In a step toward achieving Magnet designation, BWH submitted a body of evidence in April that demonstrates how the hospital meets 49 standards within the components of the Magnet model: Transformational Leadership, Structural Empowerment, Exemplary Professional Practice, and New Knowledge, Innovations and Improvements. Empirical Outcomes are required throughout the components. The 75 initiatives selected for submission are examples of our deep commitment to quality, nursing excellence, interprofessional collaboration and innovation. Throughout the year, we will use “Magnet Matters” to share some of these examples with you. We hope you will be inspired by the broad range of examples and the work being done across BWH.

Structural Empowerment

Nurses participate in professional development activities designed to improve their knowledge, skills, and/or practices in the workplace. Professional development activities are designed to improve the professional practice of nursing or patient outcomes or both.

Example 1: Nurse-led Simulation Course Improves Care

Approximately 60 to 70 patients who have been sexually assaulted present to the BWH Emergency Department each year. More than 120 nurses work in the ED, which means a nurse may care for a patient who has experienced sexual assault once every two years on average. This limits opportunities for nurses to gain the specialized hands-on skills and training required to effectively care for this patient population.

To address this, a team of nurses conducted an assessment of current practices and developed the first nurse-led interprofessional simulation course, Sexual Assault Simulation for Healthcare providers (SASH).
The goal was to improve the skill and knowledge of all health care providers caring for patients in the ED who have experienced sexual violence. The four-hour course focuses on the medical, psychological and forensic needs of patients who have been sexually assaulted.

Prior to the course, data showed that patients waited an average time of six hours and 32 minutes to receive HIV non-occupational post-exposure prophylaxis (n-PEP) medications. In the nine months following the course, data showed that time was nearly cut in half, with a new average of three hours and 20 minutes.

Example 2: Conversations about Serious Illness Improve Patient Outcomes

Early conversations with patients about their goals, values and care preferences are known to benefit patient and family outcomes, especially for those dealing with chronic diseases or life-threatening illnesses. However, clinician and system barriers to having these conversations exist: Clinicians may not feel comfortable initiating the conversation; clinicians may not have the knowledge and skills to effectively lead the conversation; and systems may lack the resources to thoroughly document these conversations.

To improve the frequency and quality of conversations about serious illness, an interprofessional team of physicians and nurses developed the “Serious Illness Initiative” as part of the integrated Care Management Program (iCMP). The iCMP improves the coordination of care by placing clinical nurse care coordinators (RNCCs) directly into primary care settings.

As part of the Serious Illness Initiative, RNCCs partner with each patient’s primary care provider to engage patients in earlier serious illness conversations. A Serious Illness Communication Skills training was developed to prepare clinicians for these conversations. In addition, a set of criteria was created to identify patients for these conversations. To date, 100 percent of RNCCs and primary care social workers and 40 percent of physicians have completed this training.

Outcomes related to the Serious Illness Initiative demonstrated a high satisfaction among clinicians and an increase in serious illness conversations. In addition, utilization of hospice care has increased, promoting an enhanced quality of life and decreased costs of care at the end of life.

Visit to access BWH’s Magnet submission website where you can read more about these two examples, listed under Structural Empowerment, SE 4EO.