AIHA Hosts Orientation for US Magnet Hospital Representatives, Charts a Course for Nursing Excellence in the NIS

"There has been an evolution in nursing and today we are here as part of this evolution to ensure hospitals and the patients they serve achieve better outcomes," said James P. Smith, AIHA executive director, during an orientation for the organization's Nursing Quality Improvement Initiative held March 24 in Washington, DC. "Although nursing has been left behind and marginalized in [NIS and CEE] countries," Smith continued, "it is improving. The commitment of nurses and nurse leaders to [AIHA's Nursing] Program has catalyzed the development of the profession in [the context of] healthcare reforms in the region."

Smith's remarks come at a time when AIHA is expanding its current nursing program by bringing Magnet Nursing status to hospitals in the NIS. Magnet accreditation is awarded through the Magnet Recognition Program (or the Magnet Program), which is based on quality indicators and standards of nursing practice as defined by the American Nurses Association. Accredited by the American Nurses Credentialing Center (ANCC), the Magnet Program focuses on quality improvement and provides a mechanism for the dissemination of best practices in the nursing profession by recognizing healthcare institutions that support excellence in the delivery of nursing care.

The initial phase of project pairs four Magnet-certified hospitals in the United States with four AIHA partnership institutions—two in Armenia and two in Russia—that are working toward such status. This stage of the program will test the feasibility of implementing Magnet standards in NIS hospitals and evaluate their impact. Nursing Magnet standards have the potential to greatly improve the quality of patient care in hospitals throughout the region and in other countries that are in the midst of healthcare reform. They can also serve as a model for institutions seeking to improve outcomes while working with limited resources.

AIHA's Nursing Quality Improvement Initiative is currently operating at pilot sites in Armenia and Russia, pairing North Shore University Hospital in New York with Erebouni Medical Center in Yerevan; Wake Forest University Baptist Medical Center in North Carolina with Emergency Scientific Medical Center in Yerevan; the Aurora Health System of Wisconsin with Central Clinical Hospital in Moscow; and Robert Wood Johnson University Hospital in New Jersey with Hospital 122 in St. Petersburg. These four NIS hospitals were selected because they have been exposed to the principles of professional nursing practice that serve as the basis for the Magnet accreditation program through their AIHA partnerships and because they have made notable progress in strengthening the profession of nursing at their institutions. The hospitals have also consistently demonstrated continuous excellence in nursing care.

The Initiative is spearheaded by Linda Aiken, professor and director of the University of Pennsylvania's Center for Health Outcomes and Policy Research. Aiken was instrumental in soliciting the voluntary services of the four US hospitals participating in the project.

Laying the Groundwork for Excellence
In August of 2001, the chief physicians and chief nurses at four graduated AIHA partnership hospitals in Armenia and Russia signed letters of intent to implement Magnet Nursing Standards of Administration and Practice.

A national call for volunteers was issued through the ANCC—one of AIHA's strategic partners in the Nursing Quality Improvement Initiative—to Magnet-certified hospitals in the United States requesting applications from those interested in becoming sister hospitals to one of chosen NIS magnet demonstration sites.

Through grants, Aiken raised the initial $53,000 needed to pay for baseline surveys and data analysis, which were conducted last fall at the four NIS hospitals to determine the current level of professional expertise among the nursing staff and patient satisfaction related to nursing care. These surveys will be used by the NIS and US hospitals as a starting point for their work plans related to quality improvement. The surveys were conducted by the American University of Armenia. The analysis is being carried out by Aiken and her research staff at the University of Pennsylvania along with Dr. Robert Hernandez, professor of healthcare management at the University of Alabama at Birmingham and US coordinator of AIHA's Yerevan/Birmingham HME partnership.

Under the auspices of the project, US Magnet healthcare professionals will be a valuable resource for their partner hospitals in the NIS and will help prepare their counterparts for the Magnet surveys used to determine if an institution meets the eligibility criteria, complies with quality care and professional performance standards, and can confirm implementation of these standards throughout its nursing services. All of the US Magnet hospitals are donating their time, expertise, and resources to the project, with AIHA providing logistical support.

"The US Magnet institutions have volunteered full funding for their participation in the AIHA Initiative, including the costs of four exchanges each that will occur over the course of the next two years," said Aiken, adding that, "The contribution is a very substantial one; one that is symbolic of their individual commitment to professional nursing."

Preparing for the Future by Learning about the Past
Key representatives from the US hospitals involved in the Nursing Quality Improvement Initiative gathered at AIHA's Washington, DC, headquarters last month to discover how their involvement in the project will promote positive changes in the nursing profession and impact related reforms in the NIS. The group was briefed on the status of nursing and healthcare in Armenia and Russia and familiarized with AIHA's role in strengthening the field of nursing and creating nurse leaders in the NIS and CEE. During the meeting, they discussed ways to better coordinate the technical assistance being provided at the NIS hospitals and learned about programmatic reporting requirements and other logistical matters.

