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General Application

Magnet Definitions

Nurse Leader | Nurse Educator | Continuing Nursing Education | In-Service Education

Nurse Leader (06/2015)

  • Nurse leaders must have a degree in nursing (bachelor's or higher).
  • Nurse leader is not a title and should not be interpreted as such for the purpose of the written documentation.
  • The definition of nurse leader is exclusive of the chief nursing officer (CNO).
  • Nurse educators who serve in the top educator role and are responsible for other nurse educators are considered nurse leaders.
  • Nurse leaders may have clinical oversight and responsibility for nurse managers or for other nurses who influence clinical care.
  • Nurses may be represented on only one eligibility table—either the Nurse Manager or Nurse Leader Eligibility Table.
    • Only nurse leaders annotated on the Nurse Leader Eligibility Table may be selected when a nurse leader example is required by the SOE.
    • Note: For applicants with flat organizational structures without nurse managers, the nurse leader may be substituted for nurse manager SOE examples.
  • Nurse leaders may report directly or indirectly to the CNO.
  • Nurse leaders practice (clinical and nonclinical) in a variety of settings (inpatient, ambulatory, or other environments) throughout the organization.
  • Other registered nurses who may broadly influence or impact the clinical practice of nurses in the organization may be considered a nurse leader. If these nurses are referenced as nurse leaders in the organization's Magnet® application, they must meet the educational criteria (bachelor's in nursing or higher) and report directly or indirectly to the CNO. Examples may include, but are not limited to, RN director of risk management or quality, RN director of nursing informatics, infection preventionists, and wound ostomy nurses.

Nurse Educators (2013)

The educator that is considered a "nurse leader" is the department head or director of all clinical nurse educators. Unit-based educators are not considered nurse leaders for Magnet purposes.

Continuing Nursing Education (10/2014)

Those activities intended to build on the educational and experimental bases of an individual for the enhancement of practice, education, administration, research, or theory development, to the end of improving the health of the public.

In-Service Education (10/2014)

Those learning experiences designed in the work setting to assist individuals to acquire, maintain, and/or increase their ability to perform job functions within a given agency or institution.

Document Submission

Eligibility Tables | Documentation Submission for Systems | Formatting | Time Frame

Eligibility Tables (2013)

As of 2013, the Nurse Leader and Nurse Manager Eligibility Tables must be sent with the application and again when written documents are submitted.

Documentation Submission Requirements for System Applications
2014 Magnet® Application Manual, page 99

Two weeks prior to a document submission date, an electronic copy of the following documents will be emailed to the Magnet Office for each organization within the System:

By a documentation submission date, an electronic copy of the following documents will be emailed to the Magnet Office for each organization with the System:

Formatting—Electronic Submission (10/2014)

  • The size of electronic files is not limited, but the files must not exceed the 350-page limit for the narrative content.
  • The entire document should be submitted in Arial 12-point font, including headings.
  • Items scanned in as evidence, such as meeting minutes, do not need to be in Arial 12-point font.
  • Narrative statements should be straightforward and concise; they should include minimal extraneous information. Organizations may write narratives in any style, but they must be easy for the appraisers to read, understand, and navigate.
  • The SOE narratives are included in the 350-page limit. The content in the Organization Overview (OO) section, evidence attachments, and graphed data for EP3EO, EP22EO, and EP23EO are not included in the page limit.

Time Frame (10/2014)

Effective October 28, 2014, the 48-month period is the new time frame for 2014 Magnet® Application Manual document submission and reflects the 48 consecutive months prior to submission of Written Documentation.

  • Baseline (pre) data, interventions, and outcomes must occur within the 48-month time frame prior to submission of Written Documentation.
  • A typical site visit occurs 6 to 10 months after an organization submits Written Documentation.

Exceptions to the time frame include:

  • EP3EO (Nurse Satisfaction) must demonstrate the most recent nurse satisfaction survey within the previous 30 months prior to documentation submission.
  • EP22EO (Nurse Sensitive Clinical Indications) must demonstrate the most recent eight consecutive quarters of data.
  • EP23EO (Patient Satisfaction) must demonstrate the most recent eight consecutive quarters of data.

