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

[mamagui]

Recently, the ACA is conducting research that asks if tight glycerin control is really beneficial for patients over 70 years of age.

Do you mean glycemic control? I know I am a new nurse, but I have never heard of glycerin control....

[ProgressiveActivist, BSN, RN]

The theme for the kickoff for my employer's "magnet journey" was "Off to the Races!" This meant that the directors raced each other in the lobby with horse heads on a stick. It was absolutely stupid and truly a low point in my career. Go magnet.

[mamagui]

The theme for the kickoff for my employer's "magnet journey" was "Off to the Races!" This meant that the directors raced each other in the lobby with horse heads on a stick. It was absolutely stupid and truly a low point in my career. Go magnet.

[vampiregirl, BSN, RN]

like what?

Several other posters referred to extra committee work and projects - we have those too, they are on the clock/ scheduled time within our normal workday. There is a clear process in place that then implements changes based on recommendations from these committees and projects. So nurses are looking at the processes that affect them and they are the ones implementing most of the changes. Each year each nurse is required to be involved in at least one EBP project.

I work hospice, so my patient: nurse ratio is a little different. There are several units that I regularly interact with as they provide the inpatient and respite care for our hospice patients. The ratios usually are reasonable per what I'm hearing and seeing. I guess this has been a problem in the past so one of the changes implemented was to expand the float pool to address this.

It's not a "perfect" hospital - but I'm not sure a such thing exists. But overall, it is a good place to work and we have the resources to provide good quality care. As issues come up, plans are implemented to address them.

[vampiregirl, BSN, RN]

The theme for the kickoff for my employer's "magnet journey" was "Off to the Races!" This meant that the directors raced each other in the lobby with horse heads on a stick. It was absolutely stupid and truly a low point in my career. Go magnet.

Wow. Thankful that I do not work this hospital. I'm guessing any visitors who witnessed this were not impressed by the professionalism (or lack there of) demonstrated by this event.

[ProgressiveActivist, BSN, RN]

one of the changes implemented was to expand the float pool to address this.

This is what I meant by over complicating what is the obvious answer to a clinical issue.

I realize that as a hospice nurse you are not involved in these councils and committees, but how many of months of meetings did it take to make this momentous decision to hire more help?

[vampiregirl, BSN, RN]

This is what I meant by over complicating what is the obvious answer to a clinical issue.

I realize that as a hospice nurse you are not involved in these councils and committees, but how many of months of meetings did it take to make this momentous decision to hire more help?

Valid question, I've worked at places before that have meetings about meetings. Not a productive use of time:)

I don't have an exact response for this question because it occurred before I was hired.

[ElizabethStoneRN]

Thanks again to all of you who are offering your opinions. Lets keep it professional- please no student bashing or bashing in general. we are better than that. we all are entitled to our own opinions and experiences. clearly our experiences differ - and it sounds like much of the difference has to do with nursing administration and their leadership practices, not necessarily Magnet status or lack thereof.

When you believe in your nursing administration and CNO, you want to see them succeed and you want to make them "look good" b/c you take pride in where you work and who you work for (I hope). I for one was happy to help show the magnet appraisers around my unit and was grateful that extra staff were brought in that day- it was necessary so that staff nurses, not just managers, could talk to the appraisers without abandoning patients.

For my hospital, the journey to attain magnet designation meant that a nursing infrastructure was put into place which had not previously existed (we finally got a CNO, shared governance, etc- and actually committees were reduced and more streamlined as a result). Staff nurses finally gained representation (and the ability to vote) at nursing administration meetings and even some BOD meetings.

For me personally the support for nursing research and EBP has been the most impactful part of the journey to attain magnet (even though any hospital "can" offer this support, some choose not to). I could literally write a book and I won't do it here. But the support I have received from the relatively new nursing infrastructure which was modeled after magnet principles has led to multiple professional development opportunities ranging from conference presentations, course creation and specialty certification (which is not AACN sponsored, btw).

And lastly- of course magnet designation doesn't "create" engaged nurses. But at my hospital, backed by strong nursing leadership, the magnet-inspired nursing infrastructure supports engaged nurses.

[jadelpn, LPN, EMT-B]

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.

But you were able to climb ladders and what not, no?!?!?! And I am sure that it had a direct impact on your nursing career at present as well? Not.

[jadelpn, LPN, EMT-B]

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

And many by nurses who do research as their job. Not nurses who are convinced that their important free working --ahem-- "volunteer" hours will be embraced, implemented and show direct patient impact next week.

It is interesting to see what propaganda is being told to newer nurses and students.

[jadelpn, LPN, EMT-B]

Thanks again to all of you who are offering your opinions. Lets keep it professional- please no student bashing or bashing in general. we are better than that. we all are entitled to our own opinions and experiences. clearly our experiences differ - and it sounds like much of the difference has to do with nursing administration and their leadership practices, not necessarily Magnet status or lack thereof.

When you believe in your nursing administration and CNO, you want to see them succeed and you want to make them "look good" b/c you take pride in where you work and who you work for (I hope). I for one was happy to help show the magnet appraisers around my unit and was grateful that extra staff were brought in that day- it was necessary so that staff nurses, not just managers, could talk to the appraisers without abandoning patients.

For my hospital, the journey to attain magnet designation meant that a nursing infrastructure was put into place which had not previously existed (we finally got a CNO, shared governance, etc- and actually committees were reduced and more streamlined as a result). Staff nurses finally gained representation (and the ability to vote) at nursing administration meetings and even some BOD meetings.

For me personally the support for nursing research and EBP has been the most impactful part of the journey to attain magnet (even though any hospital "can" offer this support, some choose not to). I could literally write a book and I won't do it here. But the support I have received from the relatively new nursing infrastructure which was modeled after magnet principles has led to multiple professional development opportunities ranging from conference presentations, course creation and specialty certification (which is not AACN sponsored, btw).

And lastly- of course magnet designation doesn't "create" engaged nurses. But at my hospital, backed by strong nursing leadership, the magnet-inspired nursing infrastructure supports engaged nurses.

A mark of an effective leader (or good CNO) is that THEY are effective, successful, and support the nursing staff. Not the other way around. Hence why they are in the position that they are in.

(And don't even get me started on the CNO's who haven't taken care of a patient at all, or in 20 years. Equally the ones who don't step foot on the unit except for when magnet comes).

Sounds like your leader is effective as he/she is having you all do her work for him/her. Under the guise of some rainbow/unicorn connection.

It is all fun and games until you have 8 patients, and the CNO is too bad, so sadding you all.

And we all participate in EBP. That is called nursing practice standards. And such standards of practice didn't come from magnet magic.

This thread makes me sad that members of our profession are buying into this nonsense. I don't "believe" in my DON ooops CNO....they need to believe in their own leadership abilities. Sounds to me OP, that your CNO is skilled in the best use of staff to make him/her look good. "You like me, you really, really like me" comes to mind. Sickening, really.

I do however acknowledge that it is wonderful if a facility is committed to helping nurses obtain education. However, most have highly paid nurse educators. Wouldn't it be nifty if the nurse educator could align with a university level and actually streamline the process?

But I put it up there with the thousands of hours nurses have spent creating and changing policy that actually WORKS for a patient that is only dug out by CNO's who would like their bonus/salary increase or their ego stoked by nurses who actually buy into the idea that the goal is nurses or patients.

The goal is money. And marketing ploys for profits. Healthcare is a business.

[traumaRUs, MSN, APRN]

Everyone has their own experiences with Magnet status. Per our terms of service please debate topic not poster. Thank you