1

A Qualitative Study on Practicing Registered Nurses Lived Experiences in Their Magnet

Required Educational Journey
by
Diane L. Roth

A Dissertation Presented in Partial Fulfillment

of the Requirements for the Degree
Doctor of Health Care Administration

UNIVERSITY OF PHOENIX
June, 2013

2013 by Diane L. Roth

ALL RIGHTS RESERVED

Abstract

Dedication

Acknowledgements

Table of Contents

CHAPTER 1: INTRODUCTION......
Background of the problem...
Problem Statement.
Purpose..

Significance of the Study...

Significance of the Study to Leadership
Research Question.
Nature of Study..
Conceptual Theoretical Framework..

Assumptions..
Scope..
Limitations.
Delimitations.
Summary__

Chapter 1: Introduction
There is lack of knowledge about how practicing nurses perceive his or her their lived
experiences of returning to school when he or she is they are required to earn a higher degree to
remain in a position or to advance in their his or her careerposition. The American Nurses
Credentialing Center (ANCC) Magnet status has set regulations and standards for healthcare
facilities. Magnet credentialing is a program developed by the ANCC that recognizes a
healthcare facility for the performance of quality patient care and nursing excellence (ANCC,
2010). This program has high standards set for facilities to meet and those standards will add to
an increase in positive patient outcomes. Many healthcare facilities are reaching for this type of
recognition and improved outcomes.
One Magnet standard requires is that all nursing managers are required to have a
Bachelor of Science in Nursing (BSN) or higher degree and eighty percent of all nurses in the
facility must also have a BSN (ANCC, 2010). These strict regulations can cause some mixed
feelings among the nursing staff in the facility. It is important for leadership in these facilities to
address these feelings not only in the beginning of the requirement process, but also throughout
the entire process of nurses earning their degrees. It will be equally important for educational
leaders to be aware of the nurses perception of returning to school to further their degree.
Supporting nursing with this change will help to increase their acceptance of the regulation and
improve their success in earning of a BSN degree.
Earning a BSN degree in nursing provides a nurse with a higher order of thinking. Nurses
believe once they earn this degree, that it has helped them to add to their critical thinking and
knowledge base allowing them to see the entire picture when caring for patients (Delaney &
Piscopo, 2007). Healthcare is a field that requires continual knowledge of new evidence-based

information. Earning a BSN allows a nurse to think at a higher level and to seek out this type of
information for improving the care they provide. Many nursing organizations and the ANCC
believe that nurses who have a BSN provide higher quality care for patients and improved
outcomes for those patients (Delaney & Piscopo, 2007). It is the improved care that is one of the
driving forces for a healthcare facility to become Magnet recognized.
In nursing leadership, it is important to foster a positive culture within the department.
With this positive culture, there will be a means for a happier and more efficient workforce. A
more efficient workforce will improve the quality of care for the patient. As the quality of care
for the patient increases, the positive patientpositive patient outcomes increase. Magnet
recognition is known for this positive work environment and attract many nurses to these Magnet
facilities.This is the main focus for Magnet status facilities.
Several studies have been done that provide information about nurses perceptions of
returning to school for their BSN degree. There is a need specifically for studying the nurses
perceptions when they are required through the Magnet process to return to school. For leaders in
health care and education, this information will provide the necessary information about how this
is affecting nurses and how the leader can best support their nurses through these changes.
Returning to school willingly and by choice is different then returning due to a regulation in your
the workplace.
This study will provide necessary information for leaders both in health care and
education on how Magnet regulations of returning to school for a higher degree affects nurses. In
chapter one, discussion of how this study is significant to healthcare and healthcare leaders will
be evident. A main challenge for nursing executives is related to involvement, education, and
ensuring nurses are engaged during the Magnet process (Russell, 2010). Healthcare today is

changing and it is important for leaders in healthcare to be aware of ways to help their nurses to
become acclimated to changes and to embrace the changes while continuing to provide the best
care for patients.

