Magnet Process Found Valuable for Hospitals

Many studies have demonstrated an association between Magnet designation for hospitals and better outcomes for patients and nurses. A 2015 study from the University of Pennsylvania Center for Health Outcomes and Policy Research has found the rigors of completing the Magnet process have value.

“The takeaway from what we found is Magnet status is not just an award for being a good hospital but an intervention employers can use to positively transform work environments and ultimately improve patient and nurse outcomes,” said lead author Ann Kutney-Lee, PhD, RN, FAAN, assistant professor at the Center for Health Outcomes and Policy Research.

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Approximately 7 percent of U.S. acute care facilities have achieved American Nurses Credentialing Center (ANCC) Magnet status.

“Magnet designation is a performance-driven credential achieved for nursing excellence and quality patient care,” said Denise Occhiuzzo, MS, RN, BC, administrative director of nursing and Magnet program director at Hackensack University Medical Center in New Jersey, which has received the designation five times, starting in 1995.

Earlier research, while showing an outcome benefit to Magnet status, did not clearly show whether that difference was due to excellent hospitals opting to go after Magnet status or if the challenging one-year application and peer-review process led to improved outcomes.

“We were able to examine hospitals and how they change over time,” Kutney-Lee said. “At the first time point, hospitals that eventually became Magnet didn’t look significantly different from non-Magnets, but by 2006, you saw significant changes.”

Kutney-Lee and colleagues, including Linda H. Aiken, PhD, FAAN, FRCN, RN, director of Penn’s Center for Health Outcomes and Policy Research, conducted a retrospective study using four secondary data sources. They compared changes over time in surgical patient and nurse outcomes and nurse-reported quality in 11 Pennsylvania hospitals seeking Magnet status and obtaining it from 1999 through 2006, and 125 non-Magnet facilities. The Robert Wood Johnson Foundation (RWJF) Initiative on the Future of Nursing funded the research.

By 2006, emerging Magnet hospitals had progressed significantly ahead of their non-Magnet counterparts, demonstrating markedly greater improvement. A significant difference existed in 30-day surgical mortality rates, with 2.4 fewer deaths per 1,000 patients in the emerging-Magnet hospitals, and failure to rescue rates, with 6.1 fewer deaths per 1,000 patients in the emerging-Magnet facilities.

“We have found that nurse engagement in the Magnet process directly impacts outcomes,” said Shelley Watters, DNP, RN, NE-BC, Magnet program director at UPMC Shadyside in Pittsburg, Penn., which has maintained the designation of nursing excellence since 2010.

Kutney-Lee attributes much of the improvement in outcomes to hospitals improving the work environment, including more collegial nurse–physician relations, nurse manager leadership and support of nurses, adequate staffing and resources and participation in hospital governance.

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“These aspects of the work environment improve over time, and we think that’s a large driver when the hospital undergoes the Magnet process,” Kutney-Lee explained. “Going through the process lends itself to improvements in the work environment, which we know is linked to better nurse outcomes and better patient outcomes.”

The number of nurses in the emerging-Magnet facilities rating the quality of care as excellent increased by 9 percent more than the non-Magnet hospitals during the study period, as did nursing job satisfaction. Nurses in emerging-Magnet hospitals were less likely to report burnout, job dissatisfaction and an intention to leave the workplace than nurses in non-Magnet facilities.

“The research reported by Kutney-Lee and others provides evidence to the sustained value of Magnet recognition, related to positive patient and nursing quality outcomes,” said Carol Jones, MSN, RN, interim chief nursing officer at Morristown Medical Center (MMC) in Morristown, N.J., which has received Magnet recognition four consecutive times. “Magnet status not only recognizes MMC nurses for providing excellent care, but provides both a culture and structure for maintaining excellence and driving innovation.”

Karen J. Anderson, RN, MSN, MBA, vice president of patient care services and chief nurse executive of Loyola University Medical Center in Chicago, said the shared government model, a key component of Magnet, helps nurses feel empowered. Loyola has held Magnet status since 2009. Additionally, she indicated some of the standards Magnet requires can improve safety and quality.

“It forces us to do the right thing,” Anderson said. “It’s made it better for our patients and our nurses.”

Hospitals that have achieved Magnet status have found the journey valuable.

“The process of applying for Magnet, writing to the sources of evidence and exemplifying the work done by nurses within a Magnet facility, is in itself a rich and dynamic process,” Watters said. “There is a sense of institutional pride that occurs naturally when everyone works toward the same goals.”

Anderson added that the process of going through Magnet designation transforms an organization and that leads to better outcomes. However, before venturing on the Magnet journey, she said a hospital needs support from hospital executives and the medical staff.

“Becoming a Magnet hospital is a significant undertaking,” Aiken said in a written statement. “The message is that it’s an investment that’s well worth it.”

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