The American Nursing Credentialing Center (ANCC) developed the notion of the Magnet® hospital during the 1980. The AANC conceived the Magnet status based on the attributes of 41 exemplary hospitals, which were selected due to their ability in retaining and attracting personnel amidst nursing shortages. The organizational strategies used in such hospitals and their human resources (HR) practices helped in the development of characteristics associated with the Magnet® hospital (Reigle, et al., 2008). The ANCC used the word “magnet” to denote the attraction that healthcare professionals had towards such Magnet hospitals having low rates of nurse turnover and vacancy. The ANCC maintains that the Magnet® Recognition Program (MRP) has the main objective of encouraging hospitals to enhance the working environment of their nurses, which can subsequently lead to positive patient outcomes. Currently, approximately 7 percent of general hospitals (390) have attained the Magnet Recognition from the ANCC. Various studies have been conducted to explore the relationship between Magnet Recognition and measures of patient and nursing outcomes. Current literature review focuses on the impact of Magnet Status recognition on patient and nursing outcomes.
Impacts on Patient Outcomes
The link between Magnet Status and measures of patient outcomes has been vastly explored in the literature. Chen, Koren, Munroe, and Yao (2014) performed a study having the objective of exploring the relationship between Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) and Magnet Recognition of hospitals. Chen, et al. specifically sought to identify whether significant differences exist between the HCAHPS scores for non-Magnet and Magnet hospitals. The authors also evaluated the degree to which the Magnet Recognition and other nursing and hospital attributes positively affected the HCAHPS scores. Chen and colleagues performed a cross-sectional analysis of secondary data obtained of 110 hospitals in Illinois that had Magnet and non-Magnet status over a course of one year. Patient satisfaction was measured using the HCAHPS survey, which focused on communication with nursing personnel and physicians, and the level of responsiveness of staff. The main topics of communication were discharge and medication information, pain management, quietness and cleanliness of the patient’s rooms, patients’ overall rating of the hospital and their willingness to recommend the hospital to others. The findings of the study showed that hospitals with Magnet Status reported higher HCAHPS scores when compared to non-Magnet hospitals. Based on the findings, Chen, et al. (2006) concluded that Magnet Status had a positive impact on patient satisfaction with care.
The relationship between patient satisfaction and Magnet Status was also studied by Smith (2014), who used a similar approach as Chen et al. (2014), involving HCAHPS surveys. Various authors agree that patient satisfaction determines the quality of care services provided by a hospital. For example, Smith (2014) compared patient satisfaction in non-Magnet, Magnet-in-Progress and Magnet hospitals. Data for the study was obtained from HCAHPS, ANCC and American Hospital Association databases. The results of the study showed that Magnet-in-Progress and Magnet hospitals had significantly higher patient satisfaction, as reported by HCAHPS scores, when compared to non-Magnet hospitals. The results were similar to those reported by Chen et al. (2014). Moreover, another study by Stimpfel, Rosen, and McHugh (2014) that compared 56 Magnet and non-Magnet hospitals reported the positive effect of Magnet Status on patient satisfaction. Overall, the studies have consistently reported the positive effect that Magnet Recognition has on patient satisfaction. In other words, hospitals with Magnet Status have higher patient satisfaction levels than non-Magnet hospitals.
Heath Outcomes/Quality of Care
Numerous authors have studied the association between Magnet Recognition and the various aspects of quality of care, particularly health outcomes, such as mortality rates, failure-to-rescue, pressure ulcers, and other indicators of quality of care. The relationship between Magnet Status and mortality rates has also been explored in the literature. Friese, Xia, Ghaferi, Birkmeyer, and Banerjee (2015) conducted a research study with the main aim of determining whether the Magnet Program had effectively recognized high-performing hospitals based on the mortality rates. The authors utilized national Medicare data in studying more than 1.9 million surgical patients in the course of 13 years. The data was sourced from approximately 1000 hospitals across the US. The study compared the mortality rates of Magnet hospitals with those of non-Magnet hospitals of the same size, features, and geography. After the controlling for the severity of the patients’ conditions, the study revealed that surgical patients who received treatment in Magnet hospitals were 7.7% less likely to die within one month after operation and 8.6% less likely to experience lethal outcome following a post-operative complication, when compared to patients who received treatment in non-Magnet hospitals. Nevertheless, the results of the study showed that patient outcomes in Magnet hospitals did not improve following the recognition, especially after three years. Friese et al. used their findings to suggest that, whereas the MRP played a crucial role in establishing excellence, it does not result in continuous improvements in patient outcomes.
