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Make way for another nursing excellence award

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Not every healthcare organization has the finances or resources to achieve ANCC Magnet Recognition Program® (MRP) designation. Some need an alternative, a chance to exhibit nursing excellence without enduring the exhausting journey. Meet the Pathway to Excellencedesignation.

“It’s anticipated that [Pathway to Excellence] might be a first step for some hospitals who then choose to go on to apply for [MRP designation]—but it doesn’t have to be,” says Nancy Mastronardi, RN, BSN, project coordinator-RN lead at Seton Family of Hospitals in Austin, TX. “Like [MRP designation], Pathway to Excellence hospitals that continue to meet the standards may achieve redesignation.”

The award, originally known as the Texas Nurse-Friendly hospital award, was first given to small (fewer than 100 beds), rural Texas hospitals that provided safe and positive work environments for nurses. But it has grown since its inception in 2003. In 2007, the ANCC acquired the award and extended it to hospitals of any size nationwide. The coast-to-coast scope of the distinction is similar to the MRP, but there are several significant differences.

Apply for excellence

Before applicants can pursue Pathway to Excellence, they are expected to complete a 42-question self-assessment survey that measures the organization’s readiness to meet the program’s standards and identifies areas for improvement. Organizations pursuing MRP designation perform a similar readiness assessment when they conduct a gap analysis.

“[ANCC] really [wants] to see that the [Pathway to Excellence] standards are embedded throughout the organization,” says Mastronardi. “A positive work environment that supports professional nursing practice and promotes excellence in patient care should be visible on all units.”

Once an organization completes the self-assessment survey and is ready to pursue Pathway to Excellence, it submits an application form four to six months prior to submitting the written documentation. The two-page application asks for organizational information, such as general patient population focus, number of beds, average daily census of patients, and CNO credentials. The written documentation must exemplify the program’s 12 practice standards.

“The Pathway to Excellence program requires financial and leadership support to maintain an environment that demonstrates nursing excellence and promotes quality patient care and improved outcomes,” says Mastronardi. “And it’s an ongoing process and commitment like [MRP designation].”

Meet the standards

After the ANCC acquired the Nurse-Friendly award, it developed 12 practice standards—much like the 14 Forces of Magnetism—that organizations are expected to illustrate in the documentation. There are elements of performance under these 12 standards, similar to the sources of evidence that fall under the 5 Model Components in the 2008 ANCC Magnet Recognition Program® Application Manual.

The following are the 12 Pathway to Excellence practice standards and a brief description of what each one seeks:

1. Nurses control the practice of nursing. A shared decision-making model is in place for nurses to have a voice in practice, policies, and procedures.

2. The work environment is safe and healthy. The hospital has policies protecting staff members and keeping them safe (e.g., security measures and nonviolence and non-harassment policies). “You want to build an environment where nurses want to practice,” says Mastronardi.

3. The organization has systems in place to address patient care and practice concerns. There are organizational policies for patient rights. Also, patients have the ability to speak with someone regarding their quality of care.

4. Orientation prepares new nurses. Programs are in place (e.g., mentoring and precepting) to help and support new graduate nurses, as well as nurses that are new to a specialty. Also, competency and evaluation tools are used to ensure that the right mix of nurses are placed on a unit.

5. The CNO is qualified and participates in all levels. The CNO is expected to be an RN with a master’s degree in nursing or be able to show he or she is pursuing a master’s or an MBA. Like CNOs at MRP facilities, he or she must be available to and advocate for direct care nurses, be a member of the executive team, and have open communication with the organization’s CEO.

6. Professional development is provided and utilized. Hospitals have comprehensive programs for staff development and opportunities for nurses to attend conferences, conduct academic work, and join professional organizations.

7. Competitive salaries are in place. Salaries are adjusted accordingly to the size of the organization, the market analysis in the area, cost of living, and similar organizations.

8. Nurses are recognized for achievements. The organization upholds the image of nursing through awards, Nurses Week activities, and recognition on the hospital’s intranet and Web site.

9. A balanced lifestyle is encouraged. Flexible staffing and scheduling allows nurses to take educational courses, enjoy time with family, take holiday vacation, and have paid time off.

10. Collaborative interdisciplinary relationships are valued and supported. Staff members are encouraged to work in interdisciplinary teams and become members of interdisciplinary councils. This allows staff nurses’ voices to be heard organizationwide.

11. Nurse managers are competent and accountable. The organization helps and supports staff nurses to become leaders and transition from staff roles to leadership roles through mentoring and succession planning. Because it is important for nurse managers to be competent, they are also evaluated to identify areas for improvement.

12. A quality program and evidence-based practices are utilized. With an emphasis on quality care and patient outcomes, nurses are expected to be utilizing evidence when they change practice standards, create policies, and work in teams. Although nurses are not required to conduct research projects, they are encouraged to join journal clubs and lead quality performance improvement initiatives, says Mastronardi.

Earning the award

The documentation submitted by Pathway to Excellence applicants should show that the organization’s practices, policies, and culture programs help create a safe and positive work environment for nurses.

It should also feature the organization’s background information, along with nursing organizational charts. “This is to make sure that nursing is at the forefront,” says Mastronardi.

After an organization has completed and submitted its written documentation, Pathway to Excellence appraisers review the documentation. Although MRP applicants receive a site visit so appraisers can verify that what’s written in the documentation is exemplified in the culture, Pathway to Excellence applicants do not.

Instead, at least 51% of the organization’s direct care nurses are expected to take an online survey if the documents receive a score of 75% or better. This confidential survey is for direct care nurses to validate that the 12 practice standards and elements of performance exist within the organization.

“The award demonstrates that we have a commitment to nursing professionalism, staff development, research-based practice, and patient needs,” says Sarah Woolsey, RN, BSN, clinical nursing supervisor at Seton Edgar B. Davis Hospital in Luling, TX. “It costs money and resources to achieve [MRP designation] and Pathway to Excellence, so I think to achieve these two awards demonstrates a commitment from the CNO and administrators to the profession of nursing.”

Editor’s note: For more information on the program, visit the ANCC Web site at