Magnet Aspirations Can Give Hospitals a Path to Excellence

Ann Kutney-Lee, PhD, RN, FAAN and Linda H. Aiken, PhD, RN, FAAN

More than 400 hospitals nationwide have been recognized as Magnet hospitals by the American Nurses Credentialing Center for demonstrating excellence in nursing. The link between Magnet status and better patient outcomes and better working environments for nurses when compared with hospitals that have not achieved Magnet status is well-established.(1) What is less clear is whether hospitals that have attained this status were already excellent or whether they achieved excellence through the rigorous process of working toward Magnet certification.

We conducted and recently published one of the first longitudinal studies to address that question, and the answer is that the work that must be done during the extensive application and review process to attain Magnet status substantially improves nurse work environments and better outcomes for patients and for nurses result.(2)

We analyzed 1999 to 2006 data for 136 Pennsylvania hospitals (11 hospitals that went through the Magnet review process and 125 that did not). And overall, those hospitals that pursued and obtained Magnet status made significant and lasting change at the patient, nurse and organizational levels.

The study, “Changes in Patient and Nurse Outcomes Associated With Magnet Hospital Recognition,” recently published in Medical Care, found that in 1999, hospitals pursuing Magnet status performed at the same level as or worse than non-Magnet hospitals on a range of measures, including risk-adjusted rates of mortality 30 days after surgery, and failure-to-rescue. By 2006, emerging Magnets had progressed significantly ahead of their non-Magnet counterparts, demonstrating markedly greater improvements including 2.4 fewer deaths per 1,000 patients for 30-day surgical mortality, 6.1 fewer deaths per 1,000 patients for failure-to-rescue, and lower adjusted rates of nurse burnout, job dissatisfaction, and intent to quit.

While becoming a Magnet hospital is a significant undertaking – and can be a costly one – our findings, coupled with the body of research documenting that Magnet hospitals provide higher quality care, establish a strong business case for pursuing Magnet status. Even the process of working toward certification boosts patient safety and increases retention of nursing staff, which saves the cost of recruiting and training new hires. Further, our results are consistent with another recent study published in Medical Care that demonstrates the economic benefits associated with Magnet status.(3).

We undertook a longitudinal study because nearly all previous studies of Magnet hospitals have relied on a cross-sectional design, which limits the researchers’ understanding of the causal relationship between Magnet status and improved outcomes.  With this longitudinal evidence, our study can give hospital leaders a different perspective on the potential for improvement. And the take-away for them is that pursing Magnet status is an investment that’s well worth it.


1. McHugh MD McHugh MD, Kelly LA, Smith HL, Wu ES, Vanak J, Aiken, LH.  2013.  Lower mortality in Magnet hospitals.  Medical Care.  51:382-388. 
2. Kutney Lee A, Stimpfel A, Sloane DM, Cimiotti J, Quinn LW, Aiken LH.  2015.  Changes in patient and nurse outcomes associated with Magnet hospital designation.  Medical Care.  53(6):550-557.
3. Jayawardhana J, Welton JM, Lindroth RC. 2014. Is there a business case for Magnet hospitals? Estimates of the cost and revenue implications of becoming a Magnet. Medical Care.52:400-404.


Ann Kutney-Lee, PhD, RN, FAAN, is an assistant professor of nursing at the University of Pennsylvania School of Nursing and Linda H. Aiken, PhD, RN, FAAN, is a professor and the director of the Center for Health Outcomes and Policy Research at the University of Pennsylvania School of Nursing. Their study was funded by the Robert Wood Johnson Foundation Initiative on the Future of Nursing.

The Nursing Profession in 2014

Top nursing leaders make predictions of nursing trends to watch for in 2014, based on what has been happening in the field over the past year, in a recent NurseZone.com article.

Leaders agree that the profession will continue implementation of the Institute of Medicine’s (IOM’s) 2010 landmark report The Future of Nursing: Leading Change, Advancing Health recommendations, which include increasing the presence of nurses on hospital, state, and federal boards.

Without nurse leadership on boards “… our perspective is missing, and it’s an important perspective,” said Karen Daley, PhD, RN, FAAN, president of the American Nurses Association. “We speak for the patients. There’s no one closer to the everyday needs and care that we provide.”

Focus on patient safety, particularly in the areas of alarm management and the prevention of healthcare-acquired infections will also continue to be priorities for the industry, according to Vicki Good, RN, MSN, CENP, president of the American Association of Critical-Care Nurses.

