Magnet Program rates hospital nursing quality
Participants are benchmarked against the best
(Editorial note: This is the first of a two-part series looking at the American Nurses Credentialing Center Magnet Recognition Program. This month, Healthcare Benchmarks gives readers an overview of the program and what the 20 hospitals and one long-term care facility around the country had to do to gain the recognition. Next month, HB will take an in-depth look at some of the hospitals that have made the mark.)
There are dozens of studies that link quality of nursing care at a hospital with positive patient outcomes. There are investigations that show that when nurses are satisfied with their jobs, patients do better. And now, there’s even a way that hospitals can measure themselves against the best of the best when it comes to nursing practice.
In fact, the Magnet Recognition Program of the American Nurses Credentialing Center in Washington, DC, has been in place for the better part of a decade, says director Carolyn Lewis, RN, PhD.
"It was created in part as a response to the nursing shortage of the 1980s," she says. "Some hospitals weren’t suffering from the shortage, and we wanted to know how they could recruit and retain quality nurses when others couldn’t."
Some empirical research followed that looked at 41 facilities which, by reputation, were considered "magnet" facilities. The result was a list of 14 characteristics shared by those hospitals.
Linda Aiken, RN, PhD, the president of the American Academy of Nursing at the time of the initial study, conducted the initial research and has continued to look at so-called magnet hospitals — facilities that are good at attracting and keeping the best quality nursing staff.
In some of her research,1 she found that some of the shared characteristics of magnet hospitals include:
- the nurse executive as part of the hospital board, indicating the importance with which nursing is viewed by hospital administrators;
- flat organizational structures for nursing;
- decision making done at the unit level, including staffing and patient care whenever possible;
- administrative support for nursing decisions about patient care;
- good communication between physicians and nurses.
Aiken found that magnet hospitals continued to improve nursing over the years. They were more likely to move to all RN staffing; they worked to increase nurse-to-patient ratios; they tried to make RNs salaried staff, not hourly workers; and they promoted shared governance structures.
The pilot program started in 1992. About 140 hospitals were studied, and 40 earned the magnet designation. "Then we put the program on hold while we evaluated it," says Lewis. It started up again in 1994. Since then, 20 hospitals, seven of them in New Jersey, have earned the designation, along with one long-term care facility. Three other long-term care facilities have applications pending, Lewis adds.
Not every facility that goes through the rigorous application process is approved; in 1998, there were only 13 approvals out of 85 applications. And although it has never happened, the designation can be stripped from a facility if routine updates find the hospital lacking in some way, or if a complaint and investigation show something has gone amiss.
To qualify, a facility must meet criteria related to nursing administration standards set up by the American Nurses Association and the association’s quality indicators. The indicators include areas as diverse as rates of nosocomial infections, decubitus ulcers, falls, and how well the facility recruits and retains nurses.
A multiday site visit follows in which staff nurses are interviewed, records are reviewed, and care plans are analyzed. "They have to amplify, clarify, and qualify everything on their application," says Lewis. "We are looking for five-star facilities — for excellence, not minimum standards."
If approved, recognition lasts for four years. Recertification isn’t as rigorous an application procedure, but it’s still intensive, says Lewis. Yearly interim reports also must be sent in.
For facilities that don’t make the cut, Lewis says there is some direction to help them understand where they fell short. "But not everyone can be a magnet hospital," she says. "And while we do give a little feedback, we feel it is important for them to look in the mirror and identify the weaknesses they have themselves."
The cost depends on bed size, she adds, so that even small hospitals can afford it. "And we do have some smaller facilities that have qualified."
The interest in the program in the United States is growing, says Lewis, as is interest from abroad. At press time, Lewis was visiting the United Kingdom, where a hospital was going to pilot the program. There is also interest from Brazil and Canada.
"It is a program that recognizes nursing excellence but in which everyone from the custodial staff to the CEO feels ownership," she explains. "I have seen it. I have been to the facilities and witnessed that. There is an environmental milieu that is so conducive to nurses learning, to supporting nurses, to communicating as an interdisciplinary team. It empowers the nurse and is a powerful tool for recruitment and retention."
That’s a message hospitals may want to hear as they face another impending nursing shortage.
[For more information, contact:
- Carolyn Lewis, RN, PhD, Director, American Nurses Credentialing Center, Washington, DC. Telephone: (202) 651 7259.]
Reference
- Havens DS, Aiken LH. Shaping systems to promote desired outcomes: The magnet hospital model. J Nurs Adm 1999; 29:15-20.
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