Magnet Hospitals Research Articles

Magnet Hospitals and 30-Day Readmission and Mortality Rates for Medicare Beneficiaries.

US hospitals are penalized for excess 30-day readmissions and mortality for select conditions. Under the Centers for Medicare and Medicaid Services policy, readmission prevention is incentivized to a greater extent than mortality reduction. A strategy to potentially improve hospital performance on either measure is by improving nursing care, as nurses provide the largest amount of direct patient care. However, little is known as to whether achieving nursing excellence, such as Magnet status, is associated with improved hospital performance on readmissions and mortality. The purpose of this study was to examine the relationship between hospitals' Magnet status and performance on readmission and mortality rates for Medicare beneficiaries. This is a cross-sectional analysis of Medicare readmissions and mortality reduction programs from 2013 to 2016. A propensity score-matching approach was used to take into account differences in baseline characteristics when comparing Magnet and non-Magnet hospitals. The sample was comprised of 3877 hospitals. The outcome measures were 30-day risk-standardized readmission and mortality rates. Following propensity score matching on hospital characteristics, we found that Magnet hospitals outperformed non-Magnet hospitals in reducing mortality; however, Magnet hospitals performed worse in reducing readmissions for acute myocardial infarction, coronary artery bypass grafting, and stroke. Magnet hospitals performed better on the Hospital Value-Based Purchasing Mortality Program than the Hospital Readmissions Reduction Program. The results of this study suggest the need for The Magnet Recognition Program to examine the role of nurses in postdischarge activities as a component of its evaluation criteria.

Original Research: How Magnet Hospital Status Affects Nurses, Patients, and Organizations: A Systematic Review.

As the number of Magnet hospitals continues to rise in the United States and abroad, the body of literature regarding various outcomes at Magnet hospitals is increasing also. A systematic review examining and compiling the most recent evidence would be invaluable to those seeking to pursue Magnet recognition for their facility. We conducted this systematic review to investigate how Magnet hospital status affects outcomes for nursing professionals, patients, and health care organizations. In January 2018, the databases CINAHL, ProQuest, PubMed, and La Biblioteca Cochrane Plus were searched for relevant studies. The reference lists of selected articles were also examined to identify additional studies. The PRISMA statement was followed, and established methods for systematic review were used to produce a narrative summary. The quality of the reviewed studies was assessed according to the 22-item Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist for observational studies. Of the 163 studies identified, 21 met the eligibility criteria and are included in this review. On the whole, lower rates of nursing shortages, burnout, job dissatisfaction, and turnover were observed at Magnet hospitals compared with non-Magnet hospitals. The rates of patient mortality, falls, hospital-acquired infections, and pressure ulcers were also lower. Nursing work environments were found to be safer and were associated with a higher quality of care in Magnet hospitals than in non-Magnet hospitals, and Magnet hospitals were found to provide more cost-effective care. This review provides nursing managers and administrators with the most recent evidence demonstrating that Magnet hospitals have better nursing work environments and are associated with better outcomes for nurses, patients, and organizations than non-Magnet hospitals. This evidence should inform future decision-making with regard to pursuing Magnet designation.

Do Magnet®-Designated Hospitals Perform Better on Medicare's Value-Based Purchasing Program?

The aim of this study was to explore the relationship between a hospital's Magnet recognition status, tenure, and its performance in the Hospital Value-Based Purchasing (HVBP) program. Previous studies have sought to determine associations between quality of care provided in inpatient setting and the Magnet Recognition Program; however, no study has done so using the most recent (FY2017) iteration of the HVBP program, nor determined the influence a hospital's Magnet designation tenure has on HVBP scores. This study used a cross-sectional study design of 2686 hospitals using propensity score matching to reduce bias and improve comparability. Magnet-designated hospitals were associated with higher total performance, process of care and patient experience of care scores, and lower efficiency score. No association was identified between the length of time hospitals have been Magnet designated. Findings suggest non-Magnet status hospitals need to consider implementing the principles of Magnet into their culture or participation in the Magnet Recognition Program to provide higher quality of care.

A cost–benefit analysis of hospital diagnostic imaging services in public hospital units in Greece

This study involved a financial analysis of five Greek public hospital units in the sixth health region from 2012–15. Geographical information systems can be used for the rational management of diagnostic imaging examinations as they allow users to exchange large volumes of financial data very quickly and their statistics allow users to estimate a number of financial indicators. The data include the cost of radiology departments, total cost, revenue, number of magnetic resonance imaging exams and number of hospital beds. Statistical Package for the Social Sciences analysis shows a strong linear correlation between the number of magnetic resonance imaging exams and hospital beds. The majority of hospital units display an overtime revenue increase of magnetic resonance imaging exams in 2012–14. In 2013–15 the cost of radiology departments (a major part of the total cost for the majority of hospital units) decreased by 2–76%.

Safety and Quality of Pediatric Care in Freestanding Children's and General Hospitals.

