Magnet Designation: What's the Attraction?

[ElizabethStoneRN]

Simply put, Magnet designation symbolizes "nurse-driven excellence in patient safety, quality outcomes and patient satisfaction" ¹. So what exactly does this mean? To better understand the meaning of nursing excellence and the value of Magnet designation, it helps to also take a look at some of the groundbreaking research by Linda Aiken ^2-7. Aiken, an internationally recognized nurse scientist, has been involved in numerous studies linking nursing excellence to patient outcomes. The results of her research have led to a greater awareness of how variables such as nurse work environment, nurse education and nurse empowerment to innovate affect a multitude of outcomes including patient satisfaction scores, mortality rates and failure-to-rescue rates. Improvements in these variables also affect hospital reimbursement ⁸. It is no surprise that, given this magnitude of evidence which demonstrates the value of nursing excellence, more and more hospitals are striving to become Magnet designated. Below are what organizations must do to achieve magnet.

(#1-#3 are based upon information obtained the American Nurses Credentialing Center's (ANCC) website's "Journey to Magnet Excellence"¹):

1) The application process involves identifying gaps in organizational performance, developing action plans to address them, and implementing nurse-driven measures to improve them.

What this means to me

Professional recognition and growth. Yes, it is more work for nurses. But to me this means that ANCC, and any hospital which achieves Magnet designation, recognizes nurses' expertise as integral to improving everything from nurse turnover to patient outcomes. Empowerment leads to engagement, and engaged nurses attract more engaged nurses. Enthusiasm is contagious.

A common concern

Who is going to pay us for this extra work? Good question, and in my opinion this is one of the biggest challenges magnet brings. Anyone who has ever been in charge of a quality improvement or nursing research project knows that the work is very time-consuming. Nobody wants to do a lot of extra work "for free". While clinical ladder programs may incentivize and indirectly reimburse for project involvement, this is not enough for everyone. I get it. I have seen creative solutions to this, but they are usually unit-based and not standardized across the organization. All I can say is that if hospitals are going to continue to be Magnet designated, they are going to HAVE to figure out a way to reimburse nurses for these extra professional involvements in a fair way. If any of you work in hospitals which have a system in place by which to regularly reimburse nurses for "extra work" that is not direct patient care, please comment below and share how your hospital does it!

2) A major culture shift for many organizations; they must either have an infrastructure in place to support nurse empowerment and innovation, or develop one pronto.

Programs such as shared governance, nursing research and evidence-based practice councils, and peer review are just some examples.

What this means to me

This culture shift is not a "dog and pony show" that can be developed quickly and then dismissed after an organization obtains magnet designation, unless they want to lose it. Magnet requires that the "infrastructures and culture [that empower nurses] are firmly embedded in the organization"¹. The very stringent magnet application process and subsequent recertification requirement ensure that this infrastructure is permanently in place.

Common criticism

"Any hospital can do these things- it doesn't require magnet status". True, but I for one would rather work in a hospital which is

held accountable

for having this infrastructure in place and maintaining it. My hospital just recently achieved magnet designation, and I have already begun to see the results of this culture shift as more and more of our nurses are applying to present their quality improvement and nursing research projects at nursing conferences or writing them up for publication. Many of them have never considered sharing their work with a larger audience; but now they have the resources and support in place to do so.

3) Leadership support of nurses is key to this culture change.

What this means to me

A LOT. Leadership at all levels (from Chief Nurse Officer to unit nurse managers) have become more in tune with the issues at the bedside: the problems staff nurses face, the ideas staff nurses have on how to address those problems. Leadership is learning how to support and encourage staff nurses to question outdated practices, explore innovative ideas, and make changes. Nurses at my hospital, and all over the world, have always had great ideas and have been innovative in their practice, but now they are receiving more recognition and support for cultivating those ideas.

Common criticism

"This is a marketing ploy for the hospital". Yes, of course it is a huge marketing decision and investment- healthcare is a business. But a magnet structure is well managed by a strong nursing leadership, there can be huge benefits on both sides. "Attracting and retaining top talent, and growing your business and financial success" are two of the benefits of Magnet listed on the ANCC site1. Magnet designation is a major investment and business decision for the hospital. When it does work to help improve nurse retention, the hospital saves considerable money. But most importantly a Magnet certification represents a dedication to and an investment in nursing excellence.

