Magnet Hospitals Research Articles

Evidence-based Nurse Staffing: ICN's New Position Statement.

Evidence-based Nurse Staffing: ICN's New Position Statement.

Construction of magnetic nursing team under the concept of magnetic hospital before first aid

Objective To explore the necessity of establishing the pre-hospital first aid magnetic care team. Methods The reform of pre-hospital first aid care management was carried out according to 14 elements of 5 major aspects of magnetic certification standards. Results Through the establishment of magnetic care team , the professional sense of achievement and theory, operation and first aid skills of nurses were improved, and the differences were statistically significant (P<0.01). The satisfaction degree of patients with nursing work was increased by 7.50%.The total amount of nursing innovation was 6.5 times higher. Conclusions Through the construction of magnetic nursing team, a reasonable and efficient pre-hospital emergency care working environment was constructed. Key words: Magnetic hospital; Pre-hospital first aid; Nursing; Team building

Systems Addressing Frail Elders (SAFE) Care: Description of Successful Partnerships Across Hospitals.

Systems Addressing Frail Elders (SAFE) Care is an interprofessional team-based program, which was developed and evaluated in a cluster randomized controlled trial. Results of this trial included reduced length of stay and complications for patients. This article describes a successful partnership across 4 Magnet hospitals in the dissemination of the model. A 2-year sequential implementation process was completed, with an approach of adoption, adaptation, and abandonment. The model was successfully implemented at each participating Magnet hospital. Implementation included capacity building, organizational change, and process implementation.

The influence of nurses job dissatisfaction on adoption of Magnet status within hospitals

Background: Hamad Medical Corporation (HMC) has a goal to achieve Magnet designation. Magnet status is a worldwide international award given to hospitals which demonstrate excellent quality of patient care, innovative professional nursing practices and effective nurse recruitment and retention patterns. To date, only 3 other hospitals in the Middle East have achieved this recognition; two in Saudi Arabia and one in Lebanon. Achieving Magnet status is highly influenced by nurses’ job satisfaction and commitment to their organization.Purpose: A literature review was used to identify factors contributing to nurses’ job dissatisfaction that may impede the adoption of the Magnet Program at HMC hospitals in Qatar.Findings: Five themes emerged from the review of literature representing the predominant factors that influence nurses’ job dissatisfaction. They include: (1) nurse staffing; (2) work and professional practice environments; (3) work relationships; (4) management styles; (5) professional development and career advancement opportunities.Conclusions: Understanding the factors contributing to nurses’ job dissatisfaction is essential in order to identify barriers which may impede the achievement of a Magnet hospital designation.

Assessment of the nursing practice environment in Greek Hospitals: a cross-sectional study.

The organisational characteristics of the nursing practice environment play a crucial role in nurses' job satisfaction, job retention, quality-of-care service provision and patient outcomes. The widely used Practice Environment Scale of the Nursing Work Index assesses the favourability of these traits, showing the grade of magnetism of these factors in the workplace. This study aims to assess the nurse working environment at five public hospitals in Greece, and to compare these data with those of Magnet and non-Magnet hospitals. The Practice Environment Scale of the Nursing Work Index was completed by 532 nurses. Findings have shown that all five hospitals were assessed by nurses as unfavourable working environments. Four of five subscales were identified as unfavourable by the participants and only Collegial Nurse-Physician Relations were evaluated as a positive organisational trait. The mean scores in all five subscales of favourability were significantly lower than the corresponding scores of non-Magnet hospitals in the US. The present study shows the favourability grade of Greek hospitals. When compared with Magnet and non-Magnet hospitals in the US, Greek hospitals were perceived as more unfavourable than non-Magnet hospitals. Action to improve the current situation must be taken by hospital management, supporting nurse involvement, continuous education, changing human resources management and adopting evaluation procedures.