Evidence & Sources of Evidence

Sources of Evidence (SOE) | Nurse Manager or Unit Educator | Evidence for Non-EO Sources | Using Examples More Than Once | Magnet Senior Analysts’ Tips

Sources of Evidence (SOE) (2013)

For the 2014 Manual, the bolded Source of Evidence statement presents the “condition” that should exist in Magnet organizations. The bulleted items, under the bolded statement, serve as the requirement(s) to which a response(s) is necessary. The bulleted requirement requests information, that is, a narrative, evidence, and data that indicate the Magnet condition exists in the organization. Provide narrative information and evidence/data for the bulleted examples only.

Nurse Manager or Unit Educator (10/2014)

The nurse manager or unit educator can be used in addressing the SOEs, depending on the specific SOE. When the source specifically states a role such as clinical nurse, then the SOE response must be specifically about the clinical nurse. If the SOE indicates nurse in general, an example using any nurse from the organization, regardless of role, is fine.

Evidence for Non-EO Sources (10/2014)

As indicated on page 24 of the 2014 Magnet® Application Manual, examples of acceptable evidence include copies of policies and procedures, meeting minutes, various types of correspondence, data, rosters, and screenshots. Evidence does not include examples and testimonials.

Using Examples More Than Once (10/2014)

You may use examples or projects in more than one source, but each source has specific requirements. As long as the example or project is able to meet the different requirements of each source (different type of outcome data, for example), then you can use that example or project for those sources.

Magnet Senior Analysts’ Tips

Gain expert insight with tips from Magnet Senior Analysts.

August 2014 Tips

  • Formatting Non-Eos
  • Providing Evidence

Section-specific

Organizational Overview

Organizational Overview | Requirements | OO7 | OO10 | OO11 | OO19 | OO20 | Magnet Senior Analysts’ Tips

Organizational Overview (2013)

Some of the required Organizational Overview items in the 2008 Manual are not included in the 2014 Manual. For each Organizational Overview item, provide only the information that is requested in the 2014 Manual.

Requirements (2013)

If any of the 20 documents requested in the Organizational Overview items are not present:

  • The application review will be stopped.
  • The organization will be notified and will have 5 business days to provide the missing documents.
  • If the missing documents are not provided after 5 business days, the review will be concluded.
  • Fees are nonrefundable.

OO7 (10/2014)

The intent of the OO7 item is that the organization provides an action plan for meeting the 2020 IOM recommendation for all registered nurses in the organization.

If more than 80% of your nurses already have at least a bachelor’s degree in nursing, describe what your organization is doing to maintain your high percentage of nurses with a bachelor’s or higher nursing degree.

OO10 (10/2014)

The OO10 requirement from the 2008 Manual was removed from the 2014 Manual.

OO11 (10/2014)

Organizations are required to provide evidence of the process by which the chief nursing officer (CNO) (or his or her designee) participates in credentialing, privileging, and evaluating APRNs.

OO19 (12/2016)

The organization’s policies, procedures, charters, or bylaws designating that at least one nurse must be a voting member of the governing body responsible for the protection of human research participants, and that at least one nurse votes on nursing-related protocols.

Unchanged

  • A nurse must be a voting member of the IRB, and the organization’s policies, procedures, charters, or bylaws designating that at least one nurse be a voting member of the governing body responsible for the protection of human research participants is still required.

Changed

  • Based on current practices and updated information regarding IRB processes, the nurse voting member of the IRB is NOT required to vote on nursing-related protocols.

Refer to the revised IRB Attestation Template posted on the Magnet Forms and Templates section of the Magnet program website.

OO20 (2013)

The time frame for the OO20 research table increased from 30 months to 48 months. OO20 requires a list of ongoing or completed nursing research studies for the past 48 months. The research study you use for NK1EO will be from this list.

If an organization was involved in nursing research that occurred over a 3-year period of time, the study may be included. This table may include nursing research studies that are completed or ongoing within the 4 years before documentation submission.

The Nursing Research Table format that needs to be used is located on the Magnet Forms and Templates section of the Magnet program website.

Magnet Senior Analysts’ Tips

Gain expert insight from Magnet Senior Analysts.

October 2014 Tips

  • Required Documentation for Organization Overview 19

Transformational Leadership

TL2 | TL3EO | Magnet Senior Analysts’ Tips

TL2 (10/2014)
The organizational goal used for this Source of Evidence (SOE) may be new or existing.

TL3EO (10/2014)
In TL3EO, "The CNO influences organization-wide changes beyond the scope of…," the term “organization-wide” means beyond nursing in the organization.

TL3EO differs from TL2 because it is specific to the CNO and includes outcome data as evidence rather than the traditional evidence required in TL2.

Magnet Senior Analysts’ Tips
Gain expert insight with tips from Magnet Senior Analysts.

