Ascension St. Vincent Evansville

Ascension St. Vincent Evansville registered nurses focus on the provision of spiritually based, holistic care, based on our Mission, Vision and Values, as well as identified needs of the community. We strive to establish a relationship-based nursing practice environment that recognizes the intentional caring relationship between a caregiver and the patient and family. We believe caring is core to the healing environment. Ascension St. Vincent Evansville professional nurses recognize each patient as a unique individual with rights to quality nursing care based on mutual goal setting between patient and nurse. We strive daily to protect patient rights and privacy, to achieve the highest quality of care, to emphasize patient safety and optimum health outcomes, and to provide nursing leadership within our facility and community.

Ascension St. Vincent Evansville employs over 800 registered nurses, with 550 nurses providing direct patient care. Over 66 registered nurses are employed in some type of indirect nursing care activity, including advanced practice, risk management, patient navigation, infection prevention, case management, quality and other specialties. The Mission, Vision, and Values, hospital and nursing strategic plans, performance improvement and patient safety plans and nursing standards provide the framework for the provision of nursing care. The quality driven planning process for the provision of care reflects Ascension St. Vincent Evansville’s commitment to provide appropriate individualized, spiritually centered, holistic care and to achieve excellent patient, nurse, organizational and community outcomes. I welcome you to read more about Ascension St.Vincent Evansville Nursing.

Gwynn Perlich
MSN, RN, MBA
Vice President of Nursing and Operations

Table of Contents

• Nursing Division
• Nursing Excellence Professional Practice Model
• Foundation for Nursing
• Professional Nursing Practice
• Legal, Professional and Regulatory Standards
• Relationship-Based Care
• Education and Professional Development
• Shared Governance
• Recognition and Rewards
• Nursing Research, Evidence-Based Practice and Performance Improvement
• Magnet Recognition Program

Nursing Division

Ascension St. Vincent Evansville’s Nursing Division consists of the following service areas:

• Perioperative Services
• Cardiovascular Services
• Medical/Surgical Services
• Hospital for Women & Children
• Emergency Services
• Behavioral Health
• Rehabilitation Institute
• Oncology Services
• Palliative Care
• Critical Care and Trauma
• Patient Access
• Admitting and Staffing Services

Our service areas are led by executive directors and directors of nursing. We employ clinical nurse specialists and nurse practitioners in a variety of roles. Registered nurses perform services, which include, but are not limited to:

• Assessing health conditions
• Deriving a nursing diagnosis
• Executing a nursing regimen through the selection, performance and management of nursing actions based on the nursing diagnosis
• Advocating the provision of healthcare services through collaboration with or referral to other health professionals
• Executing regimens delegated by a physician with an unlimited license to practice medicine or osteopathic medicine, a licensed dentist, a licensed chiropractor, a licensed optometrist or a licensed podiatrist
• Teaching, administering, supervising, delegating and evaluating nursing practice
• Delegating tasks which assist in implementing the nursing, medical or dental regimen
• Performing those acts approved by the board or by the board in collaboration with the medical licensing board of Indiana

Registered nurses executing a nursing regimen means preventative, restorative, maintenance and promotion activities which include meeting or assisting with self-care needs, counseling and Teaching.

Nursing Excellence Professional Practice Model

The Nursing Excellence Professional Practice Model reflects the essence of Ascension St. Vincent Evansville nursing - delivering exceptional patient-centered care. This care is provided in a caring and healing environment based upon the Mission, Vision and Values of Ascension. The model serves our community of patients, families, nurses and other healthcare providers. Leadership, education, research and advocacy are important dimensions in our philosophy of care. Outcomes are the “quantitative and qualitative evidence related to nursing’s impact of the structure and process on the patient, nursing workforce, organization and the consumer” (American Nurses Credentialing Center [ANCC], 2008, p. 63). The components of the Nursing Excellence Professional Practice Model are:

• Shared Governance is our operational governing system that enables sustainable and accountability-based decisions to support an interdisciplinary design for excellent patient care; unit, service area and nursing operations.
• Relationship-Based Care is our patient/family-centered care delivery system. Relationship-Based Care is excellent healthcare achieved through collaborative relationships.
• Recognition and Rewards is our system to compensate nurses for their work and to recognize their contribution to patient outcomes, the organization and the profession.
• Professional Relationships is our system of interactions that occur between nurses and other health professionals when providing patient care services.