Pediatric Nurses' Knowledge, Values, and Implementation of Evidence-based Practice and Use of Two Patient Safety Goals

PurposeTo describe knowledge, values, and implementation of evidence-based practice (EBP) and use of two National Patient Safety Goals–Central Line Associated Blood Stream Infections (CLABSI) and Surgical Site Infections (SSI)–between nurses working in Magnet® versus non-Magnet® designated hospitals. BackgroundThere is a gap in the literature concerning nurses' understanding of EBP and how EBP guidelines are used in practice and if guidelines are being used as intended. The Conceptual Model of Nursing and Health Policy was used to guide the study. MethodsA descriptive survey methodology using three instruments was delivered electronically to members of the Society of Pediatric Nurses–the Quick-EBP-VIK, the Use of Evidence-based Practice Questionnaire, and a Background Data Sheet. ResultsResults revealed statistically significant differences between the Magnet and non-Magnet participants only for the Quick-EBP-VIK value domain; nurses from Magnet hospitals had a higher value for EBP compared with nurses from non-Magnet hospitals, nurses from both groups had a moderate amount of knowledge about EBP, and very few nurses indicated they were implementing EBP. There were no differences in CLABSI and SSI prevention care for patients in acute care hospitals in the United States by nurses working in Magnet versus non Magnet designated hospitals. ConclusionThe findings of this study have implications for practice, education, policy, and research. A disconnect between the use of policy and implementation of EBP has been identified. Specifically, nurses need to understand how EBP is embedded in hospital and organizational policy.

Magnetic work environments: Patient experience outcomes in Magnet versus non-Magnet hospitals.

The term Magnet hospital is an official designation ascribed by the American Nurses Credentialing Center for hospitals that meet specific criteria indicating they have a "magnetic work environment" for nurses. The objective of the Magnet designation is to encourage hospitals to design work in such a way as to attract and retain high-quality nurses and thus improve the quality of patient care. Empirical research has demonstrated that hospitals who earn a Magnet designation appear to have nurses who are more satisfied and committed to their work environments. Although research on whether patients are more satisfied with their care in these hospitals is still in its infancy, preliminary studies suggest that patients receiving care at Magnet-designated hospitals report more positive care experiences. This study used a large secondary survey data set to explore the extent to which inpatient perceptions differed between Magnet and non-Magnet hospitals. Ordinal logistic and multinomial logistic regression analyses were used to examine whether Magnet hospital status and positive nurse communication are related to overall hospital rating and willingness of patients to recommend the hospital. Results indicated that patients treated at a Magnet hospital and patients who rated nurses' communication highly were significantly more satisfied and more likely to say they would recommend the hospital. Evidence from this study suggests that it would be worthwhile for hospital leaders to consider organizational policies and practices consistent with the criteria put forth for Magnet hospital designation.

Multisite Studies Demonstrate Positive Relationship Between Practice Environments and Smoking Cessation Counseling Evidence-Based Practices.

High-quality smoking cessation counseling guidelines for people who use tobacco are not fully integrated in acute-care services presenting missed opportunities to improve health outcomes. The role of the practice environment on enhancing or inhibiting guideline use is unknown. To examine the relationship between the nurse practice environment and nurses' use of smoking cessation counseling practices, and to evaluate the effect of the individual nurse and organization characteristics on nurse smoking cessation counseling practices. Cross-sectional secondary analysis of survey data from two multisite studies. The sample included responses from registered nurses (N = 844) in 45 hospitals (22 rural hospitals from the Eastern United States and 23 Magnet hospitals across the United States). Linear mixed model was used to adjust intradependency among the responses of individual nurses nested within hospitals. Data were abstracted from survey responses including nurse characteristics, the Smoking Cessation Counseling Scale (SCCS), and the Practice Environment Scale-Nursing Work Index (PES). Increasing positive relationships exist between PES and SCCS total and subscales scores. Also, SCCS total scores were significantly related with favorable PES total scores (SCCS score difference of 0.26 between favorable and unfavorable PES scores, SE = .08, p = .002) controlling for other covariates. Non-White respondents (vs. White) demonstrated a positive association with SCCS total scores (difference of .18, SE = .07, p = .010), but not in advanced counseling. Nurse practice environments are positively associated with the use of evidence-based smoking cessation practices by nurses. As practice environments become more favorable, higher level counseling practices occur more often. Healthcare leaders should focus on enhancing the practice environment using a quality improvement approach and framework for evidence translation. Quality improvement initiatives should be prioritized in which high-quality evidence is available to support nursing processes.

