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Why UK hospitals are trialling the US model and what its staff well-being goals mean for nurses and patients
As the COVID-19 pandemic continues in the UK, hospitals in England are among those taking part in a Europe-wide project to improve nurses’ working environments and reduce their stress.
Nursing Standard. 36, 9, 19-21. doi: 10.7748/ns.36.9.19.s11
Published: 01 September 2021
Trusts participating in the four-year Magnet4Europe study will implement the principles of the Magnet programme, a US accreditation scheme that recognises excellence in nursing care.
Research shows organisations that gain Magnet status have lower levels of staff burnout and provide safer patient care.
University of Southampton professor of nursing workforce policy Jane Ball, principal investigator for Magnet4Europe in the UK, says: ‘In a nutshell, it’s about creating places where nurses want to work.’
As the study began in January 2020, researchers were concerned trusts’ interest in taking part may have faded, in light of the immense challenges posed by the pandemic. In fact, the opposite was true, with organisations keen to explore new ways to support staff.
‘We wanted to share what we’ve learned over the years to help support nurses at other organisations just starting their own journey’
Heather Warlan, assistant director of Magnet and nursing quality, UC San Diego Health, California
‘Many say they wanted to take part because of COVID-19.’ says Professor Ball.
In the UK arm of the study there are 14 hospitals involved, all in England. They will all be twinned with a hospital in the US and work closely with their partner to develop plans and implement changes in the way they work. This includes carrying out a detailed ‘gap analysis’ to identify strengths and areas for improvement.
Participating hospitals get a Magnet handbook and other resources and take part in so-called ‘learning collaboratives’ that bring together the UK hospitals, their US partners and the project’s researchers.
The hospitals have been randomly assigned to two groups. One will embark on the Magnet-based intervention first, using its support and resources, while the second group will join in later – acting as a control group.
The research team measures the impact of changes made through surveys of front-line nursing and medical staff, repeated at different points.
It will also look at trust data, such as sickness absence levels, staff turnover and vacancy rates and undertake interviews and focus groups with staff.
For Frimley Health NHS Foundation Trust Magnet4Europe programme lead and head of quality Beth Bal, the study is an opportunity to bring something ‘really optimistic’ into the workplace.
‘Particularly with everything we have gone through with COVID-19, it felt like a light at the end of the tunnel,’ she says.
Her trust is twinned with the Cleveland Clinic in Ohio and has embarked on its gap analysis and staff survey.
‘Some nurses say the survey made them feel quite emotional because they had to stop and think about how they feel,’ says Ms Bal.
Meanwhile the gap analysis not only identified areas that need work but also highlighted where the trust is already doing well, such as its preceptorship, post-registration professional development and international nurse programmes.
‘We identified areas we need to strengthen but it also allowed us to think about pockets of excellence in the organisation.’ says Ms Bal.
One of the first steps at Frimley Health will be to launch a new nursing strategy ‘in a slightly different way’.
‘Historically, senior nurses have shaped the development of nursing strategy,’ says Ms Bal. ‘This time, we’re going to hear from our bedside nurses as to how they want to shape the strategy and what they think is important.’
She adds: ‘If, as a nurse, I come to work and I’ve got a voice, feel respected by my colleagues, and have the skills and autonomy to make decisions about patient care, then I feel happier. And that is how I want our nurses to feel.’
A question for the project team is whether a model developed in the US can work in the NHS, where care is organised, managed and funded differently.
‘We know Magnet status is associated with lots of good things but we don’t know much about what that journey is like and, in particular, what that journey might look and feel like in the NHS,’ says Professor Ball.
The model focuses strongly on ensuring front-line nurses have a say in decision-making and are at the forefront of innovation and research. It also aims to foster exemplary professional practice and strong working relationships between nurses and doctors in multidisciplinary teams.
University Hospitals of Morecambe Bay NHS Foundation Trust associate chief nurse Laura Neal is passionate about the project’s potential to recognise the contribution of nurses and help them recover from recent experiences.
