Magnet Hospitals 1

Running head: MAGNET HOSPITALS

Magnet Hospitals: The Magnetic Field of Nursing

Kathryn Herman

Queens University of Charlotte

 Magnet Hospitals 2
Abstract

This paper explores the early development, implementation, and future evolution of Magnet

Hospitals. Beginning with the first inquiries into what characteristics gave hospitals magnetism,

through the development of the American Nurses Credentialing Center, on into the Magnet

Recognition Program’s present and possible future. This paper addresses the importance of

magnet accreditation in the safety and satisfaction of professional nurses, the correlation between

magnet hospitals and patient health, as well as the innovation and future direction of the current

magnet hospital program in the United States.

 Magnet Hospitals 3

For the past twenty years the American Nurses Association has taken special interest in

uncovering, defining, and promoting the characteristics that make an elite few of the nation’s

hospitals better at nursing care than the vast majority (ANCC 2009). The reason that the full-

service professional organization representing nearly three million registered nurses in the

United States has been interested in distilling and reproducing the essence of what makes this

elite minority of hospitals better than the rest is that these hospitals attract and retain the best

healthcare professionals in the country. This overwhelming draw has been described as

magnetism, and this magnetic attraction is what the American Nurses Association believes is

responsible for creating the best environment not only for nurses, but also for patients and

physicians (Armstrong 2006). Hospitals approved by the American Nurses Association’s

Magnet Program boast higher recruitment and retention rates for professional nurses,

demonstrate higher quality of patient care and patient outcomes, and foster a climate of change in

the innovative field of healthcare (Stein 2000). To better understand Magnet Hospitals it is

important to explore the program’s history, its current philosophies and successes, and to gain

insight into how the program will likely evolve in the years to come.

Florence Nightingale is one of the first and most recognizable nursing theorists. As early as the

1850s, Nightingale studied preventable deaths in British military hospitals using statistical

analysis and the polar-area diagram (Nightingale 1999). Pioneering innovation in her own field,

Nightingale opened the door for others to objectively measure and mathematically analyze

conditions inside the hospital using data collection, tabulation, interpretation of collected data,

and graphical presentation of descriptive statistics (Nightingale 1999). Almost fifty years after
 Magnet Hospitals 4
Nightingale’s contributions to the field of nursing, the United States saw the formation of a

professional group called the Nurses Associated Alumnae. By 1911 the group changed its name

to the American Nurses Association (ANCC 2009). The American Nurses Association’s

statement of purpose is to foster high standards of nursing practice, promote the economic and

general welfare of nurses in the workplace, project a positive and realistic view of nursing, and to

lobby the United States Congress and regulatory agencies on health care issues affecting nurses

and the general public (ANCC 2009). In 1983 the American Academy of Nursing’s Task Force

on Nursing Practice in Hospitals conducted a study of 163 hospitals. The task force’s job was to

identify and describe variables that created an environment that attracted and retained well-

qualified nurses who promoted quality healthcare. Forty-one of the 163 institutions were

described as "magnet" hospitals by the task force because of their ability to attract and retain

professional nurses. The characteristics that the study identified as distinguishing "Magnet"

organizations from others became known as the "Forces of Magnetism" (ANCC 2009). The

American Nurses Association used the findings of this study to establish a non-profit

organization called the American Nurses Credentialing Center in 1990. Four years later the

ANCC accredited the University of Washington Medical Center in Seattle as the first designated

Magnet organization in the United States (Aiken 1994). According to the 2008 census there are

approximately 5,000 hospitals operating in the U. S., and of them only about 200 are designated

Magnet Program hospitals (AMA 2009). Healthcare is big business, and in a country full of

competition it is important to set your business apart from the competition--not only to attract

clients, but also to recruit the best professionals in the field.

 Magnet Hospitals 5
There are a total of fourteen Forces of Magnetism that help Magnet Program hospitals

distinguish themselves from the competition (ANCC 2009). The first involves the quality of

primarily unit-based nurse leadership in Magnet Hospitals. The second deals with an

organizational structure that emphasizes knowledgeable, risk-taking nurse leaders who follow an

articulated philosophy of nursing and actively demonstrate support for hospital staff. The third

Force of Magnetism is a participative management style that incorporates staff feedback. Next,

competitive salaries and benefits that make the personnel policies and programs inclusive of

flexible staffing models and clinical promotional opportunities is the fourth Force of Magnetism

(ANCC 2009). The fifth Force is a professional model of care that gives nurses responsibility

and authority for the provision of patient care. Sixth involves providing high quality of care with

nurses in leadership positions who help develop the environment necessary for providing such

care. Quality Improvement (QI) is the seventh Force of Magnetism, ensuring that staff nurses

participate in educational activities that strive to excel beyond the status quo in terms of quality

healthcare. Having adequate consultation and resources available, including knowledge experts

such as advanced practice nurses, is the eighth Force that sets Magnet Hospitals apart from other

hospitals (ANCC 2009). When nurses are not only permitted, but also expected to practice

autonomously with regards to professional standards, a hospital is demonstrating the ninth Force

of Magnetism. The tenth Force Magnet Hospitals strive for is the recruitment and retention of

nurses with a strong community presence. Eleventh, Magnet Hospitals, more than other

hospitals, seek to incorporate teaching in every aspect of their healthcare practice. The number

twelve Force of Magnetism as defined by the American Nurses Association deals with a

hospital’s view of nurses as integral to its ability to provide patient care services. Positive

interdisciplinary relationships form the thirteenth Force of Magnetism. Finally, Magnet

 Magnet Hospitals 6
Hospitals place significant emphasis on all types of education and professional growth and

development opportunities (ANCC 2009). Attracting the best and brightest nurses the country

has to offer is just the foundation of what makes a Magnet Hospital stand out among its peers.