These components and other important elements of our professional practice model are visually displayed in the following schematic.

Foundation for Nursing

Ascension St. Vincent Evansville’s definition of nursing, nursing commitment statement, and the values and beliefs of our professional practice model arise from Florence Nightingale, Virginia Henderson, Jean Watson and Kristen Swanson. These nursing theorists believed caring is the essence of professional nursing practice. Florence Nightingale believed nursing was a call from God and that the sick deserved civilized care, regardless of their station in life. Virginia Henderson is known as the modern-day mother of nursing. Her work focused on patient- centered care.

Jean Watson’s Human Caring Theory (2005) and Kristen Swanson’s Theory of Caring (1993) provide the caring theoretical foundation for nursing at Ascension St. Vincent Evansville. Watson’s Human Caring Theory (2005) is characterized by these principles:

1. Caring is the essence of nursing practice,
2. Caring is demonstrated and practiced interpersonally,
3. Caring recognizes the unique, individual response to illness,
4. Caring honors the dignity and worth of each person,
5. Caring protects the individual’s autonomy,
6. Caring helps each individual reach maximum capacity, and
7. Nursing occurs within the human to human caring relationship.

Caring is defined as “a nurturing way of relating to a valued other toward whom one feels a personal sense of commitment and responsibility” (Swanson, 1991, p. 162). Swanson’s (1993) theoretical framework defined Five Caring Processes through which caring is manifested:

1. Maintaining belief,
2. Knowing,
3. Being with,
4. Doing for, and
5. Enabling.

Professional Nursing Practice

Ascension St. Vincent Evansville recognizes and honors differing nursing roles, such as professional registered nurses, clinical nurse specialists, nurse practitioners, certified nurse anesthetists, licensed practical nurses and unlicensed support personnel as caregivers. Together, our staff provide a premier environment for the provision of nursing care. Ascension St. Vincent Evansville’s professional nursing practice, regardless of clinical specialty, practice setting or educational practice, is patient/family centered, and nursing care is delivered in a safe manner consistent with our Mission, Vision and Values. The highest possible quality of care, patient safety and optimal patient outcomes are achieved through measurable patient/family centered goals which are continuously undergoing systematic evaluation.

Ascension St. Vincent Evansville Definition of Nursing

Nursing is the art and science of promoting, restoring and maintaining health and preventing illness and injury for individuals, families and communities. Nursing sustains and supports individuals and families from the beginning of life through the end-of-life utilizing compassionate caring, collaboration, education and advocacy.

Ascension St. Vincent Evansville Nursing Commitment

Nursing aspires to be regionally and nationally recognized for our evidence-based nursing practice, nurse work environment, and our commitment to community. Ascension St. Vincent Evansvillle’s nursing team serve as strong patient advocates, always putting the patient first. We strive daily to improve and make a difference.

Together we will accomplish our commitment through:

• Compassion for our patients/families and one another
• Ownership of high nursing standards and professional growth
• Dedication and accountability to the lives entrusted to us
• Passion and dignity in all we do

Legal, Professional and Regulatory Standards

Registered nurses, licensed practical nurses and advanced practice nurses employed at Ascension St. Vincent Evansville hold valid and current Indiana licenses to practice nursing and are accountable to the Indiana State Board of Nursing’s Licensure Statutes and Administrative Rules. Registered nurses and licensed practical nurses are accountable to the public for providing culturally competent, safe and effective nursing care. The Indiana State Nurse Practice Act is the legal authority for nursing practice. The Indiana State Board of Nursing is accessed at this website: iga.in.gov.

In exchange for the trust society grants though licensure, Ascension St. Vincent Evansville nurses take personal responsibility, authority and accountability to maintain competence in practice through continuing education and utilization of research findings and assume responsibility, authority and accountability for individual nursing judgments and actions. Registered nurses are held accountable to the ethical and professional standards as defined in the American Nurses Association’s (ANA) Guide to the Code of Ethics for Nurses (2016), the ANA Nursing Social Policy Statement (2015), the ANA Nursing: Scope and Standards of Practice (2015), the ANA Principles for Documentation (2010), the ANA Delegation and YOU (2014), the ANA Utilization Guide for the ANA Principles for Nurse Staffing (2013), the ANA Bill of Rights for Registered Nurses (2001), and the Indiana State Nurse Practice Act. The ANA Nursing Administration Scope and Standards of Practice (2016) defines and discusses the role and responsibility of nurse administrators. These standards are fully implemented throughout Ascension St. Vincent Evansville so that we share a common set of standards to guide practice and achieve our goals.

