How Magnet Hospitals are destroying Nursing

[trinitymaster]

1. 80 to 20 ratio of BSN to ADN

a. Approximately 40% of RN's are BSN, therefore, not enough domestic BSN's available.

b. BSN's are being imported from foreign nursing mills.

c. Foreign nurses will work for far less than domestic nurses.

2. Domestic BSN hires are mostly fresh grads with zero experience.

a. New BSN's are willing to work for far less than experienced BSN's/ADN's.

b. New BSN's aren't sensitive to staffing ratios.

c. New BSN's accept more acute/critical patients than they can safely provide care for.

And the list could go on. I'm sure you guys can add more items

[ThePrincessBride, MSN, RN, NP]

Nurses have been wanting to get more respect as a profession. Most of the other professions that I can think of require a bachelor's or master's. Think Physical Therapy, Occupational Therapy, Engineering, Accounting, Social Work, Teaching. I would argue that Nursing is much more vigorous than all of these fields in terms of stress and the high standards.

And I agree that "nursing shortage" is a just a buzz phrase, but magnet status hospitals are serious. They are all over my area, and the competition to work for one is hot.

I agree that BSN should be the entry level degree for Nursing. I am an ADN and will be going back for my BSN. However, ADN's pass the same NCLEX as BSN's and are equals as far as being a floor nurse.

Experience and certifications should have more weight than degrees. "Magnet Status" and "Nursing Shortage" are nothing more than buzz words to lower the pay and benefits of RN's by saturating the market.

[NRSKarenRN, BSN, RN]

Thomas Jefferson University Magnet video

See their Magnet Journey

• An Environment of Nursing Excellence
  

• The MAGNET Recognition Program® acknowledges that when nurses are empowered, patient outcomes improve. Why? Because nurses at MAGNET hospitals place an emphasis on evidence-based practice, research, and innovations in care. The program also provides a vehicle for disseminating successful nursing strategies and practices throughout an organization.

• A Model that Supports Discovery and Innovation
  

  In late 2008, ANCC announced major changes to the organization of the MAGNET Model. These revisions represent the first major changes to the model since the program’s inception which was organized under 14 forces.
  
  The new standards organize the prior 14 Forces under five Model Components: Transformational Leadership; Structural Empowerment; Exemplary Professional Practice; New Knowledge, Innovations, & Improvement, and Empirical Outcomes.
  The new components focus much more on patient outcomes, reflecting the reality of how nursing practice impacts and influences care and safety. Empirical outcomes are required to be demonstrated in each of the other four categories.
  
  

• MAGNET® Status Contributes to High Quality Care

  Quality of Care
  According to the ANCC, the MAGNET® program provides consumers with the “ultimate benchmark” to measure the quality of care they can expect to receive. When U.S. News & World Report publishes its annual listing of “America’s Best Hospitals,” designation as a MAGNET® facility contributes to the total score for quality of inpatient care.
  
  Elevated Standards and Reputation
  MAGNET® designation elevates both the reputation and standards of Jefferson nurses, Thomas Jefferson University Hospitals, and the entire nursing profession.
  Higher Recruitment and Retention Rates
  Independent research shows that MAGNET®-recognized facilities consistently outperform their peers in recruiting and retaining nurses (JONA, January 1999).
  Catalyst for Change
  The MAGNET® accreditation process identifies systems that need improvement and enhances system-wide practices overall.
  Strengthens Collegial Interdisciplinary Relationships
  A basic premise of the MAGNET® recognition is a climate that reinforces collaborative working relationships.
  Creates a “MAGNET Culture” throughout the Institution
  The “MAGNET Culture” supports core values such as empowerment, pride, mentoring, respect, integrity, and teamwork. In this way, this nurse-initiated process helps to elevate standards across disciplines and among every member of the healthcare team.
  Attracts High-Quality Physicians and Specialists
  Research shows that high-quality nurses are one of the most important factors in attracting high-quality physicians. Achieving MAGNET® instills a positive “halo” effect beyond nursing excellence that permeates the hospital.
  Improves Patient Outcomes
  The MAGNET® Recognition Program establishes standards of excellence, which healthcare organizations must attain.

Many nurses and facilities in my area "are feeling the Force"

Abington Memorial Hospital

Children's Hospital of Philadelphia

Fox Chase Cancer Center -3x Magnet recipient

Lancaster General Hospital

Lehigh Valley Hospital and Health Network 2x Magnet Recepient

Main Line Hospitals - Bryn Mawr, Lankenau and Paoli Hospitals

Hospital of University of Pennsylvania

They have all been considered the premier places to work in my 35yr career.

[dzadzey, MSN, RN]

Just from my own experience, I have yet to see any tangible benefit to nurses derived from our Magnet certification. Shared governance is viewed as little more tha sop thrown to employees by the administraiton to secure Magnet status while administration continues peremptorily hand down decrees on staffing ratios, sick-days, floats, pay, and benefits with no input from staff. Critical care beds get filled with "overflow" from telemetry and gen med...we are forced to flex up, sometimes with disastrous consequences. But hey...gotta pay the CEO's 7 figure salary...and we're a non-profit. Until ANCC, The Joint Commission and other regulatory bodies who claim to be advancing the profession of nursimg, actually do so nothing's going ot change.