The trust, which is twinned with Summa Health in north east Ohio, has completed its gap analysis and has just put together a strategic delivery plan setting out goals and action points.
A key ambition is to develop shared governance ‘so staff are heard’, says Ms Neal.
One option the trust is keen to explore is staff councils to enable front-line nurses to play a greater role in decision-making, with a higher level of professional autonomy. Ward-level councils will be developed, as well as those for different specialties or aspects of practice, such as quality, professional development and research.
‘The really important thing is they are not led by hospital leaders but by people who hold the patient’s hand at the bedside,’ says Ms Neal.
Another ambition is to significantly boost the amount of nurse-led research. Trust goals include increasing the number of nationally recognised studies and tripling the number led by nurses, midwives or allied health professionals by 2022.
What is Magnet4Europe?
A project that aims to redesign hospital workplaces to boost the mental health and well-being of nurses and doctors and improve patient care.
How is it funded?
Via a €4 million grant from the EU’s Horizon 2020 research and innovation programme.
Who is in charge?
Two highly respected figures in healthcare – nursing professor Linda Aiken, from the University of Pennsylvania School of Nursing, and Walter Sermeus, professor of healthcare at Katholieke Universiteit Leuven in Belgium.
Who is taking part?
About 60 hospitals in six different countries – the UK, Ireland, Belgium, Germany, Sweden and Norway.
What is the big idea?
The study will look at whether redesigning hospital work environments based on Magnet principles, supported by an experienced Magnet partner, works in Europe. The findings will inform policy recommendations that could help transform the way the NHS supports nurses and other staff.
For Ms Neal, the benefits for nurses from the trust’s participation in the Magnet4Europe project are clear.
‘It empowers them and there is nothing better than empowering staff to do their job,’ she says.
Ultimately, she believes this will lead to better patient care and better value for money for the NHS.
‘The really important thing is that staff councils are not led by hospital leaders but by people who hold the patient’s hand at the bedside’
Laura Neal, pictured, associate chief nurse, University Hospitals of Morecambe Bay NHS Foundation Trust
‘Where people have autonomy on the front line and are able to advocate for patients, you get a reduced length of stay and reduced harms such as falls and pressure ulcers,’ she says. ‘That leads to a better return on investment for hospitals.’
US nurses are also enthused about taking part in the study and sharing lessons they have learned.
Nurse Heather Warlan is assistant director of Magnet and nursing quality at UC San Diego Health in California, which is partnering with South Tees Hospital NHS Foundation Trust in North East England.
UC San Diego is currently applying for Magnet status for the third time – accreditation lasts for four years after which time the award must be renewed or it will lapse.
‘We wanted to share what we’ve learned over the years to help support nurses at other organisations just starting their own journey,’ says Dr Warlan.
She says the reason the scheme works is because it inspires nurses to strive for excellence.
For East and North Hertfordshire NHS Trust, the study fits in perfectly with ongoing trust-wide efforts to create a positive working environment. It is also one of 14 trusts being supported by NHS England and chief nursing officer Ruth May to take part in the Pathway to Excellence programme – another accreditation scheme, run by the American Nurses Credentialing Center.
The two schemes ‘complement each other beautifully’, according to the trust’s director of nursing and patient experience Rachael Corser. She believes the Magnet project will help the organisation move on from the pandemic and hold on to talented nurses.
‘We’ve invested a lot of time and energy in recruiting some outstanding nurses, so it’s about how we retain those high-calibre students, nurses from overseas and practitioners coming into the profession who had never considered nursing before COVID-19,’ she says.
The trust is in the second cohort of the study, so is yet to find out with which US organisation it will be twinned. It is already sharing ideas with other trusts in the group and looking ahead to its gap analysis.
The trust’s Magnet4Europe local lead and clinical professor of nursing Natalie Pattison says the chance to work with an experienced partner is a significant advantage.
‘That’s going to be an exciting piece of work, looking at everything from shift patterns to the layout of canteens,’ she says. ‘We want this to be an amazing, fun place to work.’
How Magnet hospitals can promote nurse leadership and improve staff well-being rcni.com/magnet-leadership