Relationship-Based Care

Relationship-Based Care (RBC) is the care delivery model of professional nursing practice at Ascension St. Vincent Evansville. The Relationship-Based Care model was developed and created by Mary Koloroutis and Marie Manthey of Creative Health Care Management in 2004. Ascension St. Vincent Evansville is granted permission to use the terminology “Relationship- Based Care.”

Relationship-Based Care is defined as excellent healthcare achieved through collaborative relationships. RBC takes place in a caring, competent and healing environment organized around the needs and priorities of the patients and their families who are at the center of the care team. RBC is based on three crucial care provider relationships - the relationship with patients/families, self and colleagues.

The Nursing Excellence Professional Practice Model and the care delivery model of Relationship-Based Care’s theoretical foundations are based upon the work of Florence Nightingale, Virginia Henderson, Jean Watson and Kristen Swanson.

Education and Professional Development

Ascension St. Vincent Evansville nurses seek the opportunity to continually improve, grow in their knowledge base, and remain competent regarding healthcare issues and advances. Ascension St. Vincent Evansville is dedicated to providing continuing education to ensure excellent care. We believe nursing requires lifelong learning. The Ascension Clinical Professional Development Department’s consultants and educators conduct nursing orientation, the Transitions to Practice nurse residency program, and annual learning needs assessments that identify the educational needs of the nursing staff. The Quality, Practice and Education Council develops, implements and evaluates nursing’s formal education plan.

Transition to Practice Program

Ascension St. Vincent Evansville’s Transition to Practice Program is a “formal program of active learning for nurses implemented across all settings and designed to support their progression from an education environment to a practice setting or between practice settings” (American Nurses Credentialing Center 2016, p. 43).

Ascension St. Vincent Evansville’s Transition to Practice Program is divided into subprograms for the following groups:

1. New nursing graduates from an accredited college of nursing;
2. Newly hired experienced registered nurses;
3. Nurses transferring within the organization to a new nurse practice environment;
4. Advanced practice registered nurses (APRN) transitioning into the practice environment and
5. New nursing directors.

The Transition to Practice Program is led by the clinical professional development program consultant. The program is divided into four phases:

1. Regional onboarding center orientation;
2. Nursing orientation – the period after completion of the regional onboarding orientation through orientation to the unit or department with a preceptor (this time varies depending on the role);
3. Nurse residency – the period of time after orientation that may extend up to 12 months after entering a new nursing role; and
4. Life as a beginning/developing nurse, proficient nurse or expert nurse.

The entire program is one year long.

Job Specific Classroom Orientation for RN

A five-day introduction to the role and responsibilities of the bedside clinical staff nurse, this interactive orientation consists of didactic lecture, online self-directed learning, simulated learning experiences, content experts from other clinical specialties, and hands-on training. This orientation may be modified for RNs and student nurse interns based upon work location and experience. Validation of competence is determined by demonstration, return demonstration, simulation learning, cognitive tests, and verbal application of knowledge to prescribed scenarios/situations. In addition to the initial job-specific orientation, the associate participates in an assigned area job-specific orientation. This orientation is planned with cooperation of the assigned area’s director/manager and clinical professional development consultant or educator. The director/manager and clinical professional development consultant or educator not only plan the assigned area job-specific orientation, but also assign the preceptor the associate will work with. The clinical professional development consultant or educator and preceptor are responsible to provide the new associate with the appropriate learning support and learning activities to validate and document competence in identified knowledge and skills.

Job/Role Orientation for Unlicensed Nursing Personnel

The director/manager and clinical professional development consultant or educator assigned to the area assess the competence of the unlicensed nursing associates, including Patient Care Technicians (PCT), Unit Coordinators (UC), Unit Assistants (UA), Interns - New Nursing Graduates and Student Interns (Levels I, II, III), and determine the associate’s specific orientation. In addition to job specific classroom orientation, the unlicensed nursing associate receives an assigned area job specific orientation. Associates with experience attend classroom orientation and, based on past experience related to the required skills needed, may progress at a faster pace through the area specific clinical orientation. In addition to a trainer/preceptor assigned to the new associate to facilitate learning and development, a registered nurse also supervises the day-to-day orientation of the unlicensed nursing associate.

