Nursing staff is an important part of healthy talents, and specialist nurses are the inevitable trend of nursing professional development. However, the current situation of training and management in China is not optimistic. Most professional nurses are certified for life, lacking the supervision and promotion of re-certification, which is not conducive to the updating and dynamic management of talent knowledge. There is a big gap between the overall education level and developed countries, which restricts the mutual exchange and learning with international counterparts. Most hospitals have no long-term plan for the training and use of specialist nurses, which leads to a high turnover rate of specialist nurses, further affecting the stability of specialist nurses and the development of specialties. It is necessary to explore the training and management mode of specialized nurses suitable for the national conditions. By consulting the literature, this paper understands the development and successful experience of foreign magnetic therapy concepts, and comprehensively considers the problems existing in the training and management of specialist nurses in China. It is hoped that we can learn from transformational leadership, structural authorization, new knowledge, innovation and improvement of magnetic model, and combine the experience and achievements of foreign hospitals to guide nursing managers to better train and manage specialist nurses in combination with China's national conditions.

Keywords magnetic concept; Specialist nurse; Cultivation; operate

Nursing staff is an important part of healthy talents. In recent years, with the development of society and the expansion of nursing practice, the connotation of nursing is also expanding. Following the "Outline of Nursing Development Planning in China (2005-2010)" [1], nursing was upgraded to a first-class discipline, which provided a basis for nursing. The state's support for the development of nursing can also be reflected in the following data: by the end of 20 15, the number of registered nurses per 1,000 population had increased from 2010.52 to 2.36, the academic structure of the nursing team had been continuously improved, and the proportion of nurses with college education or above had increased from 510 to 0.3%.

In the face of the remarkable achievements made in the development of nursing during the Twelfth Five-Year Plan period, we should realize that the gap between the achievements made at this stage and the people's health needs still exists, and there are still many shortcomings compared with developed countries. For example, most developed countries have at least 5 registered nurses per thousand people [3]. The development of nursing not only needs the increase of the number of nurses, but also depends on the improvement of the quality. The professional training of nursing talents is the inevitable trend of the development of nursing specialty [4].

1 Current situation of training and management of specialized nurses in China

In China, the definition of specialist nurse is a registered nurse who has certain working experience in the specialist field, systematically studies theoretical knowledge in this field, conducts practical training, obtains corresponding qualification certificates, and can skillfully use specialist nursing knowledge and technology to provide professional services for patients [5].

1. 1 Training: After more than 10 years of practice, the professional field of specialist nurse training in China has gradually expanded, from the initial emergency and intensive care to wound stoma, blood purification, diabetes, cardiovascular and other majors, and the number of nurses trained has also increased year by year. However, the form of certification is mostly lifelong, lacking the supervision and promotion of re-certification, which is not conducive to talent knowledge update and dynamic management [6]. At present, most of the nursing staff in China have junior college education, and only 65,438+04.6% have bachelor's degree or above, and the overall education level is low [7], which is quite different from that of more than 60% in the United States who have obtained four-year bachelor's degree or above [8]. Education level restricts the ability to learn and communicate with international counterparts, and affects the improvement of specialized nursing level and the development of clinical nursing specialization.

1.2 in terms of management, there is no uniform standard for the admission qualification, post setting and qualification identification of specialist nurses in China [9], and the phenomenon of "emphasizing training but neglecting use" is prominent. Most hospitals have no overall planning for the training and use of specialist nurses, and the number of training and post setting have not paid attention to long-term design. Joe et al [10- 1 1] investigated the clinical use and management of specialized nurses in Anhui province, and the turnover rate of specialized nurses was as high as 18%. Lin Yan et al [12] found that only 4 1% of the 36 specialized nurses were engaged in specialized clinical practice. The research of Tang Hongmei [3] shows that more than 50% of the nursing staff under the age of 30 in all hospitals have relatively low qualifications. The high turnover rate and low seniority make the role of specialist nurses in advanced clinical practice not fully exerted, which further affects the stability of specialist nurses and the development of specialists.

2 the development status of the concept of magnetism

A large number of nurses left the United States in the 1980s. At that time, smart and capable young women had many choices besides nursing, which led to a shortage of nurses, and the number of nursing vacancies reached 654.38+ 10,000 [654.38+03], that is, 80% of medical institutions had a large turnover, which affected their daily work and the quality of nursing declined. However, there are still a small number of hospital nurses with low mobility, so it is easy to recruit and retain nurses to ensure the quality of patient care. The American Nursing Association (AAN) organized a special group to investigate 163 hospital [14], summed up its characteristics, put forward the concept of "magnetism", and finally defined 4 1 hospital as a magnetic hospital. Then the American Nurse Accreditation Center (ANCC) established the magnetic nursing service accreditation program (MNSRP)[ 15]. The certified hospital of this project is a magnetic hospital, and the certification period is 4 years, and the quality monitoring report needs to be submitted every year. After 4 years, the standards and procedures of the initial application are still repeated, thus ensuring the quality of the certification project.

