FigureAs the COVID-19 pandemic unfolded, hospitals had to quickly change operations overnight, transforming clinical and administrative operations to care for patients with COVID-19.1 As the pandemic evolved, many hospitals began to reach the site visit phase of the Magnet Recognition Program®.2 Site visits are a time for appraisers to clarify, verify, and amplify the written document that a hospital has submitted, as well as confirm adherence to and enculturation of the Magnet Model Components.2 In the summer of 2020, following recommendations from the World Health Organization and the CDC, and federal and state travel guidelines, the Magnet Recognition Program made the decision to conduct all site visits virtually until further notice.2 Since 2014, site visits have been approved virtually for hospitals seeking Magnet designation that are experiencing extreme extenuating circumstances, but before 2020 the only hospitals to require a virtual site visit were international organizations.2 A rural 341-bed hospital received notice in June 2021 regarding their Magnet site visit. As a first-time hospital, they needed to work through the challenges of coordinating a 3-day survey and overcome the technology barriers for a successful site visit in 2 months. Complicating matters, they needed to accomplish this during a pandemic when dealing with a surging patient census and staffing shortages. Though challenging, the excitement of becoming a Magnet facility kept spirits up and provided an opportunity for positivity in trying times. Preparation Because the hospital had only 2 months to get ready for the site visit, preparations started immediately. There were many essential components needed, including: adequate technology, Magnet champions, enculturation, education and planning, and human resources. Technology A multidisciplinary team was formed to execute a successful site visit. The team used a work breakdown structure to manage tasks, which identified technology as a top category. Logistics of virtual site visits require organizations to have a platform that can support multiple virtual sessions simultaneously to accommodate the agenda of site visits.2 Advanced planning is essential to ensure that organizations have platforms that allow screen-sharing and Wi-Fi access in all areas where meetings will occur.2 The hospital had used virtual meetings platforms but not on this scale. The team decided early in the planning process to use Microsoft Teams software. The team performed a gap analysis to identify the equipment, what needed to be purchased, and who had the skills to use it. To ensure proper information technology (IT) planning, a member of the IT team partnered with the Magnet team. The IT team helped to ensure the hospital had adequate technology to complete the visit; iPads and stands were purchased, whereas cameras, laptops, and TVs were acquired from within the organization. Curto and Martin emphasized the importance of having various mobile devices such as laptops, smart phones, and tablets that may be used by placing them on portable carts or wheels.2 The appraisers requested to be given a tour of the units via iPads, so the hospital had to acquire stands to hold the iPads. Securing a centrally located space that was large enough to hold attendees and where they could simultaneously host meetings was crucial. Sherrod and Holland stressed the need to choose a meeting space with a quiet room and carpeting to decrease hollow echoing sounds as well as raising the camera to eye level.3 The team used the hospital conference center, which was carpeted and away from the hospital's daily operations. Each appraiser would have a conference room, with the command center located across the hall. Winslow and colleagues highlighted that command centers help coordinate activities, including the escort process, setting up meeting rooms, and handling information requests.4 Command centers provide a consistent place to collect the appraisers' questions and requests for additional information and resources.4 In preparation for the virtual site visit, the team established a command center, giving them a place to coordinate requests from appraisers for additional information, especially during morning and evening briefings with the CNO and Magnet Program Director (MPD). The command center was functional and spirited, with pom poms for staff to cheer each other on and even a cutout of the CNO. Staff invited to an interview during the visit reported to the command center for attendance and were then directed to the appropriate room where they had to sign in before entering. The sign-in sheets were collected daily and scanned to the Magnet office at the end of the visit. Each room had the same technology—a camera, laptop, and TV—and the Magnet champions oversaw operation of the equipment. IT staff was present in the command center for the entire visit to troubleshoot any issues that arose and was responsible for moving the appraisers to the breakout rooms in Microsoft Teams. This allowed for the appraisers to join only one link the entire day, effortlessly moving from one breakout room to the next. Magnet champions Buy-in from dedicated and motivated frontline staff is an essential component of an organization's culture.5 These individuals, known as Magnet champions, can help engage other staff members.5 The hospital selected six Magnet champions from different specialties based on their involvement and engagement in councils. This necessitated coordination with leaders of their units because champions were required to spend their entire week preparing and guiding