The relationship between Magnet Status and mortality rates was also studied by Kutney-Lee, Stimpfel, Sloane, Cimiotti, Quinn, and Aiken (2015), who reported similar findings as those of Friese et al. (2015). Kutney-Lee et al. (2015) performed a study with the objective of comparing changes over time for surgical patient outcomes between Magnet and non-Magnet hospitals during the 199-2007 period. The authors used failure-to-rescue and 30-day morality rates for surgical patients. The findings of the study showed that Magnet hospitals had better improvements in failure-to-rescue and 30-day surgical mortality rate in the course of the study period when compared to non-Magnet hospitals. Specifically, Magnet hospitals reported 2.4 fewer deaths per 1000 patients (surgical mortality) and 6.1 fewer deaths per 1000 patients (failure-to-rescue) than non-Magnet hospitals. Magnet Status is linked to significant improvements over time in patient outcomes, which is contradicts with the findings reported by Friese et al. (2015), who reported that Magnet Recognition does not result in continuous improvements in patient outcomes. The findings of Kutney-Lee et al. (2015) contradicted with the findings of another study by Mills and Gillespie (2013) that compared patient outcome failure-to-rescue rates between Magnet and non-Magnet hospitals. Mills and Gillespie compared 160 hospitals, 80 Magnet hospitals and 80 non-Magnet hospitals found in urban areas. The authors did not report any significant difference between Magnet and non-Magnet hospitals with respect to failure-to-rescue rates.
Although Magnet hospitals perform better than non-Magnet hospitals in terms of patient satisfaction and mortality, some studies have reported that non-Magnet hospitals outperform their Magnet counterparts in some aspects of patient outcomes. For instance, Goode, Blegen, Park, Vaughn, and Spetz (2011) performed a study aimed at comparing patient outcomes in hospitals having Magnet Recognition with the other ones. The authors evaluated patient outcomes using pressure ulcers, falls, surgical infections, mortality rates, heart failure, and deep vein thrombosis. The results of the study showed that that Magnet hospitals outperformed non-Magnet hospitals in terms of pressure ulcers and mortality rates. The pressure ulcers rate reported by Goode and colleagues contradicts with the findings reported by Mills and Gillespie (2013), who found no significant difference in pressure ulcers between Magnet and non-Magnet hospitals. The finding of lower mortality rates in Magnet hospitals is also supported by Friese at al. (2015). However, Goode et al. (2011) state that non-Magnet facilities had superior patient outcomes than Magnet facilities in terms of post-operative metabolic imbalance, post-operative sepsis, and infections. Moreover, the study reported that fall rates, pulmonary failure, and deep vein thrombosis were lower in non-Magnet hospitals than in Magnet hospitals. The authors linked such poor health outcome in non-Magnet hospitals to less number of total staff, as well as lower Registered Nurses skills relative to the Magnet hospitals.
Impact on Nursing Outcomes
The focus of the MRP is to enhance the nursing environment, which is expected to result in better patient outcomes. Taking into account the fact that nursing personnel offer a great variety of care services in the hospital settings, the work environment for nurses plays a crucial role in ensuring effective functioning of the organization, guaranteeing optimal delivery of care services, and enhancing the overall quality of care. By definition, a Magnet hospital is characterized by nurses delivering excellent patient outcomes, exhibiting high levels of job satisfaction, and low turnover rates. Moreover, in Magnet hospitals, nurses should be involved in the decision-making and data collection processes with regard to the delivery of care. The underlying inference is that Magnet hospitals value their nursing personnel, involves them into the process of influencing evidence-based nursing practice, and rewards and inspires their staff members for developing nursing practice. Other features of Magnet hospitals include open communication and suitable personnel combination in order to develop a positive working environment and achieve the best outcomes for patients. The relationship between nursing outcomes and Magnet Recognition has been studied by numerous authors.
The impact of Magnet Recognition on turnover rate of nurses has been significantly studied by different researchers. The turnover rate denotes the rate at which employees are leaving the organization relative to the total number of employees working in the organization (Chen, et al., 2014). The turnover rate is also an indicator of the intent to leave the organization. Chen et al. (2014) compared the turnover rates between Magnet and non-Magnet hospitals and found out that Magnet hospitals had significantly lower nurse turnover rate. In addition, Chen et al. compared the nursing hours per patient-day (NHPPD) and the Register Nurse nursing hours per patient-day (RN-NHPPD). The authors defined NHPPD as the aggregate combined hours worked by nursing assistants, licensed practical nurses and registered nurses divided by the number of unit patient-days in the course of the reporting period. RN-NHPPD denotes the aggregate hours worked by all registered nurses having direct-care responsibilities divided by their respect unit patient-days in the course of the reporting period. The findings reported by Chen et al. showed that Magnet hospitals had significantly higher RN-NHPPD and NHPPD when compared to non-Magnet hospitals. As a result, patients in Magnet-hospitals are more likely to receive faster help from staff resulting in improved hospital experience. Chen and colleagues concluded that low nurse turnover alongside with optimal RN-NHPPD level are crucial qualities of Magnet hospitals that positively affect patient experience.
