Abstract
Background and Purpose: Nurses have been called to lead the transformation of health care to provide more efficient, safe, high quality care. However, little is known about how to prepare and enable critical access hospital (CAH) nurse executives to lead change. Research indicates that Magnet®-designated hospitals have significantly better patient and organizational outcomes as compared to non-Magnet hospitals. The purpose of this study was to synthesize challenges faced by CAH nurse executives and provide research-informed recommendations for leading change to achieve Magnet standards in CAHs. Sample and Methods: A review of the literature was conducted to understand the historical development of CAHs and to identify challenges faced by CAH nurse executives. CINAHL, PubMed, and the Rural Health Information Hub databases were searched for relevant peerreviewed studies and expert commentary published in English from 2007 to 2016. Thirty-four articles were synthesized. Findings: CAH nurse executives face significant challenges to ensuring their hospitals are providing high quality care including: (a) recruitment, retention, and appropriate staffing ratios; (b) the need for nursing staff with multispecialist knowledge; (c) fewer baccalaureate-prepared nurses; and (d) lack of financial and human resources to support new graduate nurse transition, continuing education, and evidence-based practice. Recommendations for CAH nurse executives seeking to achieve Magnet standards were developed from interviews with healthcare professionals (N = 27) at the first independent CAH to achieve Magnet designation. Conclusions: CAH nurse executives may consider the Magnet standards as a blueprint for leading change to improve organizational outcomes. Consideration should be given to: (a) securing administrative leadership support; (b) strategically planning for small, incremental change; (c) building shared governance, quality improvement, research, and education; (d) harnessing collective power; and (e) believing and staying committed to the purpose of improving staff and patient outcomes.