To apply for magnetic hospital certification, * * * has 14 elements to be evaluated [16], namely, the quality of nursing leaders, organizational structure, management methods, personnel management policies and projects, professional nursing methods, nursing quality, continuous quality improvement, consultation and information resources, autonomy, the role of nursing organizations, health educators, nursing image and the relationship between disciplines. In 20 13, the latest application manual of magnetic hospitals published by ANCC pointed out that magnetic hospitals must have five core elements of magnetic model, namely, transformational leadership, (organizational) structural authorization, exemplary professional practice, new knowledge, innovation and improvement, and empirical results [17]. By the end of 20 16, 448 hospitals [18] had obtained magnetic certification. After more than 30 years of development and accumulation, Hayden et al. [19] have begun to study how nursing managers can maintain the efficient operation of the team when applying for magnetic certificate, which proves that transformational leadership is the main factor.

The characteristic of magnetic hospital is to attach importance to nurses' clinical decision-making power, and its unique organizational management mode has improved nurses' job satisfaction. The high nurse-patient ratio in the hospital also reduces the physical and mental fatigue of nurses [20] and improves their job satisfaction and morale. Magnetic hospital has rich channels to obtain information resources, and attaches importance to the teaching activities of nurses and the development of nursing specialty, so that nurses are more competent for the development of specific fields of nursing specialty, more willing to participate in continuing education and more involved in community nursing projects. Shirey[2 1] and Tschannen[22] agree that a good working environment and working atmosphere in magnetic hospitals are the key factors to solve the high turnover rate of nurses. Because the magnetic hospital has created a good working environment for nurses [23]. On the one hand, the harmonious doctor-patient relationship improves the quality of nurses' care for patients [24-25]; High-quality nursing service greatly improves patients' satisfaction, which is in line with the original intention of developing high-quality nursing service in China. On the other hand, the magnetic hospital has strengthened the safety measures for nurses, greatly reducing the incidence of adverse events (such as needle injuries) [26], which is consistent with the management direction of patients' top ten safety goals [27]. The research of Farag et al. [28] also shows that the leadership style and working atmosphere of magnetic hospital have a positive effect on the safety of drug use practice. The virtuous circle of management promotes magnetic nursing and improves the stability of nurses [29]. Moss et al. [30] tried to change the organizational culture and attract and retain excellent nursing staff with the framework of magnetic certification system. Therefore, the magnetic certification system is considered to be the most suitable certification system for providing professional services for registered nurses in various countries or internationally, promoting the development of quality and practical ability, and promoting patients to obtain positive results [26]. The development of specialized nursing in the United States has a history of nearly a hundred years, and great progress has been made since the concept of magnetism was put forward.

3 Enlightenment of the concept of magnetism

It is important to learn the complete classification, training, qualification certification, management system and management experience of specialist nursing in Britain and America, but it also needs to be combined with China's basic national conditions. Only by getting out of the predicament of relatively small total number of nursing staff, generally low seniority and high turnover rate in China can we really strengthen the echelon construction of nursing professionals and promote the development of specialized nursing. This can be inspired by the concept of "magnetism".

3. 1 Managers should change the management mode, attach importance to nurses' clinical decision-making power, establish various communication channels, create an atmosphere of participatory management, and enhance nurses' sense of belonging and satisfaction. According to the multi-dimensional satisfaction and nursing quality of specialized nurses, nursing managers and patients, the management policy was adjusted in time.

3.2 Improve the evaluation system, standardize the qualification and post setting of specialist nurses, and re-certify their qualifications on a regular basis. With the improvement of nursing team's academic qualifications and the requirements of professional practice, appropriately raising the entry threshold of specialist nurses is conducive to maintaining the continuous competitiveness of specialist nurses, as well as to the supervision of professional behavior and the renewal of knowledge system.

3.3 Provide specific career planning for nursing staff, provide nursing career paths covering clinic, education, management and scientific research, and define the conditions, roles, responsibilities and categories of each direction. Encourage nursing staff to upgrade their academic qualifications and give certain policy support and guidance.

3.4 Improve the working environment of specialist nurses, such as conducting specialist nursing consultation, setting up specialist clinic, promoting cooperation with doctors, giving full play to the autonomy of nursing staff, reducing the proportion of job transfer and/or loss of specialist nurses, and enhancing the role of specialist nurses in improving the technical level of nursing.

3.5 Increase access to information and resources, and encourage specialist nurses to communicate regularly in the industry to keep abreast of new knowledge and trends. Learn from the training ideas of graduate students, cultivate the habit of literature review of specialist nurses, and enhance the ability of data acquisition.

By learning the experience of applying the concept of magnetism abroad, we should pay attention to the improvement of the practice environment of nursing specialty, give full play to the leading role of specialist nurses in the field of specialist nursing, promote the development of specialist nursing, and provide direction for exploring a reasonable way of training, using and managing specialist nurses with China characteristics.

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Correspondent: Li Rui and 1764598525@qq.com.

China Library Classification Number R 192.6

Document identification code a

DOI: 10. 1 185 1/j . ISSN . 1673- 1557.20 17.03 . 03 1

Priority digital publishing address: ki.net/kcms/detail/51.1688.r.20170412.1642.002.html.

(Date of receipt: 20 17-03-22)