The Advancing Research and Clinical Practice Through Close Collaboration Model (ARCC) is a conceptual framework used to guide system-wide EBP initiatives. The model begins with an assessment of the organizational culture and readiness to implement EBP. Strengths and barriers are assessed using the Organizational Culture and Readiness Scale for System-wide Integration of EBP (OCRSIEP) and point-of-care EBP mentors are developed. The key to successful application of the ARCC model involves developing mentors with the knowledge, skills, and desire for EBP along with organizational familiarity and an ability to empower staff to engage in implementation efforts. Improved clinical outcomes, beliefs, and best practices are successful with the integration of EBP mentors (Melnyk, Gallagher-Ford, Sigma Theta Tau International & Fineout-Overholt, 2016).
In 2007, the American Nurses Credentialing Center (ANCC) updated the Magnet model to reflect the complementary relationships between the “Forces of Magnetism.” These are conceptual domains that, when demonstrated within an organization, attract and retain satisfied and skilled nurses, akin to magnetic forces. Organizations provide narratives to fulfill sources of evidence, essentially showing the ANCC how they satisfy and exemplify these conceptual domains. Successful narratives show enculturation, the process by which the “Forces of Magnetism” are disseminated within the breadth and depth of the organization (ANCC, 2018). A critical component of the successful sustainment of a Magnet culture involves establishing an infrastructure to infuse the best evidence in combination with Magnet core principles for continuous change and transformation. As such, there is a need to leverage the complementary aspects of both models to effectively and practically engage nursing staff with Magnet education efforts, with the benefit of enculturating EBP.
The ARCC model can be applied to support initiatives towards a high-reliability organization (HRO) (Melnyk, Fineout-Overholt, and Gallagher Ford, 2011). Magnet and ARCC align in their conceptualization of the dynamism and complexity of health systems and the centrality of nursing in organizations in achieving high-value, high- quality care. Although centered within nursing, both models include interprofessional collaboration as crucial components to success within a complex system. Furthermore, they both acknowledge the value of the beliefs and attitudes of nurses in the care environment, in that nurses who are empowered within healthy work environments are more likely to engage in EBP implementation and Magnet initiatives. A crucial link exists between ARCC and Magnet in the concept of enculturation and its impact on outcomes. Enculturation, greatly espoused in the Magnet model, is evident in the ARCC model through the development and use of EBP mentors, increased beliefs about the value of EBP, enhanced team cohesion and decreased nurse turnover. The depth and breadth enculturation mandate of Magnet is fulfilled through the development and promotion of EBP and the associated change in nurses’ behaviors due to EBP implementation.
At UCLA Health, the union between Magnet and EBP manifests through a host of programming and educational content intended to enculturate excellence through evidence-based methods. As an element of our Professional Governance model, we established a Magnet education committee including facility and system-level program coordinators, clinical nurses, and an evidence-based practice specialist. The committee drafted a formal charter with measurable goals, shared mission, and defined membership criteria. Essential educational priorities were discussed and categorized using an impact/effort matrix. This activity revealed several integral aspects of a culture of excellence that were already embedded throughout the organization. As such, the application of the Appreciative Inquiry (AI) theoretical framework was selected as the foundation to revamp Magnet education initiatives throughout the enterprise. AI focuses on organizational strengths through inquiry to enhance learning, engage stakeholders, and improve communication through a shared vision (Halm & Crusoe, 2018). AI and EBP work synergistically to cultivate and sustain a culture of excellence. Therefore, both frameworks were strategically infused throughout all educational initiatives. The team conducted a comprehensive review of the literature, critical appraisal, and synthesis to identify best practices for Magnet education. Common characteristics emerging from the research were (1) the designation of staff nurse Magnet champions and (2) sustainment of a Magnet culture of excellence.
Using the seven-step EBP process, ARCC conceptual framework and AI, the team leveraged resources and stakeholders to recruit and train a core group of Magnet Champions. Inspired by the literature, UCLA Health adopted the term “Magnetizers,” for the champions. The allocation of resources to develop and mentor the “Magnetizers” was supported by the organization through the overarching UCLA Health nursing strategic plan. This enabled the Magnet education committee members to create the Magnetizer role. To promote staff engagement activities through the “Magnetizers,” the Magnet education committee members referred to the impact/effort matrix. Activities requiring the least amount of effort and highest impact were targeted. These activities included systemization of an established four-hour Magnet Essentials course, rounding carts, and standardized unit boards. Recognizing the importance of supporting appreciative inquiry, UCLA Health sponsored nurses to attend the 2018 ANCC Magnet conference. “Magnetizers” participated in an essay contest to explain how they embody Magnet at UCLA Health. Upon their return, attendees were given a standardized template to assist them with disseminating their newly acquired evidence through the various Magnet councils.
There are several lessons learned through our journey to cultivate a spirit of appreciative inquiry throughout the enterprise. (1) AI is a multi-faceted, successful approach involving commitment, consistency, and engagement from all members of the healthcare team and (2) opportunities for knowledge development and application of theory to practice for point-of-care clinicians are endless. With these pearls in mind, the UCLA Health approach to ignite a spirit of inquiry and excellence for Magnet education initiatives provides strategies that enable our discipline to apply and translate theoretical frameworks in practical ways to advance practice and provide a vehicle for nurses to evolve and expand healthcare systems.