Issue link: https://nnumagazine.uberflip.com/i/198021
(b) work "redesign" measures to fragment and deskill hospital registered nursing practice in order to transfer registered nurse functions to unlicensed personnel and other non-RN caregivers; (c) elimination of the direct-care registered nurse assessmentcontrolled, transparent and verifiable patient acuity system methodologies for determining registered nurse staffing levels based on individual patient needs; (d) implementation of new, "proprietary" patient classification systems for determining nurse staffing levels and "skill mix" which purport to rely on registered nurse assessment of patient needs, but conceal methodologies and determinative functions from staff nurses and government licensing authorities, are incapable of scientific verification and validation, and routinely produce outcomes forecasting nurse staffing levels which objectively serve revenue generation targets and bear no relation to registered nurse patient assessments; and (e) introduction of new technologies which override the independent professional clinical judgment of direct-care registered nurses. Essential Elements of the Magnet Recognition Program n Strategic avoidance of hospital direct-care nursing regulation; n Application of "evidence-based" deceptions to hospital nursing service patient care/practice standards; n Rip-off of high public trust in nurses (to provide care in exclusive interests of patients) to cover commercially-motivated, deceptive redesign of direct-care practice standards intended to restrain independent judgment and action by direct-care RNs, obstruct patient advocacy, and subvert direct-care nursing process with mandate to serve commercial interests over patient interests; n Marketing gimmick to promote false appearance of superior hospital nursing practices and quality patient outcomes (the "gold standard"); n Strategy to gain market advantage for public and private reimbursement for hospital nursing services; and n Most importantly, a strategy to compromise the direct-care RN duty of exclusive loyalty to patients by making commercial enterprise loyalty to hospital employers a condition of RN employment for the purpose of eliminating a significant barrier to unchecked profiteering on individual and family health care risk presented by an independent direct care RN voice, professional responsibility, and patient advocacy. Conclusion The conflicts between commercial and revenue generation interests and patient interests cannot be reconciled by marketing gimmicks and workplace deceptions—Direct-care RN participation in schemes to conceal this reality and enable industry priorities is a fundamental conflict of interest and repudiation of professional ethics. CNA/NNOC Position oppose any and all accreditation or recognition (including "Magnet" designation) schemes that: Directly or indirectly interfere with or compromise direct-care RN professional responsibilities to provide care in the exclusive interests of patients and take all necessary and appropriate actions to ensure patient safety even if such actions conflict with employer interests, policies, or orders. Establish or permit sanction or recognition of different standards of nursing service or patient care performance which allow for 26 N AT I O N A L N U R S E substandard or different classes of competent care in derogation of the universal health principle of one standard of care. Purport to replace or in effect operate to replace governmental regulation of hospital services for the public health and safety. Directly or indirectly coerce, intimidate, induce, or encourage front line caregivers to accept assignments, duties, or responsibilities which require enterprise loyalty and/or apparent assumption of managerial or supervisory authority that would disqualify them from collective bargaining representation. Apply Total Quality Management/Shared Governance schemes for the strategic purpose and effect of individual and collective patient advocacy suppression and union avoidance. Deploy technologies that override the independent professional judgment of the RN and restrict the RN duty and right to advocate; degrade skills; or are purposely developed to maintain a healthcare industry driven by private interest rather than the individual healthcare needs of the patient. Fail to establish and promote safe staffing standards based on individual patient acuity of which objective, unit-specific hospital RN-to-patient staffing ratios are the minimum. Fail to establish or allow for an objective, transparent process for determining and establishing direct-care RN control over working and practice conditions demonstrated to improve quality of RNpatient therapeutic relationship, reduce errors and adverse outcomes, and improve recruiting and retention. Deceive and confuse direct-care RNs with Total Quality Management/Shared Governance schemes, including pay for performance incentives to engage support for and suppress direct-care RN resistance to benchmarking schemes that redefine disease, treatment and outcomes, cutbacks in safe, therapeutic, effective and competent direct-care nursing service, reductions in staff and nursing service budgets, prioritization of surplus revenue generation and other anti-patient practices under the cover of "gold standard" redesign of patient care standards. —CNA/NNOC position on hospital magnet status August 2, 2007 Magnet Hospital Bibliography and References What's the Attraction to Magnet Hospitals, Valda V. Upenieks, RN, PhD in Nursing Management February 2003 www.nursingmanagement.com The Magnet Recognition Program, Recognizing Excellence in Nursing Service 2005. The American Nurses Credentialing Center Overview of ANCC Magnet Recognition Program® New Model American Nurses Credentialing Center History of the Magnet Recognition National Student Nurses' Association NSNA Leadership University www.nsnaleadershipu.org/nsnalu/ Implementing Shared Governance: Creating a Professional Organization, Tim Porter-O'Grady 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