On the morning of January 14, 2015, Mount Sinai staff from across the organization crowded into the auditorium to learn and celebrate some thrilling news: Mount Sinai was the first hospital in Canada to achieve Magnet® status, a prestigious, international credential that measures excellence in nursing and patient care. Awarded by the American Nurses Credentialing Center, only about seven per cent of American hospitals have this designation, placing Mount Sinai among the top tier hospitals in North America.
Joining the ranks of Magnet-recognized hospitals is a source of great pride for me and everyone at Mount Sinai. As a nursing professional and senior hospital leader, it reinforced for me the importance of empowering those who are directly involved in patient care and ensuring they have a voice in decision-making. Our Magnet status shows that our efforts in these areas and others have yielded real, measurable improvements in patient outcomes – always the most important metric.
The Magnet Recognition Program® supports professionalism in nursing by promoting autonomy, influence, advocacy, professional development, leadership and shared decision making. Alignment with the program underscores the high standard of nursing at Mount Sinai and our commitment to constantly raising the bar of excellence to benefit our patients and staff. The designation reflects a long-term, full-scale team effort to continually improve patient care at the hospital, supported by every group at the hospital.
The journey to Magnet
The Magnet Framework specifies a set of factors, supported by evidence, that are important for establishing positive work environments that support professional nursing practice resulting in quality patient, organizational and system outcomes. The pillars of this framework are: Transformational leadership; structural empowerment; exemplary professional practice; and new knowledge, innovations and improvements. Not only are these Magnet principles, but they are the foundation for nursing professional practice and support Mount Sinai Hospital’s commitment to delivering ethical, safe, quality, evidence-based care
I’d like to share some examples of these foundational changes. Led by the nursing team and supported by staff and leaders from every area of the hospital, these efforts helped Mount Sinai achieve Magnet status.
Transformational leadership
At Mount Sinai, leadership is about more than just the position you hold – it’s about demonstrated leadership through action and a commitment to excellence. Nurse leaders at all levels exemplify Mount Sinai’s values, mentor their colleagues, advocate and influence change to benefits patients and their families.
So when a nurse in our Neonatal Intensive Care Unit (NICU) proposed special training and certification for NICU nurses to reduce infections from Peripherally Inserted Central Catheter (PICC) insertions, her recommendation was accepted. A selected PICC team was established from volunteer nurses and put into action. They quickly saw a significant drop in PICC-related infections. This early success led to an expanded role within the unit. The leadership of this team resulted in a change in the work environment and to neonatal outcomes.
Structural empowerment
Nurses at Mount Sinai Hospital are encouraged to play an active role in organizational and professional decision-making. Fostering empowerment and increasing direct care nurses’ voices in decision-making is a key strategy within the Department of Nursing, and participation in both external and internal decision-making bodies is encouraged, promoted and expected.
The organizational structure of our clinical teams is designed to ensure that decisions are made with full interprofessional participation. Interprofessional teams make up committees and councils that actively shape care at every level.
For example, the hospital’s Effective and Efficient Utilization Committee took action when the nurses in the Pre-Admission Unit noted that many of the diagnostic tests routinely ordered were unnecessary. The findings informed a revised process that reduced the number of tests, saving time and funds. These changes also improved experience of the 6,000 patients prepared for surgery each year in the unit.
Exemplary professional practice
As an internationally-recognized academic health sciences centre affiliated with the University of Toronto, Mount Sinai is committed to teaching the next generation of health-care professionals, encouraging continuous life-long learning, and developing its professional staff. Our Nursing Department actively supports the development of nurses through professional nursing organizations at the local, provincial and national levels. Our nurses’ commitment to professional development is apparent and ongoing. Recognizing that professional certification is closely tied to clinical excellence, the Department of Nursing is working to increase the number of certified nurses by five per cent year-over-year.
New knowledge, innovations and improvements
Using evidence to create knowledge, inspire innovation and improve patient safety and outcomes is an essential component of professional nursing practice, and top priority for our team that can make a real difference for our patients. We use Sinai-specific data, as well as national benchmarks, to monitor and evaluate performance to help inform our practices and provide learning opportunities. This is critical to giving our nurses more opportunity to ask important questions and support evidence-based care, both essential for improving patient outcomes.
For example, hand hygiene compliance data informed the allocation of nurse hand hygiene champions on each unit. With their initiatives promoting hand hygiene practices, we’ve seen greater adherence to hand hygiene policies (increased to 86 per cent) and a corresponding decrease in hospital-acquired Methicillin-resistant Staphylococcus aureus infections (dropped to zero per cent).
The next steps
All of these nursing practices and programs work together to create the kind of collaborative, evidence-based, supportive environment that contributed to Mount Sinai’s Magnet status. The leadership of our nurses and clinicians and the commitment of the entire team at Mount Sinai have created a culture dedicated to giving our patients the best care. Receiving Magnet recognition was a wonderful and proud moment for everyone at Sinai. It is an important acknowledgment of the ongoing journey of development and improvement that underpins our continuous quality improvements at all levels of the organization.
