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What is Magnet?

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According to the American Nurses Credentialing Center, there are currently 523 hospitals out of 6,146 hospitals in the USA that have achieved Magnet recognition.

The ANCC originally developed the Magnet Recognition Program after noticing a nursing shortage and the need to obtain and retain nurses. Magnet status is the highest of honors for a healthcare facility, however only 8.5% of US hospitals have achieved this status.

The ANCC developed “14 Forces of Magnetism” and later the “5 Magnet Components” that each Magnet hospital must represent:

  1. Transformational leadership- nurses leading nurses in guiding the organization where it needs to go, not just where it wants to go.
  2. Structural Empowerment- Nurses creating an environment conducive to the mission, vision, and values of the organization.
  3. Exemplary Professional Practice- Nurses working interprofessionally to practice the highest quality of care.
  4. New Knowledge, Innovations, and Improvements- Nurses having an attitude of continuous learning and research.
  5. Empirical Outcomes- Structures are in place to ensure the best outcomes; nurses can view the difference their work has made.

Magnet hospitals are shown to have greater patient and employee satisfaction, a higher quality of care, higher retention rates, higher salaries, and the optimal professionalism.

The “Pathway to Excellence” typically takes about 7-10 years and is validating with a site visit.

https://www.nursingworld.org/organizational-programs/magnet/application-process/

Until next shift,

Shania

Sample Patients in Medical-Surgical Nursing

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**Identifying patient information has been altered to protect patient confidentiality

Patient 1: 68 y/o male with spinal stenosis and resulting functional paraplegia presents to the ER with abdominal dissension, nausea, vomiting, and diarrhea. Pt was found to have a small bowel obstruction. GI order NGT to low-intermittent wall suction (LIWS) for decompression. The patient also has a history of vascular dementia and delusional disorder. He frequently asks for food, water, and repeatedly states that nursing is starving him. Fortunately, pt eventually had several BMs and will get an abdominal X-ray to assess for small bowel obstruction resolve and hopefully NGT removal.

Patient 2: 75 y/o female is brought in with family c/o AMS. Lab work reveals a UTI and acute renal failure. Both BUN and Cr are critical and does not decrease for several days. CT abdomen reveals possible myeloma. Family does not yet know this and nursing must not reveal these results until oncology confirms.

Patient 3: 50 y/o male comes to the ER with abdominal distention, nausea, vomiting, constipation, and failed paracentesis outpatient. GI attempts EGD and colonoscopy, however pt unable to tolerate Golytely and/or enemas. Imaging reveals a colonic volvulus (twisting of the intestine)- a medical emergency. NGT placed for decompression, as patient continues to vomit. Surgery consulted brings pt for immediate colectomy with ostomy placement. Unfortunately was this patient’s h/o CKD and CHF, pt will likely be transferred to CCU post surgery. Family care during this surgery is crucial as they wait to hear how the pt recovers.

Patient 4: 30 y/o female comes to ER with c/o uncontrollable abdominal pain and ascites. Pain management is the main goal for nursing. Balancing IV pain medication for breakthrough with PO medication along with treating the side effects of nausea and pruritus is the challenge. **Patients with liver failure/cirrhosis are difficult cases as all lab work is often abnormal.. critically low H/H, elevated clotting factors, and elevated LFTs must be monitored.

Patient 5: 75 y/o male presents with abdominal pain, N/V/D. Pt is diagnosed with diverticulitis and will be treated with IVF, bowel rest (NPO), and finally diet advancement as pt tolerates.

**All of these cases are in a single shift. Some days are much easier than others and vice versa. Prioritization is key in these situations.. “Who will die first?” Remember the ABCs and include pain as top priorities. Leave charting for later, and keep all patients informed of rounding times, to limit call lights.

Med-Surg is also funny in the sense that you haven’t performed a nursing skill in a while or a certain skill increases anxiety, and the next shift you will have to perform it. This shift was that for me. I was always nervous around NGTs because they are easy to come out, some are hooked up to suction and others are not, placement must be checked frequently (ph), and patients are always anxious to pull them out. After this recent shift, I am comfortable with them!

Until next shift,

Shania

Terminal Agitation

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Terminal agitation. I have never heard of this term before until my last shift. A patient I had a week ago, who was admitted with a fall, died today after being placed on Hospice care. The previous week, the patient was not oriented to person, place, time, or situation, and was very restless. She was able to communicate, however inappropriately. She constantly wanted to get out of the bed, and never went to sleep. She had dementia and I thought this was a progression of her dementia. I found out on this past shift that this agitation was actually her quick decline to the end of her life.

Another nurse on the floor worked in Hospice care for several years and had a hint that this was terminal agitation. The patient was seen to be picking at the air and stated that she was seeing her late husband. I have never encountered these signs before and contributed them to hospital delirium and her baseline dementia. I could not believe that the next shift I had, was this same patient who was now comatose and passed within 24 hours after transitioning into Hospice care.

Until next shift,

Shania

You are a high fall risk: A struggle between safety and autonomy

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Nursing care is evaluated and structured from several different agencies and protocols. Nurses are expected to timely document, take all recommended breaks, stay hydrated, care-round every hour, educate on all core measures, keep all family members involved/informed in the plan of care, provide recommendations to doctors, thoroughly assess all six patients, ambulate all six patients twice a day, monitor lab values, among many others, all within a “12-hour” shift. It is often difficult to show compassion, communicate slowly, and provide patient autonomy while all these other measures are being graded.

A nurse once stated at huddle that her goal was to “document as I go.” I and all of the nurses around her could not stop laughing as this was a “quite ambitious” goal to achieve. A typical medpass takes around 10-15 minutes for one patient. Multiply this by 5-6 patients and that results in 50-90 minutes of the morning just ensuring all patients have medications. Documenting on each adds another 60 minutes, all while constantly refreshing the screen for any new orders or urgent patient concerns. Some days all patients are accounted for 4 hours later, and sometimes this is without any documentation.. If it’s not documented, it is not done.

A 12-hr shift is granted two 15 minute breaks and one 30 minute lunch break. Many nurses are lucky to take a full 30 minute lunch and will still get interrupted. It can be lunchtime before I realize that I have not had a sip of water for the past 6 hours, nor have I had the chance to pee.

Care-rounding involves checking the 3 P’s: pain, potty, and positioning, and also any needs at that time. This is expected on each patient every hour.

“Yes, we need to look at your skin.” “No, you cannot get up without us.” The Joint commission is an agency that allows for hospital reimbursement if all quality and core measures are met. This is the greatest concern and the greatest frustration on a medical floor. Upon admission, patients are asked to roll over so nurses can look at their butt, as we must assess for pressure injuries, regardless of the patient age. Patients are also assigned a fall risk scale and placed on a bed/chair alarm so they cannot get up without assistance. Patients are also taught that ambulation is important and getting out of bed will help with recovery; however, this depends on how frequently staff can get into the room. Falls are a major issue, however patients are very much limited by the “restraints” that we are forcing upon them.

“There is no particular time that the doctor will be in.” Many patients wait hours for the doctor to come in and then they are gone within 10 minutes. This leaves the nursing staff to educate the patients on the plan of care, while carrying out any immediate interventions.

Nurses became nurses to help people. The way healthcare is regulated at this time creates a major challenge between helping people and ensuring the chart looks perfect. I value moments to sit down and truly listen to each patient, but these moments are not able to be had every shift. Patients, I assure you that nursing staff are trying their best. There is a lot on our hands .

Until next shift,

Shania

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615-856-8181
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