Achieving and maintaining Magnet designation is a lot of work for the hospitals and for the nurses who work there. But in my experience, the personal, professional and work-based benefits are worth the effort. Most importantly, our patients are worth the effort. In my hospital, achieving magnet designation has already helped bring about a very positive culture change.

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References

1. American Nurses Credentialing Center (2015). Journey to Magnet. https://www.nursingworld.org/magnet

2. Aiken, L. H., Shang, J., Xue, Y., & Sloane, D. M. (2013). Hospital use of agency-employed supplemental nurses and patient mortality and failure to rescue. Health Services Research, 48(3), 931-948. doi:10.1111/1475-6773.12018

3. Aiken, L. H., Sloane, D. M., Bruyneel, L., Van den Heede, K., Griffiths, P., Busse, R., . . . RN4CAST Consortium. (2014). Nurse staffing and education and hospital mortality in nine european countries: A retrospective observational study. Lancet, 383(9931), 1824-1830. doi:10.1016/S0140-6736(13)62631-8

4. Kutney-Lee, A., Sloane, D. M., & Aiken, L. H. (2013). An increase in the number of nurses with baccalaureate degrees is linked to lower rates of postsurgery mortality. Health Affairs, 32(3), 579-586. doi:10.1377/hlthaff.2012.0504

5. Kutney-Lee, A., Stimpfel, A. W., Sloane, D. M., Cimiotti, J. P., Quinn, L. W., & Aiken, L. H. (2015). Changes in patient and nurse outcomes associated with magnet hospital recognition. Medical Care, 53(6), 550-557.

6. Lasater, K. B., Sloane, D. M., & Aiken, L. H. (2015). Hospital employment of supplemental registered nurses and patients' satisfaction with care. Journal of Nursing Administration, 45(3), 145-151. doi:10.1097/NNA.0000000000000174

7. Stimpfel, A. W., & Aiken, L. H. (2013). Hospital staff nurses' shift length associated with safety and quality of care. Journal of Nursing Care Quality, 28(2), 122-129. doi:10.1097/NCQ.0b013e3182725f09

8. New York University (2015). Nursing Research: Magnet hospitals have better overall patient experiences which may positively enhance reimbursement for hospitals. NYU News. 10/07/2015. Nursing Research: Magnet Hospitals Have Better Overall Patient Experiences Which May Positively Enhance Reimbursement for Hospitals

[suitcase calling]

Magnet status is the reason I cannot work in an institution hoping to achieve Magnet status or maintain it. I chose a Health Management BS instead of BSN & have worked as a nurse for 30+ years, need to sign on the dotted that I'll get BSN in 5 years. I don't think so. There seems to be no regard for where the BSN is achieved-diploma mill or quality nursing education. Close relative works in Magnet hospital & resented the extra committee work and the hospital was put on probationary status.

[vampiregirl, BSN, RN]

There is huge difference between achieving magnet status and embracing magnet status. I think it also depends on the motives of the administration of the hospital, from the top down.

I work for a magnet hospital, and see many positive things reflective of what magnet stands for.

[ProgressiveActivist, BSN, RN]

There

I work for a magnet hospital, and see many positive things reflective of what magnet stands for.

like what?

[ElizabethStoneRN]

Thanks for all of the passionate and at times, entertaining, feedback. I can only speak to my own experience and the experience of many nurses I have worked with in my hospital and my state (we don't have unions btw). I agree completely that Magnet does not improve outcomes- nurses do. Magnet also does not improve nurse retention- but many nurses are choosing to stay at these hospitals. In fact, Magnet doesn't "do" anything - but it supports a lot, and I for one appreciate what it supports b/c at my hospital, that has influenced a positive and needed change.

And I am MOST grateful for the nurses I work with, who do not "need" Magnet or any other entity to tell them to be engaged and to be leaders in their profession.

[ProgressiveActivist, BSN, RN]

You admit that it "doesnt do anything but it supports a lot."

Such as what?

What have you accomplished as a member of a "council?"

Your assertion that nurses dont need magnet certification to be "engaged" belies your entire premise of it being a worthwhile use of limited resources.

