Magnet status: What it is, what it is not, and what it could be
Also see our piece in Advance for Nurses "Magnet Status should be a floor, not a ceiling" published June 8, 2015 (or as a pdf)
Magnet status is an award given by the American Nurses' Credentialing Center (ANCC), an affiliate of the American Nurses Association, to hospitals that satisfy a set of criteria designed to measure the strength and quality of their nursing. A Magnet hospital is stated to be one where nursing delivers excellent patient outcomes, where nurses have a high level of job satisfaction, and where there is a low staff nurse turnover rate and appropriate grievance resolution. Magnet status is also said to indicate nursing involvement in data collection and decision-making in patient care delivery. The idea is that Magnet nursing leaders value staff nurses, involve them in shaping research-based nursing practice, and encourage and reward them for advancing in nursing practice. Magnet hospitals are supposed to have open communication between nurses and other members of the health care team, and an appropriate personnel mix to attain the best patient outcomes and staff work environment. We encourage all nurses to learn more about the principles of Magnet certification, and to consider appropriate nursing certification programs for their hospitals.
We understand that some nurses are enthusiastic about the program and feel that it promotes the important practices outlined above. However, it is important to be aware that others, notably nursing unions, have been highly critical of the way the Magnet program has been implemented. Some critics, including the California Nurses Association and the Massachusetts Nurses Association, have argued that the Magnet program is primarily a hospital promotion tool that resembles the Joint Commission on Accreditation of Healthcare Organizations in its seemingly incestuous relations with hospital management. Such critics have also asserted that there is little evidence that nurses at Magnet hospitals are really much better off than nurses elsewhere. We are concerned about the Magnet program being a an illusory program that gives the impression of nursing excellence without actually achieving it. Many nurses have written to us to say that once Magnet certification has been awarded at their hospitals, Magnet coordinators and teams are immediately fired and all the progress made through the Magnet application process is dismantled. We have heard many first-hand reports of some hospitals trumpeting their new Magnet status even as they proceed to betray some of the program's key principles.
If you work or have worked at such a hospital, we urge you to report your experiences on the Hospital Safety Reviews website so this information can become public and everyone can be aware of what is happening. Thank you!
Research comparing Magnet to non-Magnet hospitals
A 2013 study by Matthew McHugh, Linda Aiken and colleagues found that Magnet hospitals have 14% lower mortality risk and 12% lower failure to rescue rates. See the AMN Healthcare report.
A 2011 study by Colleen Goode and colleagues found that Magnet hospitals provide better care for pressure ulcers, and had higher quality of care, innovations in practice and nursing excellence. But non-Magnet hospitals had better infection control and less post-operative sepsis. Non-Magnet hospitals had better staffing, with 30 RN hours per unit more per week. See the AJN report.
An October 2011 study by Linda Aiken and colleagues found that Magnet hospitals "have better work environments, a more highly educated nursing workforce, superior nurse-to-patient staffing ratios, and higher nurse satisfaction than non- Magnet hospitals."
A July/August 2010 study by Alison Trinkoff and Meg Johantgen published in the Journal of Nursing Administration found that magnet hospitals do not have any better working conditions than non-magnet hospitals.
To the extent the Magnet program is not effectively promoting its important nurse empowerment goals, we would like to see it strengthened. In general, we hope that all nurses will work for strong, effective nursing credentialing programs to address the nursing crisis and improve patient care.
Frankly, the Truth has heard from a number of nurses who are unhappy with the changes at their hospitals since the award of magnet status, and we have not heard from many who are happy. One report was that the nurse who had led the drive for magnet status was fired soon after the hospital received it, and that the magnet reforms quickly began to unravel. Others have said that their hospitals reverted to short-staffing and excluding nurses from decision-making processes soon after receiving magnet certifications. Such reports support the claims that some hospitals are treating magnet status mainly as a promotional tool, and that the program is not effectively monitoring compliance.
