Let’s face it. The current healthcare environment is not conducive to optimal nurse staffing. A synergy of factors works to exacerbate the staffing problem: a far-reaching nursing shortage, the aging nurse workforce, a healthy economy that affords other employment opportunities, and decreased federal reimbursements to hospitals, to name a few.
In response, the Institute of Medicine Committee on the Adequacy of Nurse Staffing in Hospitals and Nursing Homes convened in 1996 to evaluate the impact of changes in the health care delivery system on nurse utilization and the quality of care. Subsequently, the President’s Advisory Commission on Consumer Protection and Quality in the Health Care Industry was created and charged with examining how changes in the nurse workforce were related to hospital restructuring and possible adverse effect on quality of care.
Patient anecdotes as well as long-vacant RN positions in hospitals and clinics provide evidence that there is a nurse staffing problem. But just as patients, nurses and administrators feel the crunch, hope arises on the horizon for those hospitals that offer excellent nursing service: the Magnet Nursing Services Recognition Program.
If a hospital achieves Magnet status, theoretically the hospital will act as a Magnet to attract and hold outstanding nurses. The program doesn’t attack the root causes of the staffing problem (such as the nurse shortage), but it can position a hospital to serve as a beacon of light toward which exceptional nurses can steer their course.
A Little History
There are two groups of Magnet hospitals — one group from the early 1980s, the other certified since the early 1990s. Amidst a severe nursing shortage in the early 1980s, nurses were leaving nursing, and hospital staffing was in crisis.
In response, the American Academy of Nursing, the American Nurses Association (ANA) and a representative group of nurse executives conducted a national study to identify hospitals which attracted and retained highly-qualified professional nurses in a competitive market. The original study, coordinated by Dr. Mabel Wandelt from the University of Texas at Austin School of Nursing’s Center for Nursing Research, resulted in awarding 41 hospitals with “Magnet hospital” designation.
In the early 1990s the ANA, through the American Nurses Credentialing Center (ANCC), established a formal program to acknowledge excellence in nursing services: the Magnet Nursing Services Recognition Program. It is a voluntary form of external professional nurse peer review available to all hospitals. The ANCC Magnet hospital designation is based on 14 standards of nursing care evaluated in a multistage process of written documentation and on-site evaluation by nurse experts. ANCC Magnet hospitals require recertification every four years.
A Texas Hospital Network Applies for Magnet Status
Seton Healthcare Network in Austin is applying for Magnet status on behalf of its four acute-care hospitals — Brackenridge Hospital, Children’s Hospital of Austin, Seton Medical Center and Seton Northwest. Two years ago Seton’s Chief Nurse Executive, Joyce Batcheller, along with our three nursing practice directors, attended a national conference in Atlanta on Magnet nursing.
While Batcheller and her colleagues listened, their excitement grew as they realized what the Magnet program required, Seton already had — a focus on positive patient outcomes, influential nursing leadership, empowered and active staff nurses, and multidisciplinary collaboration. And after all, Seton Medical Center, under the leadership of Nurse Executive Betty Thomas, was among the original 41 Magnet hospitals.
The shared governance structure Seton instituted in 1996 was the basis for their confidence. Strongly supported by Seton executive leadership, the essential elements of the structure include a Nursing Executive Council, Nursing Congress, Specialty Councils, and strong inter-professional communication via Seton’s monthly NursingNews, which I edit.
When Batcheller and the nursing practice directors returned from the conference, they floated the idea of applying for Magnet status to the Nursing Executive Council. The pieces fell into place, and at this writing, our written application is being reviewed. If the application is accepted, an on-site review will take place.
For now, we’re trying to inform the 2,500 Seton nurses what Magnet status is. If we pass the on-site review, the Seton Healthcare Network will be awarded Magnet status.
Then the public relations campaign will begin to inform the community what Magnet nursing status means to them. This will be no small feat, as “Magnet nursing” is not only an abstract concept, but one that few have heard of. After all, only 21 hospitals and one long-term care facility have achieved this status to date — and none in Texas.
Organizational Features Shared by Magnet Hospitals
The subject of numerous research studies, both sets of Magnet hospitals have been found to share organizational features that promote and sustain professional nursing practice. The original study showed that Magnet hospitals have flat (as opposed to hierarchical) organizational structures, unit-based decision-making processes, powerful nurse executives and investments in the education and expertise of nurses. They have a higher percentage of nurses with baccalaureate degrees — over 50 percent compared with 34 percent of American hospitals.
