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.
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
