National Nurses United

and restructuring patient care methods also set in motion a continuing deterioration of working and practice conditions which accelerated registered nurse flight from direct-patient-care positions in hospitals and discouraged new registered nurse interest in such positions. Hospital nursing practice today is severely burdened by excessive patient loads, mandatory extended work hours, unsafe patient handling practices, and routine exposure to risks of professional license discipline and/or malpractice liability inherent in working and practice conditions created and maintained in derogation of prevailing community standards. The new Magnet recognition program is bound by the economic imperatives and operational incentives of a method of health care service financing which transfers to health care providers the insurance risk of incurring costs for providing patient care in excess of premium revenue from participating groups. The essential hospital market conditions which were prerequisite for achieving a nursing environment eligible for magnet recognition no longer exist and cannot be replicated on an institutional basis. Shared Governance—Compromising RN Duty of Loyalty to Patient Interests the new ancc core criteria for magnet hospital accreditation reflect a significant emphasis on staff nurse decision making and influence over the delivery of patient care. While labels differ, the evidence is conclusive that a shared governance model is a key component in structuring professional nursing practice to achieve magnet recognition. Virtually all the hospitals that achieve "magnet status" use a "shared governance" structural model for sustaining professional nursing practice. The ANCC magnet accreditation process begins with a potential applicant's "Organization Self-Assessment for Magnet Readiness" according to a detailed set of standards and inquiries. A threshold condition to demonstrate "readiness" for magnet status consideration is: there must be "congruence between the mission, vision, values, philosophy, and strategic plan of the nursing department and those aspects of the organization." (ANCC, Organization SelfAssessment for Magnet Readiness.) The shared governance imperative of "congruent interests" requires staff nurse loyalty to the operational priorities of commercial health care institutions. RN professional licensure responsibilities and ethical duties require exclusive loyalty to patient interests. Magnet/shared governance "enterprise loyalty" is antithetical to the direct-care RN's fiduciary duty to provide care in the exclusive interests of patients. The structural imperatives of magnet hospital governance over nursing services cannot be harmonized with nor incorporated into collective bargaining representation. Nursing shared governance is a managerial innovation that legitimizes nurses' control over practice, while extending their influence into administrative areas previously controlled only by managers. Proponents of magnet recognition view union representation of nurses as a barrier to successful shared governance because "union restrictions may prohibit management from implementing shared governance model." More importantly, participation in magnet-acceptable shared governance procedures and committees requires staff nurses to assume expressly stated managerial and supervisory responsibilities and authority. Such participation provides presumptive evidence of exclusion from labor law rights to organize for collective bargaining. 24 N AT I O N A L N U R S E Today's Magnet Hospital Imperatives are in Fundamental and Irreconcilable Conflict With the RN Duty of Loyalty to Patients. the economic incentives of institutional providers and the commercial mandates of the healthcare industry conflict with the interests, health and safety of patients and the professional and ethical responsibilities of direct-care RNs. Today's ANCC Magnet Status Recognition certification program and its various components, including Shared Governance, are the direct and exclusive creation of the commercial priorities and economic incentives of corporate health care. The stated "goals and objectives" are deceptive and are mere smokescreens for the fundamental commercial priorities of the program. Neither these priorities nor the economic interests of the health care industry as presently constituted can be reconciled with the interests of patients or the rights and obligations of direct-care registered nurses. Moreover, any concession to Magnet Status Recognition/Shared Governance and similar schemes provides continuing cover for an ill-conceived healthcare system and significant obstruction to winning single-payer healthcare reform. Consistent with the essential purposes of the California Nurses Association/National Nurses Organizing Committee as a voice for direct care RNs and the Code of Professional RN Practice adopted in the CNA/NNOC Bylaws, the position of CNA/NNOC must be unqualified opposition to Magnet Status Recognition and similar programs, including categorical rejection of any form of participation or support for such programs and their deceptive entrapments like Shared Governance. The responsibility of patient advocacy and affirmative obligations of collective patient advocacy offer no opportunity for such concession. Standards for Evaluating Whether ANCC "Magnet Hospital" Designation Is in the Interests of Direct Care RNs and Their Patients CNA/NNOC Code of RN Professional Responsibility the cna/nnoc bylaws code of rn practice include the following standards: 1. The nurse assumes responsibility and accountability for competent and appropriate performance of the RN Duty of Patient Advocacy, acting in the exclusive interests of the patient, as the patient's advocate, by initiating action to improve health care or to change decisions or activities which are against the interests or wishes of the patient, as circumstances may require, and by disclosing information and providing patient education as necessary for informed patient decisions about health care before care is provided to the patient. 2. The nurse recognizes the importance of collective patient advocacy to the public health and the integrity of professional nursing standards of care, and participates in necessary and appropriate actions and exercises of collective patient advocacy to protect the public health and safe patient care standards against erosion, restructuring, degradation, deregulation, and abolition by the large health care corporations, hospital chains, HMOs, insurance companies, pharmaceutical corporations, and other powerful economic institutions and interests which today seek to control the availability, access, and quality of health care services for purposes of profit and surplus revenue W W W. N A T I O N A L N U R S E S U N I T E D . O R G APRIL 2010

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