the appraisers around during the 3-day site visit. Advanced planning with IT ensured the champions were well informed prior to the visit. Troubleshooting of the technology through dry runs was a critical component of the preparation process.2 A dry run ensures that no issues arise due to loss of connectivity or reduced visual or sound clarity.2 The Magnet champions attended practice sessions with leadership to refine moving the iPads steadily, troubleshooting connectivity, and avoiding “dead zone” areas to ensure a successful walkthrough tour of the units, from inpatient to ED to perioperative areas of the hospital. Technology was tested in the conference rooms many times prior to the visit to ensure that staff members could be seen and heard on camera, while allowing for safe social distancing during the sessions. After the dry runs, the Magnet team decided to assign a name to each conference room and iPad so the appraiser could be easily relocated to the correct breakout room. Phan and Radovic emphasized the significant role that Magnet champions can play during site visits, including timekeeping, room setup, and virtually escorting appraisers.6 The Magnet champions were put into pairs and would guide one appraiser for the 3 days. Assigned escorts throughout a visit help provide familiarity and consistency.4 This allowed the champions to form virtual relationships with their appraiser. The champions had individualized schedules for each day and had a direct line to the command center and IT in case they encountered any issues with connectivity. Enculturation The purpose of a site visit is to ensure enculturation within an organization of the Magnet pillars representing excellence in practice. An engaged staff is the hallmark of any organization on the Magnet journey. The nursing leadership team always felt as though commitment and dedication of employees to excellence was well established from the birth of the organization in the late 1970's. The first chief operating officer was a nurse, and her mission was to create a respectful environment, with high quality care where patients are cared for like family. Ensuring this enculturation could be felt during a virtual survey was a high priority. Many years prior to site visit, the Magnet model and the shared leadership structure was in place and functioning maturely. Operational excellence was well engrained in the organization's culture at every level, supporting transparency of communication and problem-solving opportunities. The staff members' eagerness for the appraisers' visit showed how deeply the Magnet model components were rooted within the culture of the hospital. In the shared leadership meetings, the staff requested a tool kit to help reduce anxiety. Staff members, in collaboration with leadership, developed the tool kit's key components, including information about how staff could access Magnet stories located on the organization's intranet site, packets with key stories from their unit to ensure that staff could identify and reference the stories, daily huddle tools about what to expect, and sample questions of what could be asked during the visit. The hallmark event leading up to the site visit was producing a video welcoming the appraisers that included the entire hospital and community first responders. The hospital wanted to capture the culture because the appraisers wouldn't be on site. Units and all teams were encouraged to create colorful welcome signs representing their departments. Marketing and communications personnel filmed the video outside of the hospital entrance. Fire trucks, police cars, and ambulances served as the backdrop to the employees and first responders who represented the organization's family-like atmosphere. This video was shared at the start of day one when the CNO and MPD first met the appraisers. It served as an uplifting moment and a reminder of the pride the staff and the community feel to be part of the organization. Education and planning AHN nurses throughout the organization developed the Professional Practice Model (PPM), which included a demonstrated education plan. Because this was our first survey, nurse leaders and staff were anxious about what to expect. The CNO reached out to another organization who had a virtual site visit survey. The CNO and MPD of that facility provided valuable insight into how to navigate the process and prepare the staff. Frontline staff requested education on the Magnet model components and the hospital's PPM. Leadership and frontline staff shared examples of how the PPM is incorporated into their daily practice at staff huddles. The Magnet team and executive leadership in all areas visited many of the daily huddles on each unit, and attended hospital, unit council, and staff meetings to talk about the visit in advance. The Magnet team held educational and information sessions on Magnet for the executive board, Patient Safety Committee, local nursing universities, human resources, the Patient and Family Advisory Committee, and more. Human resources The multidisciplinary team knew that one component of the site visit was the review of personnel files, which included professional development plans (PDP), performance reviews, peer feedback, and education verification of selected nurses. Appraisers randomly select employee names at all levels of the organization, including leaders, advanced practice nurses, educators, and clinical nurses.4 Every June the hospital completes new PDPs and peer reviews of staff members. This ensured the Magnet team had access to the most current information during the site visit. The team