National Nurses United

CE:Final 5/27/08 11:58 AM Page 20 service financing which transfers to healthcare 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. 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 healthcare. The stated "goals and objectives" are deceptive and are mere deceptions for the fundamental commercial priorities of the program. Neither these priorities nor the economic interests of the healthcare industry as presently constituted can be reconciled with the interests of patients or 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 illconceived healthcare system and significant obstruction to winning single-payer healthcare reform. Consistent with the essential purposes of CNA/NNOC as the 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. 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 standards 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 STANDARDS FOR EVALUATING WHETHER ANCC "MAGNET Self-Assessment for Magnet Readiness) The Shared Governance imperative of "congruent interests" HOSPITAL" DESIGNATION IS IN THE INTERESTS OF DIRECT-CARE requires staff nurse loyalty to the operational priorities of commer- RNS AND THEIR PATIENTS cial healthcare institutions. RN professional licensure responsibilities and ethical duties require exclusive loyalty to patient interests. CNA/NNOC Code of RN Professional Responsibility Magnet/Shared Governance "enterprise loyalty" is antithetical to the The CNA/NNOC Bylaws Code of RN Practice include the following direct-care RN fiduciary duty to provide care in the exclusive inter- standards: 1. The nurse assumes responsibility and accountability for compeests of patients. The structural imperatives of magnet hospital governance over tent and appropriate performance of the RN Duty of Patient Advocanursing 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 the shared governance model." More importantly, Force 1: Quality of Nursing Leadership participation in magnet-acceptable shared governance Force 2: Organizational Structure procedures and committees requires staff nurses to Force 3: Management Style assume expressly stated managerial and supervisory Force 4: Personnel Policies and Programs responsibilities and authority. Such participation proForce 5: Professional Models of Care vides presumptive evidence of exclusion from labor law Force 6: Quality of Care rights to organize for collective bargaining. Force 7: Quality Improvement Force 8: Consultation and Resources Today's Magnet Hospital Imperatives are in Force 9: Autonomy Fundamental and Irreconcilable Conflict with Force 10: Community and the Healthcare Organization the Interests and RN Duty of Loyalty to Patients Force 11: Nurses as Teachers The economic incentives of institutional providers and Force 12: Image of Nursing the commercial mandates of the healthcare industry Force 13: Interdisciplinary Relationships conflict with the interests, health, and safety of patients Force 14: Professional Development and professional and ethical responsibilities of directcare RNs. The 14 "Forces of Magnetism" 20 REGISTERED NURSE W W W. C A L N U R S E S . O R G M AY 2 0 0 8

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