Magnet Recognition: Is the Designation worth the Journey?
Submitted by Gina Quinn RN,BSN,CPAN
Jennifer Papapavlou RN, BSN, CCRN
Heather Miller RN, BSN, CPAN
Currently, only eight percent of hospitals nationwide hold the title of Magnet Recognition (AHA, Fast Facts on US Hospitals, 2019) and even less receive consecutive designations. Eight percent is a marginally small number, especially when it comes to credentialing hospitals as havens for quality patient outcomes and centers of nursing excellence. The process of becoming a Magnet designated hospital is complex and grueling; requiring submissions of data, site visits, and taxes hospital resources in doing so. What then is this rare designation, and how does it improve both patient outcomes and nursing quality? Ultimately, does the designation provide benefit to those who obtain it?
During the nursing shortage in the 1980’s, nurse researchers set out to find out why some hospitals had better nurse retention than others. The term “magnet” was appropriately used to describe the characteristics of these hospitals because of their ability to attract nurses and keep them. The research focused on the hospitals that had low vacancy and low nurse turnover rates, and more specifically, why they did. The results were analyzed and used by the ANCC in 1990 to develop a nationwide credentialing program. Fueled by this research, which correlated improved patient outcomes with both higher nurse retention and increased registered nurse education, the Magnet Recognition program was formed. Twenty-five years later, the ANCC’s Magnet Recognition Program has become affiliated with nursing excellence. (Graystone, 2018). According to the ANCC, Magnet designation holds numerous benefits for nursing staff, patient outcomes and even financial success for the hospital. There is also an increasing independent body of research out there about the benefits of Magnet Designation.
Magnet purports that its designation signifies better patient satisfaction and improved patient outcomes. Friese, Xia, Ghaferi, Birkemeyer & Banerjee M. conducted a meta-analysis of Medicare inpatient claims that compared claims for a thirteen-year period during 1998-2010 on Medicare patients, and isolated the outcomes by patients who were treated at magnet hospitals versus non- magnet. They reported that slightly under half of the patients (44.3%) received care at the magnet designated centers, and of those, the 30-day mortality was found to be 6.1%, while non-magnet hospitals had a 12% mortality. In another analysis of patient outcomes from Magnet Recognition awarded hospitals, a “matched sample of 291 Magnet hospitals and 291 non-magnet hospitals...Magnet hospitals were associated with a better (lower than national average) CLABSI rates. (Barnes, Reardon, McHugh 2016). Zhu, Sydney, Wenzel, & Wu (2018) utilized another longitudinal study of Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) data from 2008-2015, focusing on seven specific measures. Their study yielded that “Magnet hospitals and hospitals with more favorable nurse staffing consistently performed better on HCAHPS...during the study period.” The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) is designed to evaluate patient's short-term hospital care experience (Centers For Medicare & Medicaid Services, 2013) and is tied into the hospitals reimbursement based on either achievement or improvement from their baseline score.(Stimpfel, Sloane, McHugh, Aiken, 2016)
According to the ANCC, the Magnet designation holds numerous benefits for nursing staff, from lower patient ratios leading to less burnout and greater nurse retention, to requiring leadership roles be fulfilled by those with nursing degrees at higher levels, with the opportunity for nurses to advance themselves in education. “Nurses understand the value of Magnet Designation and flourish in organizations where standards are high and their worth is appreciated” (Graystone, 2018)
In addition to improved patient and nursing outcomes, Magnet Designation also claims to improve hospital financial success. A study by Kareem, S.A., Pink, G.H., & Reiter, K.L., Holmes G.M., Jones C.B., Woodard E.K. (2018) did a comparison between Magnet Recognition(MR) hospitals and never-MR hospitals. They found that operating profitability, total profitability and return on equity were significantly higher in the MR hospitals. They also noted a significant higher market share in MR hospitals. No doubt some of the factors contributing to this finding would be a lower nurse turnover rate, fewer hospital acquired infections (i.e CLABSI/ CAUTI and other core measures of Magnet) and increased patient satisfaction, all resonating to the community that the MR hospital is the first choice for medical care.