Job Specific Classroom Orientation for Student Intern (I, II, III)

There are two distinct classroom orientation tracks for the student intern. A student intern is defined as a person who is enrolled in nursing school and has successfully completed a full semester/quarter of acute hospital care.

Assigned Area Job Specific Orientation for Intern

Each intern attends a nursing orientation class. The clinical orientation for the intern is arranged by the clinical professional development consultant or educator assigned to the unit/department. This orientation is individualized for each intern, with an average length of time being five days with a preceptor. A RN supervises the intern on a daily basis. When the intern is promoted to Intern III, orientation includes job shadowing with a RN preceptor selected by the department director/manager.

Ascension St. Vincent Evansville Learning Management System

Ascension St. Vincent Evansville utilizes myLearning as its learning management system for education, training elements of orientation, ongoing education, program registrations and training documentation. This system is accessed through the Ascension St. Vincent intranet. MyLearning enables promotion of, and access to, educational opportunities throughout the organization and enables electronic management of most data related to enrollment and participation in education. An educational calendar and listing of myLearning modules are provided on the intranet. In addition, myLearning is used to supplement other educational delivery methods through pre-tests, post-tests and surveys. The myLearning system provides tracking and reporting of educational activities for individual associates, departments, job titles and identified people groups for evaluative and managerial purposes.

Formal Nursing Education

Ascension St. Vincent Evansville encourages and supports individuals seeking undergraduate and graduate degrees in nursing. A nursing degree provides diverse career opportunities. A formal degree in nursing prepares individuals with nursing knowledge, clinical skills and professional values to provide safe, quality, cost-effective nursing care to individuals, families and communities.

Recognizing the complexity of healthcare, nursing strongly encourages registered nurses with associate and diploma degrees to obtain a baccalaureate degree in nursing. Ascension St. Vincent Evansville nursing strategic plan sets goals for improvement in nursing formal education at all levels (e.g., baccalaureate, master’s and doctoral degrees). Support for advancing formal education is available and includes tuition reimbursement, flexible scheduling, computer support, library support services and on-campus classes.

National Nursing Specialty Certification

Specialty national nursing certification is the standard by which the public recognizes quality nursing care. Certification, as defined by the American Board of Nursing Specialties, is the formal recognition of the specialized knowledge, skills and experience demonstrated by the achievement of standards identified by a nursing specialty to promote optimal health outcomes. Nursing at Ascension St. Vincent Evansville believes that specialty certification is a mark of excellence and is proud to promote and support certification among our nurses.

Mentoring Program

Ascension St. Vincent Evansville’s Mentoring Program is an optional program for professional development. It is a collaborative learning relationship between two (or more) individuals who share mutual responsibility and accountability for helping a mentee work toward achievement of mutually defined learning goals.

Shared Governance

The Shared Governance component of the Nursing Excellence Professional Practice Model operates within the nursing framework of Ascension St. Vincent Evansville. Shared governance is a powerful tool for creating a culture of excellence in which staff are accountable for their actions and patient outcomes.

Definition of Shared Governance

Shared Governance is a model for shared decision-making based upon the principles of partnership, equity, accountability and ownership that form a culturally sensitive and empowering framework, enabling sustainable and accountability-based decisions to support an interdisciplinary design for patient care (Porter-O-Grady, 2001). The Shared Governance model is the vehicle that guides and drives the operational, professional, educational, quality and research processes for nursing practice at Ascension St. Vincent Evansville.

The six governing councils are:

• Nursing Alliance Assembly
• Quality, Practice & Education Council
• Clinical Services/Nursing Management
• Recruitment, Retention & Recognition
• Advanced Practice Nurse
• Clinical Informatics

The six governing councils participate in defined decision-making and coordination of nursing and provide input through the Shared Governance process in all areas where nursing care is delivered. Professional nursing organizes, integrates and manages the delivery of the nursing care services through communication, thoughtful deliberation and decision-making within the council structure.

Recognition and Rewards

Ascension St. Vincent Evansville rewards and recognizes excellence in nursing. Recognition and Rewards is our system to compensate nurses for their work and recognize their contribution to patient outcomes, the organization and the profession. Ascension St. Vincent Evansville and the Nursing Excellence Professional Practice Model provide many avenues for recognition and reward at the organizational and unit or department level.