Background of the Problem

As mentioned earlier, healthcareHealth care is a field that requires continuous education
and change due to evidence-based medicine and treatments. In nursing, skills and knowledge are
continually improving, requiring the nurse to stay up-to-date with the most recent certifications
and regulations. This is an added stressor requiring , all the while putting pressure on nurses to
continue their education. Among these regulations is are The American Nurses Credentialing
Center (ANCC) Magnet status. With Magnet achievement, there is a This regulation requiring
nurses to earning higher degrees. The nurses lived experience while going back to school and
continuing to work in the field is will be the focus of this study .
The ANCC regulations require nurses to complete higher degrees within a specific
timeframe allowing the healthcare facility to earn magnet status when all of the criteria has been
met. The ANCC is part of the American Nurses Association (ANA) and strives for excellence in
nursing and health care by credentialing health care facilities. The ANCC's Magnet Recognition
Program is one of the most prestigious distinction that a healthcare organization can receive both
in nursing excellence and quality patient outcomes. A health care organization that achieves this
Magnet recognition is part of an esteemed group that provides superior nursing practices and
outcomes (American Nurses Credentialing Center, 2013). Because of this distinction,
organizations are striving to achieve this status and therefore requiring nurses to return to school
as part of the regulations set forth by the ANCC.

The ANCC Magnet recognition program requires health care organizations to have 80 %
of their nurses to have a higher degree (BSN or MSN) within a reasonable time-frame, while
100% of all nurse managers must have a BSN or MSN degree as part of the regulations for
Magnet status. With these Magnet regulation numbers, the BSN and MSN degree programs are
rising. The perception of these nursing students in the workforce who are required to return to
school for a higher degree are of interest to this researcher.
Leadership, both in the educational setting and the workplace, must acknowledge these
perceptions and any possible stressors in order to increase the success of these nurses. Jimenez,
Navia-Osorio, & Diaz (2009), suggest that stress in the educational setting can impede learning.
The manner in which stress affects the student can vary. The higher the stress levels are, the more
symptoms a student can have physically and psychologically. Stress is something that can affect
a nurses life in many ways . Stress can affect a nurses health by changing his or her diet,
exercise routine, and sleep patterns. When these things are changed, the stress may lead to drug
or alcohol abuse, eating disorders, sleep disorders and can potentially result in absenteeism or job
loss (O Donovan, Doody, Lyons, 2013). These types of affects are especially important to any
healthcare leader. Stress can affect the way a nurse cares for his or her patients.
Leaders need to support their nurses through the necessary regulations of advanced
education. This study will show the perceptions of practicing nurses who feel the pressure
through regulations of Magnet status to return to school. Leaders who can best support these
nurses will have the ability to make theThe study will also contribute to the knowledge of leaders
when working with these nurses. nurses experience easier.
Stress has been studied extensively in the field of nursing. Continuous interaction with
stressors in nursing has been reported as a necessary element needing to be addressed by nursing

leadership. Nurses tend to allow stress to affect them and therefore cause several related effects.
Some of these effects of stress could be absenteeism, illness, alcoholism, exhaustion, and suicide
attempts (Montes-Berges & Augusto, 2007). Leaders will want to make sure to provide the nurse
with some type of stress support. In a recent conclusion of a study done on stress and health in
nursing students by Jimenez, Navia-Osorio & Diaz (2009), they it suggest that students should
be informed of the possible stressors and are be offered interventions to cope with this stress
(Jimenez, Navia, Osorio, & Diaz, 2009).
This study is focusing on the perception from the nurse who is returning to school due to
Magnet status regulations. The information collected will give the employer and the educational
facility needed information to support the nurse and help him or her succeed in his or her degree
plan and in the workplace.
Positive patient outcomes has been linked to Magnet status. In Magnet hospitals, the
mortality rate of Medicare patients is lower than in non-Magnet hospitals The mortality rate of
Medicare patients is 4.6% lower in Magnets than in other hospitals (Jones-Schenk, 2001).
Because of the lower mortality rate se startling figures and the increase in patient outcomes,
health care organizations are opting for Magnet status. Health care organizations have realized
that nursing does play a large role in increased patient outcomes. Because of this, it is important
for leaders to support their nurses through their educational journey. By supporting nurses in
their educational journey, leaders will not only improve patient outcomes but nursing satisfaction
with their education and career. This study will reflect the perceptions of nursing students who
are furthering their degree and will show what leaders need to focus on to improve the nurses
experience as they work and attend school.