The Truth About Nursing's suggestions on how to improve the Magnet Program
In June 2006, the Truth About Nursing's founder and executive director, Sandy Summers, sat on an expert panel about the Magnet Program for The World Congress Leadership Summit for Chief Nursing Officers in Chicago, Illinois. In this presentation she encouraged the Magnet Program to incorporate the following ideas:
Magnet facilities should not be reservoirs for dangerous organisms such as MRSA. Each magnet facility should:
- Create health care environments using evidence-based designs to promote better patient outcomes and less stress on nurses. For guidance, seek help from The Nursing Institute for HealthCare Design.
- provide uniforms for all staff who have contact with patients;
- wash these uniforms at temperatures sufficient to render them clean;
- provide adequate showering facilities for all staff so that all organisms are not brought out into the community and home to families;
- require that all staff change out of uniforms and shower before leaving the facility. See our analysis on this issue.
Each Magnet facility should be a safe place for patients and nurses. They should be:
- Latex-free facilities
- Mercury-free facilities
- Free of toxic cleaning chemicals that lead to illness.
Guidelines for creating safe facilities can be found on Sustainable Hospitals and Health care without harm
Green and organic environments
Magnet hospitals should be green facilities, that recycle, compost, separate out electronic waste and serve only cholesterol-free organic food in their food facilities.
See Health Care Without Harm; and
Greening the NICU: An Expert Interview With Kathi Randall, RNC, MSN, CNS, NNP-BC on Medscape.
Improve hospital policies to protect and support nurses
- Each institution should have "no lift policies" and appropriate lifting equipment. (See Franken bill on no lifting.)
- Magnet hospitals should have needleless IV systems and safe needles.
- There should be zero tolerance for abuse practices and procedures.
- Critical incident stress debriefing sessions should be offered to all employees who suffer physical or sexual assault of any kind.
- Hospital attorneys should pursue with police and the district attorney, the cases of employees who have been assaulted, physically or sexually, while at the hospital.
- Adequately address nurse fatigue.
- When considering patient assignments, patients being admitted or discharged should count as 2 patients to account for the higher mortality associated with bed turnover.
- All care should be delivered by Registered Nurses (RNs) such as is the case at Hahnemann Hospital in Philadelphia.
- The nursing model should be a primary care nursing model, not a team model.
- Magnet hospitals should have at least one-year nursing residencies for all new nursing graduates. (Studies (1, 2) show that nurses who went through residencies had about a 90% retention rate. Without residencies, a third to more than half of nurses leave the profession.) See our discussion of nursing residencies.
- Each unit of each hospital should have at least one clinical nurse specialist on duty 24 hours per day, seven days per week.
- Magnet hospitals should not recruit nurses from nations with shortages more dire than their own. When hospitals increase staffing by taking nurses from countries that desperately need them, it violates nurses' ethical obligations to the needs of our patients around the globe.
- Each nursing manager should be a clinical nurse specialist in a relevant field for his unit.
- Each nursing manager should have a full-time administrative assistant to help with paperwork and budgetary duties to allow managers the time to focus on nursing excellence, instead of clerical duties.
- Nursing managers should practice clinical nursing on his/her unit at least 16 hours per week.
- Over 50% of staff nurses on each unit should be certified in their fields.
- Each facility should have at least three centers for nursing professional improvement; one each to strengthen nursing research, nursing clinical practice and nursing education within the hospital.
- Efforts should be made to provide zero distractions to nurses as they perform critical tasks such as medication administration. (see article.)
- Build nurse-designed models of care
Strengthen nursing managers
- The chief nursing officer should have at least a master's degree in nursing.
- Nursing managers should have significant and ongoing management training.
- Nursing managers who do not receive positive evaluations by more than 80% of nurses who work under them should be replaced.
- New nursing manager hires should be interviewed by the staff nurses they will supervise.
- Charge nurses should be allowed to set the staffing levels on their floors determined by what nurses feel they can safely handle; and filled staffing should be filled by an appropriate mix of nurses based experience and expertise.
- Basic minimum nurse-to-patient ratios should be set no higher than those set by the current California legislation, whether or not the institution is located in California.
- Nurse-to-patient ratios should be posted very visibly for visitors to see on every unit and updated every shift.