The governing Recruitment, Retention and Recognition Council develops, implements and evaluates nursing’s plan for recruitment, retention and recognition activities. The Council works with the service area or unit-based councils, other hospital departments and committees on many of these activities which include, but are not limited to the list below.

Nursing Excellence Awards

The Nursing Excellence Awards recognize Ascension St. Vincent Evansville nurses who have been nominated by their peers for excellence in nursing practice. The award categories are Transformational Leadership, Structural Empowerment, Exemplary Professional Practice, New Knowledge, Innovations and Improvements, Empirical Outcomes, Rising Star and Administrator or Nursing Excellence.

2019 Ascension St. Vincent Evansville Nursing Excellence Award Winners

Nursing Scholarships

Nursing scholarships are given to nurses pursuing undergraduate and graduate degrees in nursing. Ascension St. Vincent Evansville Foundation, with support from the Auxiliary and the Sue Conner Vauthier Memorial Scholarship, provides the funds for these scholarships.

2019 St. Vincent Evansville Nursing Scholarship Winners

• Sue Conner Vauthier Scholarship Winner: Chynnia Farrar
• Ascension St. Vincent Evansville Foundation Nursing Scholarship Winners: Hannah Venderley, Brandy Mason, McKenna Peach, Abby Schoenstein
• Ascension St. Vincent Evansville Auxiliary Scholarship Winners: Tiffany Volk and Emily Sullender

Nurses’ Day Dinner

The Nurses’ Day Dinner is an annual event held during National Nurses’ Week to celebrate and honor Ascension St. Vincent Evansville nurses and the profession of nursing.

STARS

STARS is an associate recognition program. STARS is an acronym for Skills, Teamwork, Achievement, Recognition and Spirituality. The STARS Committee consists of hospital associates who conduct many types of events all year long to recognize the value our associates bring to the workplace and community. If someone would like to recognize an Ascension St. Vincent Evansville associate who has provided exceptional service, the individual may submit a STARS card that briefly describes what the caregiver did to add to the comfort or well-being of a patient’s hospital stay. Associates are also encouraged to submit STARS cards recognizing the work of fellow associates or other healthcare professionals. Associates receiving STARS cards are recognized by their immediate supervisor.

DAISY Awards

The DAISY Award was established by the DAISY Foundation in memory of J. Patrick Barnes who died at the age of 33 of idiopathic thrombocytopenia, an auto-immune disease. The Barnes Family was awestruck by the clinical skills, caring and compassion of the nurses who cared for Patrick and created this national award to say thank you to nurses everywhere. DAISY stands for Diseases Attacking the Immune System.

2019 Ascension St. Vincent Evansville DAISY Award Winners

Performance Appraisals

The Clinical Services/Nursing Management Council provides the development and oversight of the nursing job performance standards. The performance appraisal process is goal oriented and includes self-evaluation, peer review, quantifiable metrics, career development and goal setting. Associates are compensated and rewarded based upon performance.

Professional Development

Ascension St. Vincent Evansville RNs view professional development as essential to quality care, personal and professional satisfaction, and career advancement. Ascension St. Vincent Evansville provides support for professional development through the following mechanisms: flexible scheduling, paid time for project work, seminar, conference or symposium attendance, tuition, and nursing certification reimbursement.

Professional development includes, but is not limited to, participation in hospital committees, councils and projects; review of professional journal articles and scholarly research; formal and informal continuing education; certifications for jobs and training; national nursing certification; participation in professional organizations and community events.

Other Mechanisms of Recognition and Reward

Associate of the month; hospital leader of the quarter; birthday celebrations; paid registrations to conferences; Ascension St. Vincent Evansville Campus News posts; Tiny Pulse/Cheers for Peers; attendance at conferences and symposiums; holiday celebrations; meal celebrations; and book clubs.

Nursing Research, Evidence-Based Practice and Performance Improvement

The hallmark of a profession is the possession of a body of knowledge from research. Research is the bridge that translates academic knowledge and constructed theories into direct clinical practice. Along with generating new knowledge through supporting nursing research, Ascension St. Vincent Evansville has two additional methodologies to translate knowledge to improve care. Included under research in our professional practice model is evidence-based practice and performance improvement.