Problem Statement
Registered nurses who have their associate degree in applied science or diploma degree
are required to further their education in order to keep their jobs or to advance in their careers.
Magnet status requires all facilities seeking Magnet credentialing to require nurses to have
advanced degrees. The ANCC requires health care organizations to provide an action plan and
set a target, which demonstrates evidence of progress toward having 80% of registered nurses
obtain a degree in nursing (baccalaureate or graduate degree) by 2020 (ANCC, 2013). 100% of
nurse managers in an organization are also required to have their advanced degree at the time of
application for Magnet status. The specific problem is the lack of knowledge about what the
nurses lived experiences are as a direct result of these Magnet regulations of earning a BSN or
MSN degree. This study will provide a clear understanding of these nurses experiences as they
are required to obtain their advanced degree.
This qualitative study will use a phenomenological design and explore through 1220
interviews, the lived experiences of registered nurses who are required to return to school for
their careers due to Magnet status credentialing. The lived experiences and effects on the nurses
in this situation can be of significant concern to leaders in the health care field. Leaders who will
benefit from this information include the leadership in the workplace and leaders in the
educational field of health care.

Purpose of the Study

The purpose of this qualitative phenomenological study is to explore practicing
nurses perspectives on their lived experience of returning to school after being required
to further their degree. This study will use audio-taped, in-depth interviews with 1220
nursing students in the BSN and MSN degree programs at an on-line university. The
interview questions will be open-ended in order to search for common themes in the
data. An analysis of the data collected will be done by using NVivo computer software.
With this software, trends and common themes will be analyzed ..to provide a
framework for leaders to ? . better support their nursing staff in the clinical setting and
the educational setting.

Leaders in this field will have the ability to see if there are any common
experiences that are negative for the practicing nurse. The leader will then have the
option and the ability to assist these nurses with the negative experiences. Having this
type of data could potentially increase a students success and motivation in his or her
educational journey and career. This data will also allow healthcare facilities the ability
to monitor their nurses progress and provide appropriate opportunities. Ultimately, this
could potentially increase patient safety and improve quality of care. The quality of care
for a patient depends upon the nurses ability to handle stressors at work. Nursing
stress is proven to add to a decrease in the quality of patient care (Bogaert, Clarke,
Roelant, Meulemans & Heyning, 2010). If the nurse is overloaded with stressors, this
may adversely affect performance. -(need a quote??)
Significance of the Study

According to the ANCC, 2013, Magnet status has five key components. These
components are structural empowerment, exemplary professional practice, new knowledge,
innovations and improvements, transformational leadership, and empirical outcomes. All of these
components are essential in the health care field. Because of these important components, it has
become necessary to provide patients with the best care available. This is the reason for the
Magnet regulation which requires the majority of nurses working in health care facilities to earn
their bachelors degree or masters degree. Because of the growing number of healthcare
facilities that are seeking Magnet status, it is important for leaders to understand its impact on
nursing. This impact has proven to be a positive one with nursing quality of care and patient
outcomes ranking 99.9th percentile nationally (Russell, 2010). This study will address how the
regulation of returning to school due to Magnet accreditation affects nurses who are working in
the healthcare field for a facility seeking this accreditation.

Significance of Study to Leadership

Leaders in the health care facilities are trying to uphold standards for Magnet status and
improve patient outcomes. Studies show that nurses are overworked and patient to nurse ratios
are increasing causing burnout in nursing in the workplace (Sprinks, 2012). One study done in
2012 shows the burnout rates are high in undergraduate students who are working and returning
to school (Akansel, Tunkc, Ozdemir, & Tugutlu, (2012). Because of the Magnet status
regulations, the nursing staff has no option but to return to school to further their education. With
these types of regulations, leaders both in the educational field and workplace will need to know
how to support their nurses. This study will provide the necessary information on the nurses

perceptions about being required to return to school due to the Magnet status regulations and
how it affects the nurses. From this information, the leaders in education and workplace can
properly support these nurses.
Research Question
The major research questions in this study is the following:
\; Wwhat are the perceptions of, and how do these perceptions affect, practicing nurses in
the workplace and in school who are required to advance their degree as a result of regulations
and requirements from achieving Magnet status?
As a direct result of this study, information collected from the study will provide leaders
and educators with valuable information. Without this study, educators and leaders would not
have the ability to understand the perceptions of nurses who are going back to school as a
requirement for his or her job. This information will provide the leadership with the ability to
explore interventions, if necessary, to help these nurses through his or her educational journey.
Nature of Study