Association of Hospitalization for Neurosurgical Operations in Magnet Hospitals With Mortality and Length of Stay.

The association of Magnet hospital status with improved surgical outcomes remains an issue of debate. To investigate whether hospitalization in a Magnet hospital is associated with improved outcomes for patients undergoing neurosurgical operations. A cohort study was executed using all patients undergoing neurosurgical operations in New York registered in the Statewide Planning and Research Cooperative System database from 2009 to 2013. We examined the association of Magnet status hospitalization after neurosurgical operations with inpatient case fatality and length of stay (LOS). We employed an instrumental variable analysis to simulate a randomized trial. Overall, 190 787 patients underwent neurosurgical operations. Of these, 68 046 (35.7%) were hospitalized in Magnet hospitals, and 122 741 (64.3%) in non-Magnet institutions. Instrumental variable analysis demonstrated that hospitalization in Magnet hospitals was associated with decreased case fatality (adjusted difference, -0.8%; -95% confidence interval, -0.7% to -0.6%), and LOS (adjusted difference, -1.9; 95% confidence interval, -2.2 to -1.5) in comparison to non-Magnet hospitals. These associations were also observed in propensity score adjusted mixed effects models. These associations persisted in prespecified subgroups of patients undergoing spine surgery, craniotomy for tumor resection, or neurovascular interventions. We identified an association of Magnet hospitals with lower case fatality, and shorter LOS in a comprehensive New York State patient cohort undergoing neurosurgical procedures.

Factors Associated With Timely Blood Glucose Testing and Insulin Administration in Patients Receiving Mealtime Insulin Coverage in Medical Surgical Units.

Purpose The purpose of the study was to identify the rate and factors associated with timely mealtime capillary blood glucose (CBG) testing and insulin coverage in hospitalized patients with diabetes. Methods A descriptive-correlational design was used with a random sample of patients (n = 77) and nurses (n = 36) on a medicine and a neuroscience unit of a large Magnet hospital. After written consent was obtained, post-meal patient and nurse interviews were conducted to collect information about patient, nurse, and situational factors known to influence timely mealtime diabetes care. Results Timely CBG testing occurred on 85.7% of the patient participants, and 71.4% received timely insulin coverage. Timely CBG testing was associated (unadjusted) with telling the patient care associate to obtain a finger stick (FS) prior to meals and patient off the unit during mealtime. The odds of having insulin administered on time was significantly and independently associated with the nurse caring for fewer patients, patients waiting for insulin prior to eating, and patients knowing pre-meal FS was high. Conclusions One situational factor and 2 patient factors were independently associated with timely insulin coverage prior to meals. Interventions aimed at raising staff awareness of these factors and providing tailored education to patients may improve the odds of having insulin administered on time.

Engagement, empowerment, and job satisfaction before implementing an academic model of shared governance

AimBaseline information was obtained from a School of Nursing faculty and staff about perceptions of job satisfaction, empowerment, and engagement in the workplace before the introduction of an integrated faculty and staff shared governance system. BackgroundGovernance structure in schools of nursing has the potential to enhance or impose constraints on the work environment for faculty, staff, and stakeholders. Research methodsDesign. A cross-sectional quantitative descriptive design.Sample. Full-time faculty and staff (n = 69) employed in a public school of nursing in a health sciences center.Instrumentation. Four well-established instruments were selected to address key aspects of empowerment, engagement, and job satisfaction.Procedures. Data were collected using an online, anonymous survey.Analyses. Descriptive statistics, t-tests, and Pearson correlation analyses were used. ResultsFaculty and staff perceptions of job satisfaction and engagement in the workplace before the introduction of a new model of shared governance are presented. Statistical differences were found between faculty and staff responses on the overall or total scales and select subscales, and group patterns of relationships differed. ConclusionsWe provided a description of the first shared governance structure derived from the perspective of shared governance as defined and operationalized in Magnet Hospital health care systems and includes administrators, faculty, and staff in decision-making councils. As academia embarks on this change in governance structure from hierarchical to a more flattened approach findings support examining levels of work engagement, structural and psychological empowerment, and job satisfaction as key monitors of the work environment.