Rollout of the Affordable Care Act (ACA) will continue to have an impact on nurses, including increased use of community-based settings for health care delivery, Daley said. New nurses may begin their careers in such settings, rather than at hospitals. As a result, the educational system may need to recognize and accommodate this trend, Daley said.

The Future for Nurse Practitioners 

The momentum to expand scope of practice for nurse practitioners could continue to build in 2014. In 2013, Nevada became the most recent state to pass a law granting nurse practitioners the freedom to practice independently, bringing the total to 17 states.

“I believe that other states will move slowly but will eventually see the resource that they have in nurse practitioners and be more willing to grant them the ability to practice in accordance with their education,” said Kenneth P. Miller, PhD, RN, CFNP, co-president of the American Association of Nurse Practitioners.

As the ACA seeks to increase medical services for the previously uninsured and underinsured, nurse practitioners must be included. “It is going to take all health care providers working together to achieve that goal,” Miller said.

Opportunities and Challenges Ahead

As the economy improves, many nurses may finally retire, leaving job openings for newer nurses in clinical settings. However, this trend could be a challenge for the academic world as nursing educators and nursing school deans retire and leave gaps that may be difficult to fill, experts said.

The nursing leaders told NurseZone that individuals must remember why they went into nursing and keep their focus, no matter what the future holds.

INQRI in the News

HealthLeaders Media highlighted the INQRI program, and the importance of nurses to quality of care, in its recent article “Interdisciplinary Care Starts with Respect for Colleagues.” Managing editor Alexandra Wilson Pecci writes that it is time to upend the hospital hierarchy, where power starts with physicians and flows down to nurses, particularly within interdisciplinary care. “Instead of this top-down hierarchy, I believe all branches of health care should function as equals,” Pecci said. “The responsibilities of nurses, physicians, pharmacists, and other members of the clinical care team are certainly different, but none is more or less important to patient care. All members of the team are needed for their own, particular skills.”

The new INQRI-funded study “Scope-Of-Practice Laws For Nurse Practitioners Limit Cost Savings That Can Be Achieved In Retail Clinics,” continues to receive media coverage, most recently on the Reuters Health Globalpost website.  The study is led by Joanne Spetz and Stephen Parente.

Addressing Gender Divide and Improving Shared Educational Opportunities Could Spur More Interdisciplinary Collaboration

Lack of interdisciplinary collaboration remains a significant challenge for practicing nurses and other health care professionals and key barriers may include historical gender gaps and the lack of interprofessional educational experiences, according to the authors of a new article in The Online Journal of Issues in Nursing published by the American Nurses Association.

Many studies have shown that collaboration among nurses, physicians, and other members of the care team can improve the outcomes of care for patients. However, authors Karen Bankston and Greer Glazer argue that something often “gets in the way” of this happening.
 
“Medicine continues to be a male-dominated profession … while nursing continues as a female-dominated profession. These gender differences may continue to support gender bias and role expectations that are not conducive to collaborative behaviors,” the authors said.
 
In order for more collaboration to occur, deeply entrenched superior/subordinate relationships between medicine and nursing will need to be set aside. Additionally, more constructive dialogue is needed regarding each discipline’s scope of practice and the inter-dependencies between the disciplines, according to the authors.

Segregated educational programs for medicine and nursing could also be hindering professional collaboration in the field.  “We believe that our best opportunities for a successful transition to collaborative practice are to begin the socialization of our students to a collaborative environment when they enroll in our colleges. ... We recommend that nursing programs develop collaborative initiatives and joint experiences with other professions, while recognizing that the underlying issues of hierarchy, trust, valuing each other’s contributions, and sharing of power need to be addressed,” Bankston and Glazer said.

Several INQRI-funded projects have studied the impact of interprofessional collaboration on patient outcomes, including: “Implementation and Dissemination of an Interdisciplinary Nurse-Led Plan to Manage Delirium in Critically Ill Adults” and  “Multidisciplinary Organization and Outcomes for Chronic Heart Failure Patients in the VA.”

INQRI In the News

A new INQRI-funded study, which shows that retail clinics can reduce costs when Nurse Practioners (NPs) practice independently, is making headlines. The study, led by Joanne Spetz and Stephen Parente is in current issue of Health Affairs.

News media and blog coverage has included the Albuquerque Business Journal, which notes that New Mexico allows NPs autonomous practice. The study was also covered in The Lund Report and The Incidental Economist.

Additionally, the INQRI-coordinated study to examine whether public reporting laws are effective in encouraging hospitals to improve nurse staffing levels and improving patient outcomes is also receiving attention, recently being featured on News-Line.com.