, and resource constraints) yield a more favorable environment for a full transition to the DNP.

Growing pains of credentialing research: discussions from the institute of medicine workshop.

Credentialing research currently lacks substantial depth to validate the connection between credentialing and patient outcomes. However, it is essential to demonstrate that credentialed nurses and organizations can significantly impact the provision of high-quality patient care. This article highlights the challenges of demonstrating such an impact, which was identified at the recent Institute of Medicine meeting, Credentialing Research in Nursing.

The first nurse practitioner graduate programme in Japan.

AIM: This paper describes the establishment of the first Japanese nurse practitioner graduate programme and legislative activities to institutionalize nurse practitioners in Japan. BACKGROUND: To address the super-ageing population, Oita University of Nursing and Health Sciences initiated the first academic graduate level nurse practitioner programme in Japan, based upon the global standard defined by the International Council of Nurses. CONCLUSION: In 2010, Oita University of Nursing and Health Sciences graduated the first nurse practitioner. We believe that nurse practitioners will be highly valued in Japan for thoughtful nursing care to the fragile elders living in rural and urban Japan.

Specialist nurse in Europe: education, regulation and role.

BACKGROUND: The concept of a 'specialist nurse' has existed for many years and related education programmes are proliferating. However, while literature clearly outlines the roles and practice of registered nurses and advanced practice nurses, those of specialist nurses remain unclear and nursing specializations across Europe need clarifying. AIM: This pilot study aimed to explore the competencies, education requirements and regulation of specialist nurses in Europe. DESIGN: A descriptive cross-sectional survey. METHODS: An online questionnaire named 'Specialist nurse and specialization in Europe' was sent to 550 members of the European Federation of Nurse Educators and ten members of the European Specialist Nurses Organizations. Snowball sampling was then used to build a convenience sample of nurse educators, clinical nurses and specialist nurses, national nursing association members, and chief nursing officers from all European countries. Besides quantitative aspects, responses to open-ended questions were analysed using a qualitative content analysis process. RESULTS: A total of 77 experts from 29 European countries responded to the questionnaire. Findings highlighted variations in titles, levels and length of education, certification, regulation and scope of practice for specialized nurses in Europe. Analysis of the promoted competencies revealed dominant clinical and technical aspects of the role with a high level of knowledge. CONCLUSIONS: The study emphasized the need to improve standards for education, certification and regulation for specialist nurses. Interpretation of the role and competencies is diverse with a weak presence of health policy that would enhance and develop the specialities. IMPLICATIONS FOR NURSING AND HEALTH POLICY: To address the current lack of provisions for automatic recognition of specialist nurses, common training frameworks corresponding to the relevant level of the European Qualifications Framework should promote lifelong learning and mobility, and enhance levels of health care and patient safety.

New Zealand nurses' views on preceptoring international nurses.

BACKGROUND: New Zealand encourages internationally educated nurses to seek registration in New Zealand to reduce local nursing shortages. Internationally educated nurses must meet requirements of the Health Practitioners Competency Assurance Act 2003, and demonstrate competency to practise through a clinical competency assessment programme. AIM: The purpose was to establish whether preceptors believe they are adequately prepared to assess nurses for whom English is a second language, and to determine the support and recognition received in the role. METHODS: Preceptor training, workload, understanding of ethical and legal accountability, and perceived organizational values, support and attitudes were evaluated via an anonymous internet survey. RESULTS: Some preceptors do not meet Nursing Council of New Zealand standards and some work environments require nurses to preceptor international nurses. Many nurses believe the role is not valued despite the high workload requirements. Training increased preceptor confidence and preparedness for clinical assessment but additional education is required to understand ethical and legal accountability within the role. Many preceptors indicated they felt pressured into recording assessments they were uncomfortable with. DISCUSSION: Enhancing preceptorship acceptance could be achieved through institutional recognition of the role's value via workload consideration, institutional recognition or financial means. Increased preceptorship training, particularly around ethical and legal issues, would encourage preceptor confidence. CONCLUSIONS: Organizations must find ways of meeting these challenges while recognizing they are responsible for the work environment of both preceptors and internationally registered nurses for whom English is a second language. A register of preceptors could provide a platform for audit and quality assurance principles, ensuring adequate education and preparation of preceptors. IMPLICATIONS FOR NURSING AND HEALTH POLICY: Effective preceptorship requires training, recognition and support. Successful integration of international nurses depends on organizational recognition and implementation of these factors.

Effect of Magnet hospital recognition on 2 patient outcomes.

The purpose of this study was to explore whether Magnet hospitals had better nursing-sensitive outcomes than non-Magnet hospitals. Eighty Magnet hospitals were identified in the Agency for Healthcare Research and Quality Healthcare Cost and Utilization Project databases and matched with 80 non-Magnet hospitals on 12 hospital characteristics. Comparative analysis demonstrated no significant differences for risk-adjusted rates for pressure ulcers and failure to rescue. Future investigation should examine what clinical benefits might exist that distinguish Magnet from non-Magnet hospitals.

Dysfunctional doctors--will revalidation help?

Numbers of National Clinical Assessment Service referrals concerning practitioners' performance are much higher for the over-50s, especially in GPs. In 20% of cases there are concerns with diagnosis that are unlikely to be recognised by revalidation. Accurate and timely diagnosis is fundamental to patient safety, and the results of studies in which GPs were tested using mystery patients are not encouraging. We need to assess pratictioners' competencies in diagnosis throughout their careers. Plans to extend working life may require changes to the clinical responsibilities of older doctors.

Credentialing the clinical ethics consultant: an academic medical center affirms professionalism and practice.

In response to national trends calling for increasing accountability and an emerging dialogue within bioethics, we describe an effort to credential clinical ethicists at a major academic medical center.This effort is placed within the historical context of prior calls for credentialing and certification and efforts currently underway within organized bioethics to engage this issue.The specific details, and conceptual rationale, behind the NewYork-Presbyterian Hospital's graduated credentialing plan are shared as is their evolution and ratification within the context of institutional policy. While other programs will design their credentialing schema consistent with their local context and demographics, the description of one such effort is offered to be instructive to others who want to bring additional standardization to the assessment of the readiness and credentials of those who will engage in the practice of clinical ethics case consultation.

Credentialing: understanding the terms.

Credentialing is an umbrella term that encompasses several categories, many of which have an impact when considering professional development for registered nurses. This column identifies select categories within the credentialing domain.