[Gafortin]

Magnet hospitals are based on data that on the surface seems to validate the patient mortality rate is improved when a hospital increase the ration of BSNto at least 80 percent of the nursing workforce (Aiken, L et. al.). The effects of this data is less convincing when you look at the market this is applied too, as (Aiken, L, et. al) further writes“While the positive effect of increasing percentages of BSN nurses is consistent across all hospitals, lowering the patient-to-nurse ratios markedly improves patient outcomes in hospitals with good work environments, slightly improves them in hospitals with average environments, and has no effect in hospitals with poor environments.”

What this tells us basically, is experiences may vary, and that the theory of Magnet hospitals could easily produce the same results by improving the patient to RN ratio and improving working conditions.

The seperation from what we see is BSNs typically move into superviosry roles as they gain experience and the Assoiciate RNs remain on the floor. (where I am ) (40 credits until my BSN). Some of us do not care to be in supervisory roles and prefer to remain on the floor with patients. If we all suddenly have to hold BSNs then the delineating factor is anyone who wants to hold a supervisory role will require a Masters! Seriously!

It is this old chesnut again, since the 1965 they have been pushing for this BSN minimum requirement, all for the Professional Status!

Nurse accreditation authorizes need to realize that even as an associate degreed RN we are professionals. Nurses have specialized educationand training validated by "professional licensure" in each state. We have a code of ethics and established practice standards we are bound to adhereto, a violation of which can result in our license being revoked or sanctioned.We have our own body of ongoing research that shapes and governs our practice. Nurses work autonomously within our scope of practice. We formulate and carry out our own plan of care for clients (when applicable); we apply judgment, use critical thinking skills, and make nursing diagnoses ergo we are professionals.Seemingly the motivations of accreditation authorities are to elevate nurses as a whole to the level of physicians. There are so many reasons that this is a bad idea, let me recap a few, student cost, faculty shortage, and cost to the consumer. I will ask another rhetorical question, if all RNs hold BSNs do you believe that they would then require more pay? Yes!

Who is going to pay forthese higher wages? The consumer, this can mean higher insurance rates for everyone to cover this bill. The adverous never ends~

Aiken, L., & cimiotti, J. (2011). effects of nurse staffing and nurse education on patient deaths inhospitals with different nurse work environments. . (2 ed., Vol. 43, pp.1047-1053). Nation Institute or Nursing. Retrieved fromhttp://europepmc.org/articles/PMC3217062/reload=0;jsessionid=t7t9AQPQ8EwpbbMMWOij.6

original study done in 2003

[trinitymaster]

The Hospitals in my area that aspired to Magnet Status were not successful. Now the push is toward "Team Nursing". Basically, RNs are replaced by LPNS so that you have an RN, LPN, and CNA for a certain number of patients. The RNs do all assessments and wound care, LPNs pass the meds, and CNAs assist with the menial tasks.

RN jobs have been lost and replaced by LPNs, many of whom are new graduates from non-competitive programs. The ADN to BSN ratio could not be realized, therefore the hospitals switched their focus to saving as much money as possible. The evil of "Magnet" has been replaced by the evil of "Team-Nursing".

[Esme12, ASN, BSN, RN]

and the cycle begins again.

[toomuchbaloney]

It is a bit like an episode of the Twilight Zone, isn't it?

[Cathy4836]

LOL!

Well hear we go again!

Back to team work!

[BeentheredonethatRN]

" Movements become business -that turn into rackets " and that is what I see with Magnet. Yes, I'm in a wealthy Magnet hospital and things are good , but they were good anyway with so much cash on hand . However, in the end , the CEO's bonus is through the roof and laying off the seasoned nurses. Plus, lower orientation for new hires/new grads that has resulted in many bad situations. Also, the more that I have read up on Magnet -the more I realize -if you pay for Magnet -it's in the bag. Go figure I'm a Magnet Champion .

[APRN., DNP, RN, APRN, NP]

I don't think Magnet hospitals are destroying nursing.

I enjoy working at my Magnet hospital; nothing is perfect, however, there is much more going on that is right, than wrong.

Only 6.7% of hospitals worldwide are Magnet-worthy. I'm certainly no expert, but I think our hospital might be one of the more successful Magnet hospitals. I don't know how that equates in comparison to other hospitals across the country, though. It may very well be the ‘culture' of the hospital. In my hospital, there is more of a willingness of management and HR to work through issues, and people get second chances, versus getting fired for no reason, or for actually being a patient advocate and bucking the system. That's huge stuff to a plain old critical care unit floor nurse like myself. I normally don't overhear management say things that would make my stomach turn. There is a shared governance structure, and issues are taken to the shared governance to be dealt with, versus in an office somewhere with management telling you what is going to be done to fix it.

I think that there may be some Magnet hospitals with a shared governance structure that is in name only, which makes it look good on the outside, but on the inside, a very crippled system spurts out stupid decisions without any input from the staff it affects. To a Magnet surveyor, you'd have to let a lot of water out of the bathtub in order to see all the scum that has developed.

It took me a couple of years to get over the crappy attitude I developed from the abuse at all the other hospitals I worked for prior to the one I work for now; I have worked for more than my fair share of them over my career. I approach issues with a whole different attitude now.

My facility put their money where their mouth was when they announced the goal of all BSN staff (with a few grandfathered exceptions) by 2020. As a previous ADN RN, I was upset at first, but I will be done with my Masters in a few short months, and my facility is footing the bill (for myself and a whole bunch of other nurses as well).

This Magnet hospital is building up nursing.