January 2015 Tips

  • TL3EO
  • TL6
  • TL9EO

Structural Empowerment

SE3EO | SE7 | SE9

SE3EO (2013)

For the unit or division example in SE3EO, the Source of Evidence requests “a targeted goal for improvement in professional nursing certification by unit or division.” The intent of this example is that 1 goal for 1 unit or 1 division is provided. Do not provide 1 goal for several units or divisions, or several goals for 1 unit or division.

SE7 (10/2014)

The evaluation of the transition process is based on how your organization sets up your evaluation process. Please include supporting evidence for the evaluation(s) of effectiveness.

SE9 (10/2014)

It is not acceptable to highlight multiple nurses on different projects. Provide one example for the clinical nurse and one example for the nurse leader. The appraisers will evaluate only the first story and evidence for each example.

Exemplary Professional Practice

EP3EO | EP9EO | EP16EO | EP22EO | EP23EO | Magnet Senior Analysts’ Tips

EP3EO (2013)

The new requirements for EP3EO in the 2014 Manual do not become effective until April 1, 2016. If you submit documents before April 1, 2016, and you choose to continue using the 2014 Manual, ensure that your vendor can provide data in accordance with the requirement of the SOE (4 of 7 categories).

Domains / Dimensions / Scales / Subscales (groups of questions) established as valid and reliable by the vendor must be presented to meet the intent of EP3EO. Each domain must clearly align with 1 of the 7 categories listed in the 2014 Magnet® Application Manual. Individual questions extracted from Domains / Dimensions / Scales / Subscales do not meet the intent of EP3EO.

The nurse (RN) satisfaction survey must include questions related to the following 7 categories. Data must be submitted on your choice of 4 of the 7 categories:

  • Autonomy
  • Professional development (education, resources, etc.)
  • Leadership access and responsiveness (includes nursing administration/CNO)
  • Interprofessional relationships (includes all disciplines)
  • Nursing foundations for quality care
  • Adequacy of resources and staffing
  • RN to RN teamwork and collaboration

Note:

  • For single organization applicants: The same 4 categories must be presented for the entire organization (both inpatient and outpatient).
  • For system applicants: The same 4 categories must be presented for a single organization within the system; however, each organization may choose four different categories.

Unit level data are required for all units/clinics (inpatient and outpatient) in which nurses practice. A written statement must be included in the documentation to explain why a unit/clinic is not included.

EP9 (10/2014)

Two examples from different practice settings are required. The examples can include 2 practice settings in the outpatient setting, 2 practice settings in the inpatient setting, or 1 example from the inpatient setting and one from the outpatient setting.

EP16 (10/2014)

Policies can be appropriate evidence for clinical and organization decision-making autonomy, if the policy includes what is required by the SOE.

EP22EO (2013)

When reporting CLABSI and CAUTI data for inpatient units to the Magnet Program, data must be submitted for all units for which the vendor will accept data and for which a benchmark can be provided. Each vendor establishes valid and reliable benchmarked data with comparable organizations and can assist in determining if unit data can be collected on specific units.

The 2014 Manual does not explicitly state that for each of the required indicators only data that are applicable to a particular unit or outpatient clinical area should be reported.

To present data for EP22EO, start by listing each of the indicators:

  • For each of the required 4 indicators, include data for all inpatient units that collect and benchmark to a national database.
  • For a nurse-sensitive Core Measure, present data at the organizational level compared with a national benchmark.
  • For an outpatient indicator, include data from any outpatient area(s) that collects the data and compare to a specialty guideline or internal goal. For instance, if data are collected in the ED and compared with an ED specialty guideline, then no data would be provided from any other outpatient clinic or area for that particular indicator—just from the ED.

EP22EO: Updated Guidance: NHSN SIR (May 2017)

1. May we use the NHSN Standardized Infection Ratio (SIR) metric when submitting CLABSI and CAUTI (or other nurse-sensitive clinical indicator) data?

  • New information from the CDC National Healthcare Safety Network (NHSN), A Guide to the SIR (Jan. 2017) indicates that “SIRs are currently not calculated when the number of predicted infections is less than 1.0”. Consequently, there is a high likelihood that quarterly, nationally benchmarked, unit-level SIR data may not be consistently available to organizations in order to demonstrate outperformance of a national benchmark over the majority of the most recent eight quarters.