With cross comparison studies and longitudinal studies such as these, the evidence supports that the eight percent of Magnet designated hospitals do live up to their claims. What sets theses eight percent of Magnet designated hospitals apart is clearly defined by the ANCC and heralded by these hospitals as best in practice measures. The Magnet Model consists of five components and are those are comprised of the Fourteen Forces of Magnetism. The ANCC has tabulated that these specific qualities of nursing create an infrastructure in which the foundation of nursing is so stable, patients and nurses can thrive. So, what are the five model components that make a Magnet hospital?
The first component, Transformational Leadership is the ability for leadership to recognize the fast-changing world of healthcare and be prepared to meet the changes and challenges of the future. The leadership of a Magnet Hospital has the vision and plan to create systems to move the organization into the future all the while inspiring its personnel to commit to the organization. Strategic planning for the organization, advocating for resources to support nursing and patient care, and accessibility and communication between nurses and their leaders are some of the key components of Transformational Leadership (Schwartz, D. B., Spencer, T., & Wilson, B., Wood K. 2011)
Structural Empowerment, the second component of the Magnet Model, sets up nursing staff for success by getting them involved with decision-making on all levels, supporting their education, encouraging professional growth, and recognizing them throughout their organization. (Tinkham, M. R. 2013) Shared governance councils, ongoing education, transitional program, and certifications are just some of the ways that structural empowerment contributes to the success of the nurse, and ultimately the patient and the hospital itself.
Magnet Model component number three is Exemplary Professional Practice. Using a Professional Practice Model as a guide, nurses are involved in unit operations, inter-professional collaboration and workplace advocacy to improve outcomes for patients and improved work life for the staff. Annual goals are set based on the nurse sensitive indicators and benchmarked data is used to understand performance and improve care. A Magnet hospital strives for continuous improvement in patient and nurse satisfaction. (Luzinski, 2012a)
New Knowledge, Innovations and Improvements is the fourth component of the magnet model and focuses on nurse involvement to come up with new and creative ways to solve problems. Nurses use research-based evidence to guide them and often partner with other departments to innovate and improve everything from operational processes to bedside nursing improvements. Nurses who participate in research share their findings within the nursing community, for example through presentations at conferences or publications that serve to improve care in all organizations. (Luzinski 2012b)
The synergistic effect of the first four components is Empirical Outcomes, the fifth component of the magnet model. There is a reason why Empirical Outcomes lies in the center of the model. Ultimately, it is the compounded results (the outcomes), of all the other components that drive Magnet. Otherwise what would be the point? Hospitals who apply for Magnet Designation must show sources of evidence that their practice of the four other components of the Magnet Model lead to demonstrable positive outcomes. (Luzinski 2012b)
The application for Magnet Recognition is rigorous and documenting a hospital’s unique representation of the components of the Magnet Model is a huge undertaking. Many may question if it is worth the effort or if Magnet Recognition does all that it claims in ways of supporting both patient outcomes and nursing staff. Imagine a world where Magnet level care was the norm, and not the exception. That vision is more than likely why most nurses entered healthcare. After reviewing the independent research, it appears that any hospital that can prove they are worthy of Magnet Recognition is a hospital where nurses should want to work, take their loved ones for care, and be a proud member of that organization.
American Nurses Association(n.d.). Retrieved from https://www.nursingworld.org
Barnes, H., Reardon, J., & McHugh, M. D. (2016, April). Magnet Hospital Recognition Linked to Lower Central Line Associated Bloodstream Infection Rates. Res Nurse Health, 39(2), 96-104.
Friese, C. R., Xia, R., & Ghaferi, A., Birkemeyer J.D., Banerjee M. (2015, June). Hospitals in "Magnet" program show better patient outcomes on mortality measures compared to non-magnet hospitals. Health affairs 34(6), 986-992.
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Hilton, L Modern Magnet: Five model components shift focus to outcomes
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Zhu, J., Sydney, M., & Wenzel, J., Wu A.W. (2018, February). Association of Magnet Status and Nurse Staffing Improvements in Patient Experience With Hospital Care. Medical Care, 56(2), 111-1119.
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