The ins and outs of Magnet designation: What it means for the nursing profession

Magnet designation from the American Nurses Credentialing Center has served as the ultimate credential for high-quality nursing to patients and clinicians alike since the University of Washington Medical Center in Seattle became the first Magnet-designated organization in 1994.

Since then, the program has grown and, as of Oct. 8, there are 422 Magnet facilities in the U.S. and around the world.

Here, Linda Lewis, MSA, RN, NEA-BC, executive vice president and chief ANCC officer for the American Nursing Credentialing Center, Jan Moran, BSN, RN, director of Magnet operations at ANCC, and F. Patrick Robinson, PhD, RN, dean of Capella University's School of Nursing and Health Sciences, touch on what Magnet designation means for nurses and the hospitals they work at.

Note: Conversation has been lightly edited for length and clarity.

Question: Why would a hospital pursue Magnet accreditation?

Linda Lewis: I'm currently running ANCC, but I started as a CNO bringing a hospital to Magnet recognition in 2003. The reason why we did that — the reason organizations do it today — is because it is a tried and true standard roadmap to create excellence in a culture that really is sustainable over many years. And that excellence is what everybody is driving toward for value-based purchasing.

Dr. Patrick Robinson: As an academic, I have always told students to look for Magnet designation for a hospital or healthcare organization they are considering for employment. What it demonstrates, in a very concrete way, is that nursing matters to the institution and it matters in a measurable way in terms of patient and system outcomes and increased quality and patient safety. It really is a place where nurses want to work if they want to be part of the cutting edge of nursing and maximally contribute to their practice and patients. It's quite an honor to have earned Magnet designation and an honor for a nurse to work in a Magnet-designated hospital.

LL: I didn't pay him to say that!

Q: How can hospitals market Magnet status to nurses who are seeking employment?

LL: If you go back through the history of Magnet, research was done in the mid-1980s when there was the really severe nursing crisis in staffing and in talent, and the research gave us the foundation of Magnet today. The environment drives retention of highly qualified nurses and attracts nurses who want to work in an environment where they are empowered, entrusted and respected. Nursing is not easy, it draws a special type of person into that role, and they want to feel valued. Magnet designation is an outward sign to the public that it's not only a very safe environment to be treated, but attracts the very best nurses in the world, which is true in the U.S. and around the world.

PR: We need to make sure that Magnet designation and its impact is part of nursing education curricula. Regardless of the level of education pre-RN licensure through graduate studies, students should understand that the Magnet model components are foundational for excellence in professional nursing practice. Magnet matters. It's interesting to note, Magnet really means magnet; it's not an acronym. The name and the movement started with a research study conducted in 1983 that identified characteristics that differentiated organizations best able to recruit and retain nurses during the nursing shortages of the 1970s and 1980s. The characteristics were named forces of magnetism because they were shown to attract nurses to the hospital. Nurses understand that Magnet organizations are where nursing is transforming healthcare. It is so valuable to the individual nurse to work in an organization where he or she knows he or she can make an impact, not just on the profession, but also on patient outcomes, like decreasing mortality and morbidity and preventing all kinds of complications from health conditions and procedures — it's pretty extraordinary what the Magnet program has been able to demonstrate.

LL: One of the fun things about it is we recognize it as nursing professionals but the outside world recognizes it as well. The only nursing criterion for excellence in U.S. News & World Report rankings is Magnet recognition. That tells you something from an external source.

PR: Magnet is not just a nursing thing. It has far reaching implication to the entire healthcare industry and systems.

Q: How can nurses encourage their hospital to go through the Magnet journey? And how long does it take?

Jan Moran: It depends on the organization and where they are in the foundation and how they build. A lot depends on the leadership. Some hospitals take a couple of years, have many requirements already built into organization. When the tenets of Magnet are there — a visionary leader, attracting Magnet-types of nurses, leadership and collaborative practice and respect and honor for professional development — it takes a shorter period of time.

If you have to build from the ground up, it takes longer to introduce it to the organization and create the buy-in. Hospitals have to demonstrate that working in a collaborative fashion is the best, to partner with patients and family, implement evidence-based practice and mutual respect for members of the healthcare team.

If you have it, it's a short step. If you have to create it, that takes years to develop.

PR: Sometimes starting the journey involves demonstrating to organizational leaders outside of nursing that adopting the Magnet components drives true business outcomes like financial success. Magnet hospitals see decreases in use of agency nurses, RN staff turnover and costly musculoskeletal and needle stick injuries. Increasingly with value-based payment, poor quality or uncoordinated care is now uncompensated care, so excellent nursing care not only decreases the cost of care, but also can increase the reimbursement for care. Patient satisfaction also tends to be higher in Magnet hospitals, which now also impacts level of reimbursement. It is not a hard sell to invest in everything it takes to become Magnet.

LL: People may look at the incremental cost and think, "We couldn't afford it." But how could you not afford it if it can prevent turnover and serious clinical and safety events to the patient. It's a no-brainer.

PR: We actually aren't talking about the cost of Magnet; we are talking about the cost of transforming organizations to ones of higher levels of quality and safety. That transformation is implicit in every healthcare institution's mission and is our moral imperative as health professionals.

Q: What are the advantages for nurses who work at a Magnet-recognized hospital?

LL: Practicing in the best environment. Also, it is well-researched that in Magnet organizations, the litigation costs are far less because of the types of workforce that remains in the hospital — they are highly educated and motivated and loyal to the organization. Goes into great patient relations, drives down the litigation even if a serious event.

PR: For most of us, nursing is partly a vocation, we're drawn to nursing for reasons that fulfill some needs for us in wanting to make a difference and serve humanity. The biggest advantage I think is that Magnet recognition or the process of the journey allows us to do that in the most impeccable way possible, in an organization where systems and processes are designed for that goal. It's not about achieving Magnet and staying there; it's all about the continuous improvement process. It's safe to say innovations in nursing practice are coming out of Magnet hospitals, so why wouldn't you want to be part of the best.

LL: There are a lot of fantastic things about Magnet, but it's not a magic bullet. It's about solid, thoughtful, progressive leaders. Bad things happen to good places. A Magnet organization will know how to manage those bad things, and learn and transform form them, which puts them apart from other organizations that don't have that Magnet culture.

Q: Where does the "Magnet culture" come from?

LL: A lot of different places. Sometimes it is a CNO, sometimes a CEO. There are quite a few examples where it is birthed by a front-line staff nurse who happens to moonlight at a Magnet organization or goes to a Magnet conference or has a friend who works in a Magnet organization and talks about how wonderful it is. It comes from all different places.

JM: The CNO may just be that visionary leader who wants to take the hospital to a different level. It could be a nurse who works at a Magnet hospital and transfers to another location, and they trigger that interest. It is exposure at all different levels.

PR: One of Capella's DNP graduates became the Magnet program director at Kaweah Delta Hospital Foundation [in Visalia, Calif.]. During her time with us, she really got excited about Magnet and went on to put her hospital on the journey. One of the things we're really proud about at Capella is our approach to and model of competency-based nursing education. We carefully map our competencies to evidence-based external standards, and because of our commitment to Magnet, we have ensured alignment of our RN-to-BSN and graduate nursing program competencies with Magnet model components. We want to make sure our graduates are well-positioned to work and lead in Magnet organizations.

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