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

[Larry2016]

I think I have a different perspective on this issue. Magnet designation means the hospital is certified to conduct research and test evidenced based practice. EBP is important for many reasons. Recently, the ACA is conducting research that asks if tight glycerin control is really beneficial for patients over 70 years of age. That is a really good research topic.

One reason nurses and ancillary especially provide oral care and elevate patients heads to at least 30 degrees is to prevent pneumonia, which is a practice that was based on research findings.

I would love to work at a hospital where research is encouraged and implemented as part of our daily routine in health care. Much of what we do is EBP.

[canigraduate]

As a floor nurse, I haven't seen any benefit to me in Magnet vs non-Magnet hospitals.

I have seen more work, poorer ratios, and more meetings. Also, the Magnet hospitals tend to require BSNs, which means a smaller pool for me to apply to since I have a diploma.

At some point, we are going to have to dispense with all the idealist crap that means more uncompensated labor and deal with actual issues in nursing.

[dec2007]

I think I have a different perspective on this issue. Magnet designation means the hospital is certified to conduct research and test evidenced based practice. EBP is important for many reasons. Recently, the ACA is conducting research that asks if tight glycerin control is really beneficial for patients over 70 years of age. That is a really good research topic.

One reason nurses and ancillary especially provide oral care and elevate patients heads to at least 30 degrees is to prevent pneumonia, which is a practice that was based on research findings.

I would love to work at a hospital where research is encouraged and implemented as part of our daily routine in health care. Much of what we do is EBP.

Yes, we all advocate EBP; however, a facility does not require Magnet status to do research.

[nursewall-e]

magnet status...many pros and cons here. Hard to know what to think. All I know is I very much appreciate the debate.

[Mavrick, BSN, RN]

I suppose there was a time when Magnet status reflected a hospital work environment that was so positively peachy it attracted and retained nurses. Child care, flexible scheduling, educational opportunities and nurse friendly stuff like that.

Then the bean counters got involved and have tried to use magnet status in an attempt to attract patients. Marketing BS. That doesn't work so well when patients don't pick their hospital anyway, as stated before it's an insurance decision for the most part.

Nurses certainly aren't fooled by the excessive "free" labor opportunities and presenting ideas that would make for a better work environment for the nurses but not necessarily bonuses for management.

The conflict of interest inherent a mouse issuing free cheese vouchers is laughable.

[RNdynamic]

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.

Hilarious and true. When my hospital was trying to get redesignated for magnet, they had posters everywhere about shared governance, evidence based practice, and other such temporary shams that went away after the hospital was recertified. Staffing also miraculously (and temporarily) improved. During that time administration even emailed out newsletters called the magnet minute, which quizzed nurses about how important magnet status status was. Pathetic..

[RNdynamic]

I think I have a different perspective on this issue. Magnet designation means the hospital is certified to conduct research and test evidenced based practice. EBP is important for many reasons. Recently, the ACA is conducting research that asks if tight glycerin control is really beneficial for patients over 70 years of age. That is a really good research topic.

One reason nurses and ancillary especially provide oral care and elevate patients heads to at least 30 degrees is to prevent pneumonia, which is a practice that was based on research findings.

I would love to work at a hospital where research is encouraged and implemented as part of our daily routine in health care. Much of what we do is EBP.

Hello nursing student. By glycerin control, I am going to assume you mean "glycemic control?" Who or what is the "ACA" conducting this research? What does the ACA stand for, other than "Affordable Care Act?"

You're talking about stuff you don't even know anything about. Magnet does not mean the hospital is certified to conduct research or use evidence based practice. Plenty of hospitals without magnet status are capable of facilitating research and evidence based practice. Where did you hear this crap from?

[meanmaryjean, DNP, RN]

I think I have a different perspective on this issue. Magnet designation means the hospital is certified to conduct research and test evidenced based practice. EBP is important for many reasons. Recently, the ACA is conducting research that asks if tight glycerin control is really beneficial for patients over 70 years of age. That is a really good research topic.

One reason nurses and ancillary especially provide oral care and elevate patients heads to at least 30 degrees is to prevent pneumonia, which is a practice that was based on research findings.

I would love to work at a hospital where research is encouraged and implemented as part of our daily routine in health care. Much of what we do is EBP.

Incorrect. Magnet does not 'certify' anything, and thousands of nursing research projects happen in non-Magnet hospitals every year.

[ProgressiveActivist, BSN, RN]

An actual copy of a magnet application is $300.00

This lack of transparency begs the question - are they afraid of nurses holding the hospital accountable for these standards and criteria ?

Our clinical nurse specialists who were EXPERTS, were eliminated with implementation of this do it yourself model. That was the end of true collaboration and peer reviewed EBP in our health

system.

It's disgusting that student nurses are taught this

baloney and writing papers about it as part of theirleadership classes. Leadership comes with experience not regurgitating what you found on

google scholar. Awesome way to teach students to be independent thinkers.

If magnet status hospitals are the gold standard, nurse patient ratios and data about HAI would be part of the criteria.

If that day ever comes I will get behind it.

[BittyBabyGrower, MSN, RN]

Like I previously posted, when we had a superb VP of Nursing and we obtained Magnet under her guidance, it was great. We had a very strong Nurse Senate, many antiquated nursing policies and guidelines were revamped, they paid for our certifications, increased tuition reimbursement/number of universities offering a discount, we abolished whole house floating, we abolished mandation, and much more.

But she made enemies of some other higher ups, wasn't welcome in the old boys club, they started cutting money for us to have out of staffing and for more nurses to be involved in research. When they all received a raise, she didn't. We then got a new CEO who pretty much shut her down and she left. He didn't want to spend money to keep the nursing staff happy. In came her replacement and our Senate is useless and many changes that were made are now being revoked.

Without a strong manager backing you, you are dead in the water. They always "fix" things for the "journey" and have their talking heads to woo the surveyors, so we can have that cute little symbol on our letterheads and badge.

And the ANCC collects their fee and smiles.

[ProgressiveActivist, BSN, RN]

Nurses are involved in many research projects,

like what?

we have many nurse authors.

working in a magnet facility is not a criteria for publication

We have many projects, programs that are all nurse lead.

please elaborate

I want to know what tangible improvements you have personally implemented as a

result of your "research" and committee work that werent actually CMS and CDC

recommendations.

[NRSKarenRN, BSN, RN]

Thanks OP for presenting your Magnet experience.

I'm posting previous threads about Magnet, Magnet requirements to increase understanding program and positive impact on nursing and healthcare.

PA has 28 Magnet designated hospitals. Many Philadelphia area facilities with multiple re-accreditation: Fox Chase Cancer Center retained designation since 2000 --considered the top facility to work in Philadelphia area. I've visited many of these hospitals-staff RN's demonstrate high degree of professionalism and job satisfaction compared to others in my area.

Magnet Nursing Info

"the important part of magnet is the process of engaging people in the work of self-study, analysis, and commitment to ways and means that help achieve the standards," says Pesut. "the real learning takes place along the way."

Does having ONLY a MSN-RN allow one to work in a magnet facility?

How Magnet Hospitals are destroying Nursing

ANCC Magnet Benefits:

Achieving Magnet status serves patients, nurses and health care organizations. Learn what independent sources say about Magnet and how your organization can benefit.

• Attract & Retain Top Talent
  
• Improve Care, Safety & Satisfaction
  
• Foster a Collaborative Culture
  
• Advance Nursing Standards & Practice
  
• Grow Business & Financial Success