Calling the Shots: Nursing News and Notes

Magnet Myth?

Magnet Myth?

Thursday, July 23, 2015

Did you know that there’s a common misconception that Magnet standards require hospitals to staff their facilities with an all-registered nurse (RN) staff?  According to the chief officer of the American Nurses Credentialing Center, Lisa Lewis, MSA, RN, NEA-BC, FACHE, despite what many believe Magnet doesn’t mandate a particular staffing mix or detail numbers of staff members. The reason why is that each health care facility has a unique environment with a unique patient population that requires flexibility to adapt staffing, processes, and procedures as necessary to produce the excellent outcomes that set Magnet facilities apart from other facilities.

Moreover, each state may have licensure requirements and a scope of practice that differ from other states. Facilities may also lack access to sufficient qualified staff to meet their specific needs. Although staffing and skill mix formulas have been developed to determine staffing requirements, they’re very complex. Health care leaders continue to study the situation in hopes of finding a formula that is less complex and meets facility needs.

Lewis believes that the misconception about staffing requirements may stem from the fact that Magnet standards primarily discuss the role of the clinical RN. For example, Magnet standards require that clinical RNs play a role in:

  • their governance
  • identifying issues and implementing quality improvements that impact patient care
  • their work environment.

These standards are specific to RNs, but by mandating these requirements for RNs, the standards also help to develop a work environment in which the voices of all staff members are heard; most importantly, the voices of those who are directly responsible for patient care, patient safety, and healthcare quality.

Skills in the mix

Over the years nursing leaders have examined ways to change care delivery; they’ve experimented with different skill mixes. One method focused on a less costly skill mix that utilized more unlicensed assistive personnel. Unfortunately this method didn’t produce the patient outcomes that were desired by most organizations. The most recent studies show that the highest quality patient care and financial outcomes result when care is provided by highly-skilled, well-formed clinical teams comprised of an optimal RN to patient ratio. However with an all-RN staff, RNs are forced to perform tasks that others could easily assume.

Could LPNs or LVNs benefit acute care?

Licensed practical nurses (LPNs) or licensed vocational nurse (LVNs) can benefit the clinical management of acute care patients. LPNs can perform a variety of tasks to free up valuable time for RNs:

  • Administer medications
  • Provide basic care
  • Address patients’ basic comfort needs
  • Monitor basic health
  • Report patient status changes and concerns to the RN or practitioner
  • Document patients’ signs and symptoms
  • Discuss provided care and listen to patient concerns.

By utilizing LPNs to perform these tasks, RNs can concentrate on interventions that only they can perform, such as coordinating care, assessing the patient, and teaching the patient and his family.  Despite these advantages of having an all-licensed staff (comprised of RNs and LPNs), Magnet doesn’t have a standard requiring an all-licensed staff either because there isn’t data to support that an all-licensed staff is needed to achieve excellence.

No staffing standard

Magnet may not have a standard for staffing, but they encourage nursing leaders to experiment, innovate, collect data, benchmark, and research to find the best practices for staffing that transform care.  Optimizing the roles of licensed staff, both RNs and LPNs, may be the key to transforming care, improving outcomes, and increasing health care quality.

What innovative staffing practices are you using at your facility? What impact have these innovations had? We’d love to hear about it.

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