Nurses in Magnet hospitals perceive their work environment as providing greater autonomy, allowing more control over the practice setting and having adequate support services to provide high-quality care.
Subsequent research demonstrates that these characteristics have endured in Magnet organizations.
Magnet Hospitals Have Better Outcomes than NonMagnet Hospitals
The organizational attributes that attract nurses to Magnet hospitals have been found to be consistently associated with significantly better patient outcomes than those of nonMagnet hospitals. The first major study showed that for Medicare patients, Magnet hospitals had a 4.6 percent lower mortality rate, which translates to betweeen 0.9 and 9.4 fewer deaths per 1,000 discharges. A second major study (reported in the March 2000 AJN, referenced below) showed that AIDS patients in Magnet hospitals had a 60 percent less chance of dying than AIDS patients in nonMagnet hospitals.
Other analyses have shown that Magnet hospitals have significantly higher levels of patient satisfaction, lower rates of nurse burnout and lower rates of needlestick injuries in nurses.
Tips for Achieving Magnet Nursing Status
• Do not underestimate the enormity of the writing task.
The ANCC application has 14 nursing care standards each with five to 15 sections, each with subsections, each having to be answered. The ANCC doesn’t want applicants to just tell them about their hospital. No, it wants physical evidence. So, we provided appendices to back up what we said. (Keep in mind that our application was for a network of four acute-care hospitals.) Final word count for Seton’s application, excluding the appendices, was 56,360. For perspective, the average book is 40 to 60,000 words.
In addition we had 330 appendices. Collecting and properly numbering the appendices within the application was extremely tedious, and in the end, they filled five three-inch binders. E-mail was essential. Thousands upon thousands of electronic messages were exchanged, greatly simplifying the task.
• Appoint a Magnet project director who has the tenacity and “people” skills to complete the project.
Seton designated Nursing Practice Director Barbara Doerr Potts former member of TNA District 5 Board of Directors. Barbara divided the 14 nursing standards among a team of six RN writers including myself. I was the full-time overall editor. The neontal intensive care unit where I work as a staff nurse originally agreed to lend me for a month. No one realized what a gargantuan task the writing and editing would be, and one month turned into four months during, coincidentally, the busiest time in NICU. My NICU director was unamused by the delays, but fortunately could see the ultimate value to her unit and all of Seton and allowed me to complete the project. There were some tense moments.
Barbara kept the team focused with all “Eyes on the Prize”. As editor, until I got near the end I thought I might never finish, that it was just too much.
One month into the project my 15-year-old son sustained a life-threatening head injury from a carelessly thrown baseball during a pre-game warm-up in rural Texas, 20 miles from the nearest (community) hospital and 40 miles from home. The blow resulted in an epidural hematoma and surgery. Without the support of the project director, I probably could not have finished the job. Barbara Potts is just one of those understanding, compassionate nurses that you need when times are rough.
• Appreciate the necessity of teamwork.
Obviously teamwork among the writers is essential. Network-wide teamwork must be in place as well. Executive leadership must understand the utility of applying for Magnet nursing status. From the beginning the hospital communications and nursing departments must work together to inform staff of the application and their role in achieving the status. Almost like a JCAHO (Joint Commission on Accreditation of Healthcare Organizations) review, staff nurses must be able to respond to the ANCC Magnet reviewers at the site visit. If successful, the nursing and communications departments must continue to work together to inform the community about what it means.
Applying for Magnet: A Leap of Faith
Make no mistake about it: Applying for Magnet nursing/hospital status is a leap of faith. For a hospital (or in Seton’s case, hospital network) to take this step is a bold and gutsy gamble with no guarantee of success. It requires a nursing leadership with an uncommon confidence, energy, and focus.
The bar for Magnet standards is raised quite high, and the application process itself is extremely rigorous. I think that is why so few have achieved this status. The ones who have, such as the Johns Hopkins hospital and the Mayo Clinic system, are extremely proud of their achievement. To see for yourself, review the Mayo Web site at www.mayo.edu:80/nursing-rst/Magnet.htm.
Gertrude Rodgers, MSN, RN, was an administrator at Fairfax Hospital when it was designated in 1982 as one of the original 41 “Magnet hospitals”. She is considered a pioneer in Magnet nursing. She says, “With Magnet status, nurses really feel they work in a setting with high standards that values nursing leadership. Magnet hospitals support a positive environment in which nurses practice and encourage successful patient outcomes. If nurses are satisfied in their work and are respected, the patients know it, and they do better.”
The bottom line is that the program offers a research-based model to promote consumer confidence in their choice of h
Austin, Texas