[jadelpn, LPN, EMT-B]

Thanks for all of the passionate and at times, entertaining, feedback. I can only speak to my own experience and the experience of many nurses I have worked with in my hospital and my state (we don't have unions btw). I agree completely that Magnet does not improve outcomes- nurses do. Magnet also does not improve nurse retention- but many nurses are choosing to stay at these hospitals. In fact, Magnet doesn't "do" anything - but it supports a lot, and I for one appreciate what it supports b/c at my hospital, that has influenced a positive and needed change.

And I am MOST grateful for the nurses I work with, who do not "need" Magnet or any other entity to tell them to be engaged and to be leaders in their profession.

Magnet does nothing, and the administration of the facility (who are in the business of healthcare) need to support anything that a committee comes up with. And if it negatively affects the bottom line, then by all means, THAT is not going to be even remotely supported. But what they are getting is a think tank of nurses who for free are increasing their profits.

And giving you all the illusion that their koolaid is the best flavor.

Nurses don't need entities to have them be a leader. But that is in direct contraindication of what any entity is attempting to do.

We all have patients who need to function at the highest level they can. In order to do that, nurses invest time and energy to make that so. In order for it to work, there needs to be staff that is appropriate, innovative levels of resources, and everyone all in--to motivate the patients to be their best selves. From nursing, to CNA's, to PT/OT, to social work, to the lab, x-ray--all parts that make a whole. It takes a village. And if leaders spent time coordinating care maps that cross all levels of care, take invested people and encourage and support furthering specific certifications directly related to the care of patients--count me in.

Otherwise, I am all set with the thousands (and apparently in some cases millions) of dollars spent on rigamarole that is useless to direct patient care.

And last I knew, insurance companies don't approve based on magnet status. Nor do ambulance companies bypass appropriate hospitals to get to magnet--and in fact that goes directly against policy--in any event patients all get the exact same survey at the end of it all. And facilities will still support the highest level of degrees, the most "volunteer" hours they can, for the least amount of salary feasible and/or bare minimum staffing.

[OhioCCRN, MSN, NP]

I worked for the magnet committee (once upon a time) .... At least I was paid for the countless hours I worked with another nurse to come up with ideas that were immediately shot down by my manager (fun)

[RNdynamic]

1.It has zero to do with outcomes.

2. It has zero to do nurse patient ratios.

3. ANCC sells magnet certification as well the nurse certifications that they require. That is an obvious

conflict of interest.

4. Outside of true academic world class medical centers it just over complicates what is obvious to anyone with half a brain.

5. It's just a means for a self promoting nurse administrator to put a feather in her cap and put that on a cv.

6. Nurses resent the second job of unit albums, cheesy posters and mandatory committee work.

7. At a cost of 250k per 50 beds plus all of the consultants and man hours, it is a kick in the teeth to nurses who are working in dangerously understaffed hospitals.

Agreed. The OP is just an exercise in overthinking a whole lot of boo-hooray. I worked for a magnet hospital; it was the most corporate style, impersonal environment that I've worked in during my entire life.

[mamagui]

And Magnet means nothing to the public, don't buy that! People can't and don't choose hospitals based in Magnet, the choose where their insurance sends them. Bottom line.

Could not agree with this more!

[RNNPICU, BSN, RN]

I work in a Magnet hospital and think it does support great outcomes. Nurses are involved in many research projects, we have many nurse authors. Our council's affect outcomes. Having been at the hospital before it was magnet, it has changed our hospital for the better. I am someone who likes to be involved in care and outcome. I want to be a part of change. Being at the bedside is great, but there are so many other aspects of nursing, and we all have the same goal in mind, improving the care for our patients.

I am sorry or all of those who feel negatively about magnet, I think it has made a difference. We have many projects, programs that are all nurse lead. I don't personally think that these projects would have the same support if we were not magnet.

I do not work for ANCC just as a qualifying statement

[Been there,done that, ASN, RN]

That all might look good on paper. My last hospital position was at a facility that gained magnet status while I was there.

I had the least respect from administration, and the highest nurse- patient ratio in my 30 year career.

[40thEditionRN]

Interesting tidbit. The last hospital I worked for was in the process of trying to re-attain Magnet status during my tenure there. During the three-day Magnet site visit, our unit manager had an extra body on the floor to work as a navigator (to help with patients) and made sure the charge RN had no assignment. When Magnet left, so did the navigator, and our charge was back to having a full assignment. I'm sure I don't have to tell you what that did for morale. Yet we were all supposed to have our Magnet buttons on and little Magnet stickers on our WOWs. Farcical.