Deciding between a qualitative and quantitative research design is key in the

dissertation process. This study will use a qualitative design. This qualitative study will
be a phenomenological data analysis method. In a phenomenological design, the
researcher has the ability to identify common themes from data. This type of collection
of data allows the researcher to determine the practicing nurses perceptions of the live
experiences of returning to school after feeling the need to further his or her education
due to new rules and regulations. A quantitative design would not allow the researcher
to analyze themes of the lived experiences of nurses required to return to school.
In an attempt to correlate and show validity of the interview questions to answer the
studys research question, a pilot study is going to be done. In this pilot study, two registered
nurses enrolled in school for their BSN and two nurses enrolled for their MSN will be
interviewed. All of these nurses will be enrolled in school due to regulations in their workplace
as a direct result of reaching Magnet status credentialing. This data will allow the researcher to
determine the credibility and validity of the interview questions, alleviate any bias, and
determine how to ask the questions with the remaining participants.

The main collection of data will be done by the researcher. The researcher will
conduct 2016 interviews. TenEight interviews will be with BSN students and teneight will
be with MSN students. The sample will consist of male and female nurses who have
been working as a nurse for two or more years. All participants will have their current
nursing position for at least one year and will be between the ages of 25-55 years old.
This interview process will take a total of one hour each. Each of the nursing students
will have returned to school for an advanced nursing degree due to recent changes and
regulations in his or her work environment specifically due to Magnet status
credentialing.
The interviews will consist of open-ended questions and discussion. The interviewer is a
registered nurse who is currently working on her doctorate in healthcare administration and is a
nursing educator. The chance of bias is possible due to this relationship. She will take the
necessary steps to ensure that she does not agree or disagree with any of the interviews. The
interviewer will remain silent most of the time, listening to the subject. In this interview process,
it is important that the interviewer has the ability to remain impartial and does not bring in any
preconceived notions.
A communication technique commonly used in nursing, therapeutic communication
technique will be used. This technique is similar to what is commonly known as active listening.
In this technique process, the interviewer is using his or her listening skills and will remain nonpartial to the subject. By using this type of technique, the interviewer is providing more
credibility to the study.
All of these interviews will be tape recorded and later transcribed. Common themes from
all of the interviews will be gathered. The data analysis used is coding data into themes. NVivo

software will be used to organize this information. This is accomplished by identifying any type
of statement that is related to the topic. Two categories are used to divide the statements into.
These categories are relevant and irrelevant. Once the relevant information is found it is broken
down into smaller categories such as phrases. The researcher will then group these phrases into
categories. Next, the researcher will examine the phrases in ways to determine how the
individuals perceive things. Finally, the researcher can develop an overview using NVivo of the
phenomenon as these nursing students experience this return for higher education.
The common themes found in this study will provide leaders with relevant information
that shows patterns of how a nurse perceives her requirement to return to school due to Magnet
status. With this information, the leader can plan accordingly on how to assist the nurse through
her educational experience.
The data will be put into a report. In this narrative report, a detailed description of the
participants in the study and the data collection methods will be included. Validity checks are
done on the data. This is when the participants are asked if the significant statements accurately
express the participants view. More information regarding methods and design will be provided
in Chapter three of this proposal. Chapter 4 will include the findings of the study.