Association of Magnet Status and Nurse Staffing With Improvements in Patient Experience With Hospital Care, 2008-2015.

Little is known about the longitudinal association of hospital Magnet status (an indicator of nursing excellence) and nurse-staffing level with inpatient care experience. To examine temporal trends in hospital performance on patient experience measured using the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey and the association of these trends with Magnet status and nurse-staffing level. Longitudinal study of hospital-level data from the HCAHPS survey, the American Hospital Association Annual Survey, and the American Nurses Credentialing Center. Growth curve models were used for the analysis of longitudinal associations. A total of 26,752 hospital-year observations from 3614 US hospitals that collected at least 3 years of HCAHPS data from patients discharged between 2008 and 2015. Dependent variables were 7 HCAHPS measures. Independent variables included linear and quadratic time terms, hospital Magnet status, and nurse-staffing level. There were significant improvements (P<0.001) in all 7 HCAHPS measures, but the trends were nonlinear; the improvement rates have decreased over time. Magnet hospitals and hospitals with more favorable nurse staffing consistently performed better on HCAHPS but did not improve faster than other hospitals during the study period. In subgroup analyses, HCAHPS scores did not improve for hospitals after they received Magnet recognition during the period from 2009 to 2015. The hospital organizational attributes that lead to Magnet recognition or better nurse staffing may be associated with higher performance on HCAHPS. Magnet status and favorable nurse staffing may be markers of hospital commitment to better patient-centered care.

Professional Forces of Magnetism and Patient Safety Culture at Suez Canal University Hospitals

Background: Attainment of the forces of magnetism improves the recruitment and retention of nurses. Also, the higher levels of nurses' autonomy and empowerment in magnet hospitals improve patient safety culture. The need for assessing patient safety within hospitals and determining the areas of improvement become urgent. The aim of the study: This study aims to identify the relationship between the fourteen forces of magnetism and patient safety at Suez Canal University hospitals. Subject and method: A descriptive correlational design was utilized to carry out this study. A sample of 324 staff nurses was included in this study. The study was conducted in Suez Canal University Hospitals. Tools: two tools were used. Tool1: Forces of magnetism questionnaire was developed by the researcher. Tool2: Hospital survey on patient safety culture was adopted from Agency for healthcare research and quality (AHRQ) and modified by the researcher. Results: There are positive correlations between all forces of magnetism and patient safety at Suez Canal University Hospitals. There is a highly significant positive correlation between total magnetism and patient safety at Suez Canal University Hospitals. Conclusion: Suez Canal University Hospitals were evaluated by the majority of studied nurses as moderate magnetic hospitals. Only five dimensions of patient safety were considered as areas of potential improvement at Suez Canal University Hospitals. Recommendations: Modification of hospital policies of remaining and recruiting nurses and establishing a climate of communication openness, teamwork and non-punitive response to errors

Correlation of hospital magnet status with the quality of physicians performing neurosurgical procedures in New York State