Nursing Research

Research is a scientific process that validates and refines existing knowledge and generates new knowledge that directly and indirectly influences nursing practice (Burns & Groves, 2005). The Ascension St. Vincent Evansville Nursing Research model provides nursing with the process of identifying clinical phenomena and constructing a research plan.

Evidence-Based Practice

Ascension St. Vincent Evansville believes that research drives the development and clinical application of nursing knowledge. Nursing knowledge is generated from three sources:

1. Research,
2. Evidence-based practice, and
3. Performance or quality improvement.

Research is necessary for evidence-based practice. Evidence-based practice is a systematic process to evaluate relevant evidence to answer a clinical question considering patient preference and clinical expertise in nursing practice (Melnyk & Fineout-Overholt, 2010). Ascension St. Vincent Evansville evidence-based practice model is based on the Iowa model (Titler & Everett, 2001).

Performance Improvement

Performance improvement is a data driven systematic approach by which individuals work together to improve specific systems, processes and quality outcomes. Ascension St. Vincent Evansville’s performance improvement methodology is AIM4Excellence, which is Ascension Health’s Model for Excellence. AIM4Excellence has three objectives:

1. Engage the hearts and minds of associates and health partners to deliver ever-increasing value to those we serve, achieving the Quadruple AIM as evidenced by:
• Improved Health Outcomes
• Enhanced Patient Experience
• Enhanced Provider Experience
• Lower Overall Cost of Care
2. Create system alignment with integrated management systems and improvement techniques.
3. Simplify and align “The Improvement Model” principles and behaviors to ensure they are an expression of our identity as a ministry and connected with our Core Values.

The Ascension St. Vincent Evansville Improvement Model is to enable, align and achieve the Quadruple AIM through:

• Cultural enablers
• Respect every individual
• Lead with humility
• Embrace transparency
• Enterprise alignment
• Create constancy of purpose
• Think systematically
• Continuous process improvement
• Focus on process
• Embrace scientific thinking
• Focus on flowing and pulling value
• Assure quality at the source
• Seek serfection

This model uses the A3 Problem Solving Method for Improvement. AIM4 Excellence model components are defined as:

• Title of project and team members
• Issue/problem statement
• Background/measurement
• SMART goal
• Current condition
• Root cause analysis

The Methodology Ascension St. Vincent Evansville also uses is PDCA. PDCA must have a start date, a process owner and an executive sponsor.

• Plan. Plan the change. Establish the objectives and processes necessary to deliver the results in accordance with the specifications.
• Target condition – new process to lead closer to goal
• Goals
• Countermeasure(s) – must be tied to root cause
• Do. Implement the processes, test the change.
  • Action plan – start with a pilot: what, who, why, by when
• Check. Monitor and evaluate the processes and results against objectives and specifications and report the outcome.
• Act. Take action based on what you’ve learned in the check step. Apply actions to the outcome for necessary improvement.

Magnet Recognition Program

Journey toward Nursing Excellence

In 2005, Ascension St. Vincent Evansville committed to a long-term journey toward nursing excellence and Magnet ™ Designation. Ascension St. Vincent Evansville was awarded the Magnet® designation in January 2011. As an ANCC Magnet® recognized facility, Ascension St. Vincent Evansville is now among the top six percent of hospitals in the nation. As we continued our journey to build on this success, we submitted our documentation for Magnet® Redesignation and were granted a site visit in January 2016. After a thorough examination by the American Nurses Credentialing Center (ANCC), Ascension St. Vincent Evansville was awarded second Magnet® Designation on March 15, 2016.

The Magnet Recognition Program designates organizations worldwide where nursing leaders successfully align their nursing strategic goals to improve the organization’s patient outcomes. The Magnet Recognition Program provides a roadmap to nursing excellence, which benefits the whole of an organization. To nurses, Magnet Recognition means education and development through every career stage, which leads to greater autonomy at the bedside. To patients, it means the very best care, delivered by nurses who are supported to be the very best that they can be.

The Magnet Model Components™ were developed out of the effort to condense the fourteen Magnet Forces and were introduced in late 2008. These newly identified components are evident in Ascension St. Vincent Evansville’s Journey to Nursing Excellence. The four Magnet® components are:

• Transformational leadership;
• Structural empowerment;
• Exemplary professional practice; and
• New knowledge, innovations and improvements.