Conceptual or Theoretical Framework

The holistic view of this study is essential in the determination of what the lived
experiences of nurses are who are required to return to school. The entire model of understanding
their experiences and determining what can be done to support these nurses through their
educational journey is one that will be taken into consideration. Ethical, caring, understanding

perceptions, and determining interventions needed are a main focus of this study.
I believe I will be adding to this theory area, grounded theory and why I choose it
for my study type ( In leedy page 142 look at information)
Definition of Terms

Assumptions
Health care is based on evidenced-based medical information and new technologies. It is
important to stay current in the health care field as a registered nurse. In the workplace, there are
continual in-services, educational opportunities, certifications, and conferences for registered
nurses. With Magnet credentialing for health care organizations, it is essential to provide the
public with the very best nursing care. In order to obtain this excellence in nursing care, nurses
are required to return to school to further their education for a BSN or MSN degree.
This study is based on the assumptions that nurses returning to school due to Magnet
status may feel the pressures and be affected by the added stress and role strain. The literature
does provide information based on nurses returning to school and the stressors involved. One
assumption is that nurses who are required through Magnet credentialing to return to school
would not have otherwise done so. Another assumption is that during the interview process, the
nurses will answer the questions honestly and completely.
Scope
The scope of this study is 20 registered nurses who have been required to return to school
to further their education as a direct result of Magnet credentialing in their workplace. All of

these students are going to school at the same on-line university. Open-ended interviews will be
conducted. Trends will be found through these interviews of the nurses lived experiences. The
specific concern is that these requirements to return to school has effects on the nurse both in the
educational setting and the workplace. These nurses are from random states and various
backgrounds.
Limitations
Researcher bias is one limitation of this study. Because the researcher is a registered
nurse and a nursing educator, it is important that the researcher takes necessary steps to alleviate
any bias in the interviewing and collection of data. The researcher will be using a listening
technique called therapeutic communication which will allow participants to answer questions
freely and openly without interruption. Data will be collected and analyzed through NVivo
software.
Another limitation is the sample size. Due to the nature of the study, a small sample size
is used. Because of this small sample size, the results are not able to be applied to a large
population. The results are therefore a mere suggestion of a larger population. The researcher is
also an employee of the on-line university where the sample is taken. Due to this fact, necessary
safe-guards will be in place to protect participants rights. All participants will volunteer and also
have complete confidentiality and anonymity.
Delimitations
The phenomenological study is confined to master and bachelor nursing students
returning to school due to Magnet status requirements. This study also is confined to one online
university that offers these degrees. The sample size is small in this type of study to examine the

nurses perceptions and lived experiences of returning to school.

Summary

Diane,
When you go through the comments and make changes, please create a change matrix for
me to see the change and where you made it. If you need a sample of what a change matrix is,
let me know. You are in a good position right now. Sorry about not getting this to you sooner:
somehow I thought I did send it off I dont know what I was thinking! Anyway, call if you
have any questions.

Dr. Joe

This will give you a rough idea of how to outline Chapter 2. You may use it as a reference. Also
consider going to dissertations to see how other students have handled this.

Content Outline of Chapter 2

(This will also give you an idea of the order in which these sections should appear in this
chapter)

1. Purpose Statement
2. Introduction and brief overview of what will be contained in Chapter 2
3. Section on sources used: number of documents, articles, books, etc.

4. Reminder of the Research Question

5. Historical Section deals with the variables and a summary of the significant and
relevant historical theory related to the variable.
Historical reviews trace the development of an issue
over time (Newman, 1997). Hart (1998) posits that a solid literature reviews:

1. Show a clear understanding of the topic

2. Cite and discuss all key landmark studies

3. Develops, through gradual refinement, a clear

research problem

4. States clear conclusions about previous research

using appropriate evidence

5. Shows the variety of definitions and approaches to

the topic area

6. Reaches sound recommendations using coherent

argument that is based on evidence

7. Shows a gap in existing knowledge( p.198)

-OR-

Historical Overview (which contains elements of the above)

Current Theories

Gaps

6.) GAPS (specifically a gap) will be the focus of your research)