Purpose: The quality of physicians practicing in hospitals recognized for nursing excellence by the American Nurses Credentialing Center has not been studied before. We investigated whether Magnet hospital recognition is associated with higher quality of physicians performing neurosurgical procedures.Materials and methods: We performed a cohort study of patients undergoing neurosurgical procedures from 2009–2013, who were registered in the New York Statewide Planning and Research Cooperative System (SPARCS) database. Propensity score adjusted multivariable regression models were used to adjust for known confounders, with mixed effects methods to control for clustering at the facility level. An instrumental variable analysis was used to control for unmeasured confounding and simulate the effect of a randomized trial.Results: During the study period, 185,277 patients underwent neurosurgical procedures, and met the inclusion criteria. Of these, 66,607 (35.6%) were hospitalized in Magnet hospitals, and 118,670 (64.4%) in non-Magnet institutions. Instrumental variable analysis demonstrated that undergoing neurosurgical operations in Magnet hospitals was associated with a 13.6% higher chance of being treated by a physician with superior performance in terms of mortality (95% CI, 13.2% to 14.1%), and a 4.3% higher chance of being treated by a physician with superior performance in terms of length-of-stay (LOS) (95% CI, 3.8% to 4.7%) in comparison to non-Magnet institutions. The same associations were present in propensity score adjusted mixed effects models.Conclusions: Using a comprehensive all-payer cohort of neurosurgical patients in New York State we identified an association of Magnet hospital recognition with superior physician performance.

Nursing magnet hospitals have better CMS hospital compare ratings

Nursing magnet hospitals have better CMS hospital compare ratings

Assessment of professional nursing governance and hospital magnet components at Alexandria Medical Research Institute, Egypt

Background and objective: In the context of a rapidly evolving health care system, health care institutions strive to set a path towards an excellent professional practice environment. Since improving clinical nurse work environments is a major issue faced by nurse executives and administrators, they become challenged to establish nursing governance models, and leadership practices so that clinical nurses can engage in the work processes and relationships that are empirically linked to quality patient outcomes. The main aim of this study was to assess the current status of professional nursing governance and hospital magnet components at Alexandria Medical Research Institute, Egypt.Methods: A descriptive research design was conducted at Alexandria Medical Research Institute hospital, using a convenience sample (N = 220) that composed of two groups including; all hospital medical administrators (n = 10) and hospital nursing workforce (n = 210). Index of Professional Nursing Governance Questionnaire (IPNGQ) and Magnet Hospital Forces Interview were proved valid and reliable to measure study variables.Results: The overall mean score of professional nursing governance was (187.59 ± 63.74) reflected that staff nurses practice the first level of nursing shared governance (primarily nursing management who take the decision with some staff input). In addition, both medical administrators and nursing staff identified the hospital has a good structure, nursing leadership practices that support shared governance and magnet recognition. Structural equation model and correlation analysis revealed a positive association between overall professional nursing governance and hospital magnet components (p &lt; .05).Conclusions and recommendations: The study emphasized the hospital administrators’ important role for providing supportive organizational structures and leadership practices for increasing participation of nursing staff in work design, problem-solving, conflict resolution, committees and organizational decision-making as “key ingredients to a successful organization” in turn, lead to a healthy and magnet-like work environment. Training programs for nurses’ professional development are recommended which enhance and increases their autonomy and empowerment.

Attributes of a Magnetic work environment, and its relation to work stress among nursing staff at Children’s Cancer Hospital Egypt (CCHE 57357)

Background: The Magnet hospital is the hospital that implements specific organizational attributes in order to achieve a high quality of care through well-qualified and committed nursing staff.Aim of the study: The study was aimed at studying attributes of the Magnetic work environment, and its relation to work stress among nursing staff.Methods: Setting: It was carried out in the children’s cancer hospital, Egypt. Design: Using a descriptive correlational design. Subjects: Consisted of 172 nursing staff. Tools and procedure: two different self-administered tools were utilized (Magnet attributes questionnaire, and stress questionnaire). The fieldwork lasted from April to July 2016.Results: The study revealed that the highest percentage of nursing staff aged between 20 and 30 years. Nearly two thirds (64%) were having a bachelor degree in nursing. Total attributes of work environment were available with strength. 96.6% of nursing staff recorded low scores of stress.Conclusions: The nursing staff in the study setting considered “total attributes of Magnet work environment” as an area of strength. The total scores of stress were generally low. Statistically significant negative correlations were revealed between the scores of total Magnet attributes and stress.Recommendations: It is a matter of priority for Egyptian children’s cancer hospital to enhance and promote the development and maintenance of Magnetism and taking the lead in promoting the status of Magnetism in Egypt.