Since majority outperformance of a national benchmark over the majority of the most recent eight quarters is required to meet Magnet expectations for each EP22EO nurse-sensitive clinical indicator (NSI), the SIR is unacceptable for use as a national benchmark for nurse-sensitive clinical indicator data, unless a calculated SIR is available for at least the majority of the eight quarters of unit-level data for the majority of applicable units.

  • Options for data presentation when SIR data cannot be calculated for the majority of eight quarters of unit-level data:
  • Comparison to a national vendor – to which an organization contributes data - may be used if the vendor provides a national benchmark other than SIR, for CLABSI, CAUTI and/or other nurse-sensitive indicator data. Follow 2014 Magnet® Application Manual (and manual updates) data requirements for presentation.

Reminder: Multiple vendors are not allowed within a single nurse-sensitive clinical outcome presentation. Different vendors may be used across the NSI data sets but not within a single NSI.

  • If CAUTI and/or CLABSI nurse-sensitive indicator data are not contributed to a national vendor (other than NHSN), substitute another nurse-sensitive clinical indicator(s) and follow EP22EO data requirements as follows:
  • Provide unit-/clinic-level data, for the most recent eight (8) quarters available prior to the applicable documentation phase (e.g., Written Documentation, Additional Documentation)
  • Submit to and use national databases when available. If a national database is not available, the organization must demonstrate that internal benchmarks
  • are based on professional standards, literature review, and/or internal trended data, or all three.
  • Note: The NHSN Rate calculator is unacceptable for EP22EO nurse-sensitive clinical indicator data presentations.

EP23EO (2013)

Provide 8 quarters of inpatient, pediatric, and ambulatory/outpatient patient satisfaction data at the unit/clinic level collected within the previous 30 months prior to documentation submission.

Select and report data for 4 of the 9 categories listed below:

  1. Patient engagement / activation / patient-centered care
  2. Care coordination
  3. Safety
  4. Service recovery (may be ambulatory)
  5. Courtesy and respect
  6. Responsiveness
  7. Patient education
  8. Pain
  9. Careful listening

To meet the intent of EP23EO:

Questions established by the vendor as valid and reliable must be reviewed and aligned to the appropriate categories with the approval of the ANCC Magnet Recognition Program®. The same 4 categories must be presented for the entire organization (both inpatient and outpatient). Questions may vary unit to unit; however, the same 4 categories must be used across the organization.

Note:

  • For single-organization applicants: The same 4 categories must be presented for the entire organization (both inpatient and outpatient). Questions may vary from unit to unit; however, the questions must still represent the same 4 categories.
  • For system applicants: The same 4 categories must be presented for a single organization within the system; however, each organization may choose 4 different categories. Questions may vary from unit to unit; however, the questions must still represent the same four categories for a single organization within the system.
  • For organizations with inpatient and outpatient areas, the four indicators chosen must be the same for inpatient and outpatient areas. For example, if you choose “Patient Education” as one of the indicators, provide the results for all inpatient units and outpatient areas that are surveyed for this indicator. Please note that the questions related to “Patient Education” in the inpatient area may not be worded the same as those for the outpatient area.
  • For the Core Measure indicator, choose a nurse-sensitive component of a Core Measure and present the data at the organizational level. The organizational level data is compared with a national benchmark. This is the only nurse-sensitive indicator for the 2014 Manual that presents organization-level data (not unit-level) and compares that data with the national benchmark.

Magnet Senior Analysts’ Tips
Gain expert insight with tips from Magnet Senior Analysts.

December 2014 Tips

  • EP3EO: Nurse Satisfaction
  • EP22EO: Nurse-Sensitive Clinical Indicators
  • EP23EO: Patient Satisfaction with Nursing

October 2014 Tips

  • EP22EO: CAUTI and CLABSI
  • EP3EO, EP22EP, and EP23EO: Comparison Cohort (for Benchmark) in the Graph Presentations
  • EP23EO: How to Align Questions in Patient Satisfaction Survey with the Nine Categories in the Magnet Manual

August 2014 Tips

  • EP23EO
  • Cohort Groups

New Knowledge, Innovations & Improvements

NK1EO (10/2014)

One completed IRB-approved nursing research study is required. Results of data analysis or findings must have occurred within the 48 months before an organization submits Written Documentation.

NK6EO (10/2014)

Examples of outcomes that would fit for operational improvement, waste reduction, and clinical efficiency include

  • Length of stay
  • Financial savings
  • Savings in manpower
  • Supply/resource savings
  • Time/motion study results
  • Patient wait times for procedures or results
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