7.) Chapter 2 Conclusion
8.) Chapter 2 Summary
9.) Transition into Chapter 3

CHAPTER 3: METHODOLOGY
Purpose Statement
The purpose of this qualitative phenomenological study is to provide information about
the lived experiences of nurses who are required to return to school to further their education due
to Magnet status regulations. This study will also provide information for leaders in healthcare

and in the educational setting on the perceptions of these nurses and how they could possibly
assist their success in returning to school. Magnet status is a recognition which many healthcare
facilities pursue in order to provide patients with the best possible care and outcomes. Many
studies have been done to provide information on how acquiring Magnet status will affect the
patients outcomes and how nursing excellence is achieved. A study done by Delaney & Piscopo
states, Recent research suggested that there is a correlation between BSN program-prepared
nurses and reduced mortality among surgical patients (2007, p. 167). What is lacking is the
knowledge of how nurses perceive the regulations of returning to school specifically to acquire
their BSN.
Chapter 3 provides a review of the phenomenological design of this study and its
appropriateness. The research questions, pilot study, instrument used, sampling frame, informed
consent, confidentiality, and geographic location is addressed. Other areas covered in this chapter
include data collection, triangulation, observation memorandums, data recordings, data analysis,
and validity and reliability.
Research Design
Research both in nursing and education have used phenomenology to describe lived
experiences of individuals. Phenomenology is a design used to provide information about a
phenomena. Inner subjectivity is what provides truths about the persons perceptions and their
environment is what also affects this information (Flood, 2010).

Appropriateness of Design

Research Questions
What are the perceptions of practicing nurses who are required to
return to school due to Magnet regulations?
How do these perceptions affect the practicing nurses workplace?
How do these perceptions affect the practicing nurses educational
journey?

(Pilot Study? Questions Development?) How will you validate your interview questions?)
Instrument?

Sampling Frame
The population for this study will include registered nurses who have been required to
return to school due to Magnet regulations within their healthcare facility they are employed.
The sample size will be 12 registered nurses from an on-line university. The participants will be a
purposeful sample on a voluntary basis from across 50 states. A letter will go out to potential
participants who fit the criteria and volunteers will be collected until the sample size is full. The
sample size was determined by.
Informed Consent
The invitation letter will be emailed to potential participants. A phone call will follow up
the invitation to answer any questions and to solicit participation. A copy of this letter is in
Appendix A. An informed consent will be important in this phenomenological study to provide
the necessary trust and protection for the participants.

Confidentiality

Geographic Location

Data Collection

Triangulation

Observation Memorandums

Data Recording

Data Analysis

Validity and Reliability

Summary /Transition into Chapter 4

References
Akansel, N., Tunkc, G., Ozdemir, A., & Tugutlu, Z. (2012). Assessment of burnout levels among
working undergraduate nursing students in turkey: Being a full time employee and
student. International Journal of Caring Sciences, 5(3), 328-334. Retrieved from
http://search.proquest.com/docview/1114168337?accountid=35812 Cristobal, J., Pilar,
M., & Carmen, V. (2009). Stress and health in novice and experienced
nursing students. Journal of Advanced Nursing, 66(2), 442-455. doi: 10.1111/j.13652648.2009.05183.x
American Nurses Credentialing Center. (2013). Magnet recognition program faq: Data and
expected outcomes. Retrieved from http://www.nursecredentialing.org/DEO-FAQ
American Nurses Credentialing Center. (2010). Certification policies. Retrieved from
http://www.nursecredentialing.org/default.aspx
Flood, A. (2010). Understanding phenomenology. Nurse Researcher, 17(2), 7-15. Retrieved
from http://search.proquest.com/docview/200780602?accountid=458
Jones-Schenk, J. (2001). How magnets attract nurses. Nursing Management, 32(1), 40-42.

Jimenez, C., Navia-Osorio, P., & Diaz, C. (2010). Stress and health in novice and experienced
nursing students. Journal Of Advanced Nursing, 66(2), 442-455. doi:10.1111/j.13652648.2009.05183.x
Montes-Berges, B., & Augusto, J. (2007). Exploring the relationship between perceived
emotional intelligence, coping, social support and mental health in nursing students.
Journal Of Psychiatric & Mental Health Nursing, 14(2), 163-171.
Sprinks, J. (2012). An ever-increasing workload is causing burnout and exhaustion. Nursing
Standard, 26(25), 12-13.
Van Bogaert, ,., Clarke, S., Wouters, K., Franck, E., Willems, R., & Mondelaers, M. (2013).
Impacts of unit-level nurse practice environment, workload and burnout on nurse
-reported outcomes in psychiatric hospitals: A multilevel modelling approach.
International Journal Of Nursing Studies, 50(3), 357-365.
doi:10.1016/j.ijnurstu.2012.05.006