Staffing numbers play an instrumental role in determining the quality of care services provided by hospitals. The relationship between staffing levels and Magnet status has been vastly explored by various authors in the literature. Goode et al. (2011), when comparing staffing levels in Intensive Care Units between 108 Magnet hospitals with 528 non-Magnet hospitals, reported that non-Magnet hospitals had better staffing levels than Magnet hospitals. The authors concluded that Magnet hospitals in the sample had less total staff, as well as lower skill combination than their non-Magnet counterparts. According to the authors, it was attributed to some elements of poor patient outcomes in Magnet hospitals, such as post-operative sepsis. In addition, non-Magnet hospitals are better staffed in general units, having an excess of 30 RN hours relative to Magnet hospitals. It is an interesting observation, since Chen et al. (2014) reported that Magnet hospitals have better RN skill combination than non-Magnet hospitals, but Goode et al. (2011) showed that they are understaffed. It is contrasted with non-Magnet hospitals that have better staffing levels but lower RN skill combination.
As part of enhancing the working environment for nurses, the Magnet Recognition program emphasizes nurse satisfaction through strategies, such as horizontal management approaches (flat organizational structures), interdisciplinary communication, staff recognition, and developing an organizational culture characterized by safe and quality care. Such strategies have the main aim of creating a positive work environment, which can be used in attracting and retaining staff. In theory, Magnet hospitals are expected to have higher job satisfaction levels than their non-Magnet counterparts. The impact of Magnet Status on nurse job satisfaction has been examined in the literature. Hickson (2013) performed a study that aimed at investigating the perceptions of job satisfaction and hostility among new RNs working in Magnet and non-Magnet hospitals. Hickson performed an online survey involving new graduate RNs using the Casey-Fink Graduate Nurse Survey, the McCloskey/Mueller Satisfaction Survey and the Negative Acts Questionnaire – Revised. The findings of the study did not show any significant differences between the perceptions of hostility between RNs working in Magnet and non-Magnet hospitals. Nevertheless, RNs in Magnet hospitals reported higher levels of job satisfaction than those working in non-Magnet hospitals. Moreover, RNs in Magnet hospitals experienced more superior working surroundings than those in non-Magnet facilities.
Quality of the Work Environment
The quality of the nursing work environment is also an important aspect of the MRP. Theoretically, it is expected that Magnet hospitals would have a better quality of the working environment than non-Magnet hospitals. The staff work atmosphere is a predictor of quality care. Kutney-Lee et al. (2015) used the Practice Environment Scale of the Nursing Work Index to compare the quality of the practice surroundings between Magnet and non-Magnet hospitals. The results of the study showed that Magnet hospitals had greater improvements in their practice environment when compared to non-Magnet hospitals. The authors also pointed out that Magnet hospitals continually improve the quality of their practice atmosphere, which, in turn, contributes to positive nurse and patient outcomes that surpass those of their non-Magnet equivalents.
Urden, Ecoff, Baclig, and Gerber (2013) performed a study to develop a comprehensive description of the concept of Magnet journey based on the views of RNs in clinical settings offering direct patient care in hospitals that have been recently recognized as Magnet status. The authors utilized focus groups at the Magnet hospitals. The core themes that emerged from the study related to practice environment, including supportive work environment, professional development, professional relationships, staff voice, professional accountability, and good relations with leaders. The RNs also acknowledged the positive transformations that occurred in their work environment following the approval of the Magnet status of their respective hospitals.
From the review of the literature, there is no consistence evidence to suggest that the Magnet stratus has a positive impact on patient and nursing outcomes. In other words, the effect of Magnet Recognition varies in accordance with the specific patient and nurse outcome of interest. For instance, studies have consistently showed the positive relationship that exists between patient satisfaction and Magnet Recognition. In terms of health outcomes, studies have not reported consistent findings. A similar trend is observed with regard to the impact of Magnet Recognition on nurse outcomes, such as staffing, whereby Magnet recognition has been linked to low staffing despite having a superior RN skills combination. Nevertheless, the impact of Magnet Recognition on practice environment and nurse satisfaction has been consistent in the literature. Overall, it is evident that the relationship between Magnet Status and patient and nurse outcomes is still unclear.