The meeting also gave US Magnet hospital representatives the opportunity to meet three nurses—all veterans of AIHA's partnership programs—who are acting as principal advisors to the pilot project because of their sustained relationships with the participating NIS institutions. These advisors are Salpy Akaragian, director of international programs and a clinical education specialist at UCLA Medical Center in Los Angeles, California; Sharon Weinstein, president of Core Consulting Group Limited in Lake Forest, Illinois, and principal technical resource for AIHA's Nursing Program; and Jane Younger, president of the Kentucky Nurses Foundation and coordinator of AIHA's now-graduated St. Petersburg/Louisville partnership.

Aiken began the orientation by highlighting research reports from US hospitals that indicate US Magnet hospitals have better mortality and morbidity outcomes than non-Magnet hospitals. Aiken noted that while nursing is an acknowledged building block for quality hospital care, it has been underdeveloped—and often undervalued—in the NIS. She went on to explain that AIHA's Nursing Quality Improvement Initiative has an evaluation component that includes surveys of nurses and patients both before and after implementation of Magnet standards.

Aiken then shared some of the preliminary results from the baseline surveys conducted in the four participating NIS hospitals, which indicate that some elements of best practices in nursing are already in place at the pilot units of the hospitals. Patient satisfaction with nursing care is significantly higher in the pilot units where Magnet standards are being applied than in the rest of the hospital. Additionally, other indicators of improved quality of care—such as lower reported rates of nosocomial infections—are evident in Magnet pilot units.

Nurses also rated the quality of care in the Magnet pilot units higher than the hospital as a whole, Aiken pointed out. Furthermore, nurses in the Magnet units reported higher levels of autonomy, job satisfaction, and better professional interaction with physicians. "If the AIHA Nursing Quality Improvement Initiative can successfully improve patient care, it would be a model of great interest in many places throughout the world where quality of hospital care is deficient," Aiken concluded.

Participants then heard about AIHA and its partnership model. "AIHA's role in NIS health reform is that of 'catalyst and broker' for volunteer activities," Emily Fedullo, AIHA program officer said during her presentation on the organization's history and its nursing program. Adding that AIHA has maintained ongoing relationships with foreign governments and international communities, Fedullo maintained that the creation of AIHA's International Nursing Leadership Institute (INLI) has contributed to strengthening and building nursing leadership within partnership countries, while its Nursing Resource Centers have helped advance nursing education on clinical topics via the Internet and other didactic capabilities.

These sentiments were reiterated by Weinstein, who credited INLI, Sigma Theta Tau International Nursing Honor Society, and various professional associations for nurses with enhancing the roles, responsibilities, and image of the occupation in the NIS. Noting that education, practice, professionalism, and leadership are evidence of success, Weinstein discussed how AIHA's Nursing Program began and has since evolved, calling the organization "a champion of initiating the elimination of the 'mid-level personnel' stigma for nurses."

The US hospital representatives then heard from Akaragian, who provided historical information about Armenia, sharing facts about the country's economics, government, language, population, and natural resources. She explained that while Armenians recognized the importance of improving the nursing profession early on, the process to implement reforms has been slow. "To date, there about 3,500 nurses who are a part of the Armenian Nursing Association. That alone is a testament to the nurses' commitment to change [their status] and move forward."

Eleanor Howell, interim dean at Creighton University School of Nursing in Nebraska, will serve along with Akaragian as an advisor for the project in Armenia, while Weinstein and Younger will consult on the Initiative's projects in Russia. Both Weinstein and Younger are faculty for AIHA's INLI workshops that are designed to enhance the skills of nurses, create nurse leaders and nurse educators, and advance nursing as a profession within AIHA partnership countries. Other Nursing Quality Improvement Initiative volunteers—all consultants with ANCC's Institute for Research and Education Consultation (IREC)—include Vicki George, former chief nurse executive and regional vice president of the Wisconsin-based Aurora Health Care Metro Region and the current senior vice president and chief nursing officer of Catholic Health Initiatives; Peggy Jones, a member of ANCC's Board of Directors; and Anita Lymburner.

Summing up the important role nurses play in AIHA's healthcare reform efforts, Smith said that he has witnessed a special commitment on the part of the nurses involved in AIHA's Nursing Program. "AIHA's collaborative programs continue to produce results that are incredible, particularly in the area of nursing, because they engage the best US and overseas healthcare providers and educators in a gratifying and productive manner."

After the presentations, attendees gathered in small groups where they interacted with presenters to gain additional insight into the progress and status of AIHA's Nursing Quality Improvement Initiative and to develop strategies for upcoming professional exchanges. The four US Magnet hospitals are currently planning their first visits to the NIS hospitals where they will meet with the individuals they will be working closely with over the course of the next year. Follow-up Nursing Quality Improvement Initiative surveys are scheduled for 2004.