- Nurses should receive full tuition reimbursement for education that will enable them to stay in nursing or public health.
- Hospitals should pay for at least 15 hours of continuing education hours for each nurse per year.
- From the day they begin work, all employees, including part-time employees, should be provided with health insurance for themselves and their families.
- All employees, including part-time employees, should be provided with retirement benefits.
- At least half of the public relations officials at Magnet hospitals should be charged with solely promoting nursing.
- When a hospital loses its magnet status, the Magnet Credentialing Center should send press releases to at least the two largest newspapers in the area, the four major television networks and local news radio stations regarding the removal of magnet status and the specific reasons why the status was removed.
Strengthen credentialing process
- The Magnet Credentialing Center evaluators should come to evaluate hospitals at a surprise time.
- The Magnet Credentialing Center should choose hospital staff members they wish to interview--not allow interviewees to be hand-picked by hospital managers.
- The Magnet Credentialing Center should separately contact, through home mailing addresses, all nurses who works at the institution to inform them of policies by which they can report infractions by hospitals.
- The Magnet Credentialing Center now has an anonymous tip line to report hospital misbehavior, which is recent since we last reviewed the ANCC informationi. We applaud this action.
Collaboration between the professions
- The professions should have recurrent training in how to function as a team.
- Physicians should be expected to seek nursing input on patient rounds and morbidity and mortality rounds.
- Physicians and medical students should follow nurses at work for at least 12 hours per year so that they can understand the value of nursing and how to collaboratively work with nurses.
- Magnet hospitals should have an incivility and bullying hotline to address all acts of reported incivility by a committee that is comprised of at least half staff nurses.
Magnet hospitals should be nursing institutions
- At least 51% of the board of trustees should be nurses.
- The CEO of the hospital should be a nurse.
Magnet hospitals should seek to provide the best care possible based on the latest research
- Magnet hospitals should be non-profit institutions. Corporate profits have no ethical place in the delivery of health care. Studies show that non-profit nursing homes provide better care than for-profit nursing homes.
- Uninsured patients should pay no more for any service, procedure or item than the lowest amount accepted by the hospital from any private or government insurance program.
- Absolutely no dumping of patients should occur.
- Patients should not be woken to have labs drawn. If physicians want lab results with their rounds, they should come to the hospital at noon or later, so lab draws do not interrupt sleep and patient health.
Magnet hospitals should exist to provide humane care to all patients
- Music in should be provided in rooms of all patients. A growing body of research shows that music reduces pain, blood pressure, depression, physical signs of stress and cortisol levels. See this interesting research in many different studies by nurses from Japan, South Korea and Sweden. Music affects the blood pressure of pregnant women more intensely.
- Noise should be reduced as much as possible. See the nursing research.
- Hospitals should institute The Pause after someone dies to take a moment to reflect on the person's life, and efforts of the health workers to save them. See more about it on the website of Jonathan Bartels, who is a nurse, and the innovator of the practice.
- Magnet hospitals and each person who works in them including physicians, should adhere to the principles of accepting no gift from any pharmaceutical company or medical supply company, and be a member of No Free Lunch.
- Being that hospitals are nursing institutions, the ethics committee should be comprised of at least half nurses.
- Magnet hospitals should follow the Code of Ethics for Nurses.
Overall changes to the magnet program
The Magnet program should be a government program to which all hospitals must adhere.
Above is the list of changes and improvements to the Magnet program that our executive director presented to the World Congress of Nurses in June 2006. We would like to hear what all nurses (and patients) think of Magnet hospitals and our suggestions for improvement, especially those who are at magnet facilities.
Please let us know your experiences with Magnet hospitals at email@example.com. Thank you!
The list for suggested improvements to the Magnet program expressed herein are those of Sandy Summers, RN, MSN, MPH, the Truth About Nursing's founder and executive director. They do not necessarily reflect those of the Board Members or Advisory Panel of The Truth About Nursing.
Last updated October 2, 2016
(Formerly titled "What is Magnet status and how's that whole thing going?")