Magnet Recognition Program Budget for VA Nursing Excellence

Introduction to Magnet Designation

The objective of this work is to create a budget for Magnet Recognition Program designation and to describe how these resources will advance professional nursing. Nurse leaders' experiences with budget development are often "lock-step": the data are typically based on historical tracking, and nurse leaders need only confirm the figures. The purpose of this paper is to provide an opportunity to develop a budget that supports the advancement of the nursing profession — a core responsibility of nurse leaders. In developing this budget, an organizational strategy is established, current professional information and data are incorporated, and an analysis of organizational implications is provided. For the purposes of this assignment, the MD Anderson Cancer Center unit of the Michael E. DeBakey Veterans Affairs Medical Center (MEDVAMC) is used.

According to the University document entitled "Magnet Designation": "Magnet designation signifies that an institution's nurses have high levels of education, adhere to the highest professional standards, and provide the best patient care" (2006). The document further states that "Magnet recognition provides consumers with the ultimate benchmark to measure the quality of care they can expect to receive." The Chief Clinical Officer and Chief Nursing Officer noted: "Being recognized as a Magnet institution signifies not only excellence in nursing care and professionalism, but it also acknowledges the collaboration throughout the organization to support quality of care, shared governance, and the promotion of nurses as leaders." Independent studies have shown that in Magnet-designated facilities "patients have shorter lengths of stay, higher satisfaction, higher nurse-to-patient ratios and lower mortality rates. Nurses are more satisfied with their work and Magnet recognition strengthens nursing recruitment and retention efforts."

The stated mission of M.D. Anderson Cancer Center is: "To eliminate cancer in Texas, the nation and the world through outstanding programs that integrate patient care, research and prevention, and through education for undergraduate and graduate students, trainees, professionals, employees and the public."

Organizational Mission, Vision, and Values

The stated vision of M.D. Anderson Cancer Center is that it "shall be the premier cancer center in the world, based on the excellence of our people, our research-driven patient care and our science." The vision is further captured through the PRIDE acronym:

P — Patients are number one.
R — Research advances clinical care.
I — Individual employees make a difference.
D — Dedication leads to quality.
E — Excellence is achieved through education.

MEDVAMC states that it will maintain and advance its position as a quality healthcare institution by being: (1) the healthcare provider of choice; (2) the employer of choice; (3) the leader in research and education; (4) a leader in innovative healthcare delivery; and (5) a leader in building healthy communities.

The values of MEDVAMC include:

1. A commitment to Veterans by being responsive, respectful, trustworthy, and compassionate.
2. Working as a team to provide excellence in patient care and research.
3. Utilizing accurate data and information for decision-making, practicing good stewardship of resources, and incorporating new and innovative approaches to remain at the forefront of healthcare delivery.
4. Effective and timely communication with outpatients, staff, union partners, volunteers, academic affiliates, and the corporate body.

Leadership Structure and Forms of Power

The leadership at the MD Anderson Cancer Center follows a governmental agency design, with the top position being that of the Medical Center Director — a role carrying responsibilities equivalent to those of a CEO. The Medical Center Director oversees one of the most complex VA medical facilities in the United States, with more than 2,750 employees and an annual budget of $410 million. This scope of authority establishes the Medical Center Director's power base as legitimate. The Associate Director serves as the operational head for the MD Anderson Cancer Center unit, managing day-to-day operations and the annual facility budget — likewise a legitimate power base. The Chief Nursing Officer (CNO) serves as a key member of top management, providing leadership and expert knowledge for the VA medical facility in Houston, Texas, as well as four community-based outpatient clinics in southeast Texas. The CNO's power base is therefore considered a combination of expert, legitimate, and reward power.

The Michael E. DeBakey Veterans Affairs Medical Center (MEDVAMC) serves as the primary healthcare provider for approximately 200,000 veterans in southeast Texas. When patients from satellite clinics in Beaumont, Lufkin, Galveston, Clear Lake, and Texas City are included, the total reaches approximately 750,000 outpatients in fiscal year 2005. A total of 11,854 veterans were admitted as inpatients in fiscal year 2005, with 237 admitted to the Transitional Care Center. MEDVAMC uses a vertical organizational structure aligned with congressional mandates governing all VA facilities.

In the work entitled "Power and Politics," it is held that power, authority, and influence lack standard definitions. Hampton, Summer, and Webber have noted that "influence is the process by which one person follows another's advice or suggestion," while power is described as "a personal or positional attribute that enables one to influence." Six suggested forms of power are:

1. Coercive power — based on fear of punishment.
2. Reward power — based on hope for reward.
3. Legitimate power — based on the belief that the authority figure has formal authority.
4. Referent power — based on charismatic leader traits.
5. Expert power — based on the leader's special expertise.
6. Representative power — based on the democratic delegation of power to a leader.

In order to vest power with nursing staff within the organization, provision of educational and training opportunities is essential, along with associated expenses such as travel, periodical subscriptions, and costs for initiatives such as weekend retreat classes for education and training. If nursing is to be advanced at the MEDVAMC and within the broader nursing community, empowering nursing staff by funding their professional development is crucial.

The "First Progress Report on the Implementation of the Individual Budget Pilot Programme" (2006) states that the central task is to develop and model new approaches to organizing and delivering services and supports. Key success indicators include: (1) a significant extension of the degree of choice and control experienced by people using services, with associated outcome improvements; (2) alignment and integration of different resource streams; and (3) achievement of improvements within the resource envelope.

In respect of key elements, local models for individual budgets should: allocate resources transparently; streamline the assessment process across agencies; bring together a variety of streams of support or funding from more than one agency; give individuals the ability to use the budget in the way that best suits their own particular requirements; and allow support from a broker, advocate, family, or friends as the individual wishes (First Progress Report on the Implementation of the Individual Budget Pilot Programme, 2006).

Fixed budgets can become "traps" that limit financial flexibility and creative thinking (Managing the Investigative Site, 2006). A relevant model is the Balm of Gilead Center at Cooper Green Hospital in Jefferson County, Alabama — a comprehensive program for end-of-life care supported in large part through the Robert Wood Johnson Foundation's Initiative for Excellence in End-of-Life Care. The organization partners with the Jefferson County Department of Health and the Care Team Network at the University of Alabama at Birmingham, and has established partnerships with local foundations, colleges, universities, religious institutions, civic groups, and professional organizations to help meet the costs of patient and family services, staff education, and community outreach (Bailey, 2000). The vision of this center is described as holistic, emphasizing "comfort and pain-free living" through care that "incorporates medical, emotional and social services as well as spiritual care." Care is provided to "underserved people with terminal illnesses who do not have a place to live or do not have support services at home, regardless of their ability to pay" (Bailey, 2000). Funding resources include Medicare, Medicaid, non-insured sources, VA funding, and third-party funding.