Newly Licensed RN Retention: Hospital and Nurse Characteristics.

The aims of this study were to examine the relationship between 1-year retention of newly licensed RNs (NLRNs) employed in hospitals and personal and hospital characteristics, and determine which characteristics had the most influence. A secondary analysis of data collected in a study of transition to practice was used to describe the retention of 1464 NLRNs employed by 97 hospitals in 3 states. Hospitals varied in size, location (urban and rural), Magnet® designation, and university affiliation. The NLRNs also varied in education, age, race, gender, and experience. The overall retention rate at 1 year was 83%. Retention of NLRNs was higher in urban areas and in Magnet hospitals. The only personal characteristic that affected retention was age, with younger nurses more likely to stay. Hospital characteristics had a larger effect on NLRN retention than personal characteristics. Hospitals in rural areas have a particular challenge in retaining NLRNs.

Does Hospital Size Affect Patient Satisfaction?

Centers for Medicare & Medicaid Services reimbursement is now contingent on quality measures such as patient satisfaction as determined by Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS). In providing patient-centered care that is guided by patient satisfaction measures, it is critical to understand system-level factors that may influence how patients assess their care experiences. One important system-level influence to consider is hospital size. HCAHPS scores, number of hospital beds, and nursing magnet status were obtained from publically available Hospital Compare, American Hospital Directory, and Magnet Hospitals Web sites, respectively. An aggregate score for patient satisfaction was created across all domains of the HCAHPS. Multilevel regression modeling was performed to examine the associations between hospital size and HCAHPS aggregate and individual dimensions. Hospital size was significantly associated with patient satisfaction such that larger size was associated with lower satisfaction (β = -.312, P < .001). Hospital size was most strongly associated with less patient satisfaction on the following HCAHPS items: "receiving help as soon as needed" (β = -.441, P < .001), "room and bathroom cleanliness" (β = -.286, P < .001), and doctor communication (β = -.213, P < .001), whereas nurse communication (β = .194, P < .001) was the one modifiable dimension that was associated with more favorable ratings in larger hospitals. Magnet nursing designation was significantly associated with larger hospital size (P < .001). Patient satisfaction scores may be lower in large hospitals because of patients' perceptions of hospital cleanliness, receiving help on time, and doctor communication. Focusing on improving these factors may improve patient satisfaction scores for larger hospitals.

Is Magnet® recognition associated with improved outcomes among critically ill children treated at freestanding children's hospitals?

PurposeWith increasing emphasis on high-quality care, we designed this study to evaluate the relationship between Magnet® recognition and patient outcomes in pediatric critical care. Materials and methodsPost hoc analysis of data from an existing administrative national database. We used inverse probability of treatment weighting and multivariate models to compare outcomes between two study groups after adjusting for confounding variables. ResultsA total of 823,634 pediatric patients from 41 centers were included. Of these, 454,616 patients (55.2%) were treated in 23 Magnet hospitals. The majority of baseline characteristics did not vary significantly among the two study groups. In adjusted models, there was no difference in mortality between the two groups (Magnet vs. non-Magnet; odds ratio: 0.92, 95% confidence interval: 0.77–1.11). When stratified by various subgroups, such as cardiac, non-cardiac, ECMO, cardiac arrest, respiratory failure, use of nitric oxide, genetic abnormality etc., Magnet status of the hospital did not confer a survival advantage. In a sensitivity analysis on patients from crossover hospitals only, attainment of magnet status was associated with increased hospital charges. ConclusionsThis large observational study calls into question the utility of the Magnet Recognition Program among children with critical illness, at least among the freestanding children's hospitals.