coordinated with all leaders to ensure they had copies of all PDPs and peer feedback for every staff member, as this information hadn't been kept electronically at the hospital. These files were kept as hard copies in employees' personnel files. The team developed and labeled binders for all nursing units that contained PDPs and peer feedback in alphabetical order. This allowed for easy access during the site visit for those nurses randomly chosen for review. The team needed to coordinate closely with the human resources department during the visit to collect performance review information. In 2020, due to the pandemic, staff members who were considered on track didn't have to go through the normal review process with manager comments and self-evaluation. As such, human resources provided performance reviews for selected staff for 2019 and 2020. At the beginning of the visit, the employees' names were given to the Magnet team. Human resources collected the performance reviews while another member gathered PDPs and peer feedback. A spreadsheet was used to track the collection of information for selected staff members. It was broken out by clinical nurses, leadership, certified registered nurse anesthetists, and certified registered NPs. In advance, the Magnet team had collected all educational degrees, performance reviews, peer feedback, and PDPs at the manager and director level. Each employee's file, with all corresponding documents, was scanned individually and named. The other employees' 2019 and 2020 reviews were examined to decide which would be best to use in the review process. After selection, each of those files were individually uploaded in the same manner. This allowed information to be easily shared with Magnet appraisers during the human resources' review session. Challenges A few challenges arose throughout the planning process for the virtual site visit. The appraisers requested a SharePoint site so that documents could be shared during the site visit. Compliance, IT, and the Magnet team collaborated to develop a new process for the health system, which allowed employees to share privileged documents securely with external users. Some documents included data vendor reports, meeting minutes, council charters, patient and staff complaints, clinical ladder criteria, BSN and certification rates, and disciplinary information. Disciplinary information requested included verbal and written warnings, and the policies surrounding these. As the site visit progressed, the SharePoint was used to share other documents that the appraisers requested. This allowed the appraisers to review documents on their own time. Another challenge was ensuring there was adequate coverage on the unit when staff members had to leave for planned meetings, breakfasts, lunches, and dinners. Schedules at the hospital are made 6 weeks in advance, so managers attempted to upstaff during the site visit. The managers didn't know which members of their team would be pulled until 1 to 2 weeks prior to the site visit. During the visit, unit educators were deployed each day to help with coverage when staff members were attending sessions. Implications for leaders Preparation and communication are essential for a successful Magnet site visit. True enculturation starts with the onboarding process in nurse orientation and nurse residency. Through shared governance, all the meetings are held under the structure of the Magnet pillars. Planning of logistics and securing technology early are vital. Dry runs helped ensure all staff members knew what to do when the appraisers arrived virtually and that all technology was working appropriately. Transparent communication with unit leaders was crucial to ensure leadership had adequate staff scheduled to participate during the site visit. This was key as the visit happened during a volume surge and vacation season. At the end of each day, the command center staff, champions, and unit leaders could debrief about strengths, weaknesses, and planning for the next day, identifying any opportunities for improvement. For example, the team identified an opportunity to change the current schedule for the appraisers to allow for a more seamless transition between meetings, and they subsequently adjusted the schedule. In addition, the Magnet team realized that no one had time to eat throughout the site visit. For the next two days, meals were planned accordingly for everyone assisting behind the scenes with the visit. Having a multidisciplinary team with aligned goals and assigned jobs allowed for purposeful execution of tasks. Staff could focus on their area of responsibility during the virtual site visit. This allowed a more streamlined approach, giving people the freedom to make decisions around their responsibility while achieving the overarching goal. A daunting task Reaching the site visit phase of the Magnet process can be an exciting time for hospitals. Ensuring that the appraisers perceive the enculturation of Magnet virtually can be a daunting task. The effects of implementing the framework for a virtual site visit proved instrumental. Since the survey, the infrastructure has been replicated in a Joint Commission visit, a nursing retreat, group therapy, and other large meetings. In October 2021, the hospital received public notice that they successfully achieved Magnet designation. During the announcement, the hospital deployed the same technology throughout the nursing units to involve as many staff members as possible. Moving forward, the hospital can build off this experience to incorporate technology to enhance everyday practice.