Magnet Hospitals have the best nurses in the country working for their hospitals, and the level of

patient care is head and shoulders above their competition (Armstrong 2006). Florence

Nightingale addressed the needless deaths attributed to unsanitary hospital conditions for British

military soldiers during the Crimean War (Nightingale 1999). The Magnet Recognition

Program, in a similar fashion, addresses modern issues with patient care that contribute to

lowering mortality rates and increasing overall safety for patients in Magnet Hospitals. A study

was published in 1994 that concluded that there was significant evidence that administration by

Magnet Hospitals resulted in a 5% reduction in patient mortality among their Medicare

discharges (Aiken). The study went on to suggest that the cause for the greater reduction in

mortality rates for Magnet Hospitals was the organization of nursing care within these facilities

(Aiken 1994). A more recent study has discovered that the increased emphasis on empowerment

and professional practice environment conditions within Magnet Hospitals not only decrease the

mortality rate for patients, but also significantly increase patient safety for their facilities

(Armstrong 2006). Magnet Hospitals are shown to employ more nurses, reducing the workload

for individual nurses and increasing the quality for each nurse’s patient care. The reduction in

workload also reduces the rates of professional burnout, and that can lead to an increase in

patient safety when nurses are more alert and less encumbered by an exhaustive workload.

Magnet hospitals show significant decreases in medication errors, patient falls occurring with
 Magnet Hospitals 7
injuries, and nosocomial infections to list just a few of the examples of the Magnet Program’s

effects on patient safety (Armstrong 2006).

Over the course of the last three decades the Magnet Hospital program has lead to improvements

and innovations for the field of healthcare, but the deeper development of the program has not

yielded during those few years. Recently, the ANCC has adopted a streamlined set of five

Model Components for their Magnet Recognition Program. Each of the five Model Components

contains one or more of the original fourteen Forces of Magnetism (ANCC 2009). The new

Model for the Magnet Recognition Program summarizes the most important qualities of an

exceptional hospital as containing Transformational Leadership; Structural Empowerment;

Exemplary Professional Practice; New Knowledge, Innovations, and Improvements; and finally

Empirical Quality Outcomes. This simplified Model makes it easier not only to identify the key

attributes of the most successful hospitals, but also why those attributes attract and maintain the

best and brightest nurses. As of 2008, the ANCC Magnet Application Manual began

incorporating these five components as the primary criteria for achieving Magnet recognition

going forward. Another recognition the ANCC can accredit to a hospital is the Pathways to

Excellence designation. Adapted from the 2003 Texas Nurses Association’s Texas Nurse

Friendly Hospital Initiative, the Pathways to Excellence program has established 12 practice

standards to improve the work environment and increase worker retention for professional nurses

(Wood 2009). Taking over the Texas Nurse Friendly Hospital Initiative in 2007, the ANCC has

spent 2008 and 2009 transitioning to the new program. Included in the Pathways to Excellence

recognition program are practice standards such as control of nursing practice, safety of the work

environment, systems addressing patient care concerns, solid nurse orientation, establishing a
 Magnet Hospitals 8
chief nursing officer who is involved at all levels of the hospital organization, developing

professional opportunities, maintaining competitive wages, recognizing nurse achievement,

balancing nurses’ lifestyles, having exemplary interdisciplinary collaboration, holding leadership

accountable, and enforcing quality initiatives. This alternative program places less emphasis on

nursing research and gives hospitals another option for striving to improve working conditions

for their nurses (Wood 2009).

The Magnet Hospital program has shown compelling evidence that by enhancing personal

empowerment, career satisfaction, and professional credibility among nurses increases

recruitment and retention of the most highly qualified nursing professionals in the country.

Hospitals participating in the ANCC’s certification programs show evidence of lower patient

mortality rates and an increase in patient safety. By building a strong foundation for the

administration of its medicine, Magnet Hospitals are sought after by patients and physicians

looking for the best hospitals in the United States. The program is so successful in this country

that it has begun to spread to other countries around the world. The field of nursing is

intrinsically tied to science, technology, and innovation, and programs like the Magnet

Recognition Program and the Pathways to Excellence Program assure that the field will strive to

improve itself through such innovations well into the future.

 Magnet Hospitals 9

References

Aiken, L., Smith, H., Lake, E. (Aug., 1994). Lower Medicare Mortality among a Set of Hospitals

Known for Good Nursing Care. Medical Care. Vol. 32, No. 8, pp. 771-787.

American Nurses Credentialing Center. (Oct., 2009). Board Certification of Nurses Makes a

Difference. Retrieved from http://www.nursecredentialing.org/default.aspx

American Medical Association. (Oct., 2009). Physician Characteristics and Distribution in

the U. S. Retrieved from http://www.census.gov/prod/2008pubs/07ccdb/taba6.pdf

Armstrong, K., Laschiner, H. (2006). Structural Empowerment, Magnet Hospital

Characteristics, and Patient Safety Culture: Making the Link. Journal of Nursing Care

Quality, Vol. 21, No. 2, pp. 124-132.

Nightingale, F. (1999). Measuring Hospital Care Outcomes. Oakbrook Terrace, IL. Joint

Commission on Accreditation of Healthcare Organizations

Stein, T. (11 May, 2000). Respect Breeds Contentment: Magnet hospitals tend to attract and

retain nurses. Retrieved from http://www.nurseweek.com/features/00-05/magnet.html

Wood, D. (2009, October 10). ANCC’s Pathways to Excellence: Commitment to Good Nursing

Environments. Retrieved from http://www.nursezone.com/Nursing-News-Events/more-

features/ANCC%E2%80%99s-Pathway-to-Excellence-Commitment-to-Good-Nursing-

Environments_32216.aspx