The purpose of this study was to evaluate quality and safety of care in acute pediatric settings from the perspectives of nurses working at the bedside and to investigate hospital-level factors associated with more favorable quality and safety. Using data from a large survey of registered nurses in 330 acute care hospitals, we described nurses' assessments of safety and quality of care in inpatient pediatric settings, including freestanding children's hospitals (FCHs) (n = 21) and general hospitals with pediatric units (n = 309). Multivariate logistic regression models were used to estimate the effects of being a FCH on favorable reports on safety and quality before and after adjusting for hospital-level and nurse characteristics and Magnet status. Nurses in FCHs were more likely to report favorably on quality and safety after we accounted for hospital-level and individual nurse characteristics; however, adjusting for a hospital's Magnet status rendered associations between FCHs and quality and safety insignificant. Nurses in Magnet hospitals were more likely to report favorably on quality and safety. Quality and safety of pediatric care remain uneven; however, the organizational attributes of Magnet hospitals explain, in large part, more favorable quality and safety in FCHs compared with pediatric units in general acute care hospitals. Modifiable features of the nurse work environment common to Magnet hospitals hold promise for improving quality and safety of care. Transforming nurse work environments to keep patients safe, as recommended by the National Academy of Medicine 20 years ago, remains an unfinished agenda in pediatric inpatient settings.

Promoting Direct Care Nurse Engagement in Research in Magnet Hospitals: The Parent Education Discharge Support Strategies Experience.

Multisite study participation provides an opportunity for hospitals to gain access to the resources required to facilitate nursing research. The nurse-led Parent Educational Discharge Support Strategies for children newly diagnosed with cancer (PEDSS) multisite study engaged direct care nurses for successful implementation across 16 Magnet-designated hospitals. This article addresses strategies to overcome barriers to nursing research demonstrated through the PEDSS experience.

The Value of Nursing Research.

Innovations in patient care, nursing, and the practice environment are hallmarks of organizations receiving American Nurses Credentialing Center (ANCC) Magnet Recognition. In this month's "Magnet Perspectives" column, the chair and vice-chair of ANCC's Commission on Magnet Recognition examine the growing importance of nursing research on patient care and outcomes and the role of Magnet hospitals as research pacesetters for the nursing profession. The authors discuss the critical difference between research and evidence-based practice, why both are important, and how organizations can develop the structures and processes to inspire and advance a robust culture of clinical inquiry.

Teaching Father-Infant Massage during Postpartum Hospitalization: A Randomized Crossover Trial.

The purpose of this study was to evaluate acceptability and impact of infant massage video instruction on fathers' behaviors in early postpartum. A randomized crossover design was used. Participants were fathers of healthy term infants born at a Magnet hospital in Southern California. Measures included a demographic survey, Father-to-Infant Bonding Scale, Father-Infant Observation Scale, and postdischarge phone interview. Study nurses observed father-infant interactions for 5 minutes. Fathers were randomized to one of two groups: fathers in group 1 saw the massage video before they were observed with their infants and fathers in group 2 saw the video after. Fathers completed the Bonding Scale at baseline in person and again within a week of discharge by phone. Statistics were descriptive and comparative. Responses to interview questions were categorized and described. Ninety-eight fathers aged 18 to 44 years participated. Over half of fathers identified as Hispanic and the majority spoke English at home. Most fathers had positive responses to infants on individual Bonding Scale items. Fathers differed significantly in observed interactions with infants depending upon timing of massage instruction; fathers observed immediately after the video had more total interactions, specifically fingertip touching. Poststudy evaluations were predominantly positive. We found a brief infant massage instruction offered by video was well accepted by fathers and increased observed father-infant interactions.

Hospital-Acquired Conditions Reduction Program, Patient Safety, and Magnet Designation in the United States.

The aim of the study was to investigate the association between hospitals' nursing excellence accreditation and patient safety performance-measured by the Hospital-Acquired Conditions Reduction Program (HACRP). We linked data from the American Nursing Credentialing Center Magnet Recognition Program, Centers for Medicare and Medicaid Services HACRP, and the American Hospital Association annual survey from 2014 to 2016. We constrained the analysis to hospitals participating in Centers for Medicare and Medicaid Services' HACRP and deployed propensity score matching models to calculate the coefficients for our HACRP patient safety measures. These measures consisted of (a) patient safety indicator 90, (b) hospital-associated infection measures, and (c) total HAC scores. In addition, we used propensity score matching to assess HACRP scores between hospitals achieving Magnet recognition in the past 2 versus longer and within the past 5 years versus longer. Our primary findings indicate that Magnet hospitals have an increased likelihood of experiencing lower patient safety indicator 90 scores, higher catheter-associated urinary tract infection and surgical site infection scores, and no different total HAC scores. Finally, when examining the impact of Magnet tenure, our analysis revealed that there were no differences in Magnet tenure. Results indicate that the processes, procedures, and educational aspects associated with Magnet recognition seem to provide important improvements associated with care that is controlled by nursing practice. However, because these improvements do not differ when comparing total HAC scores nor Magnet hospitals with different tenure, there are likely opportunities for Magnet hospitals to continue process improvements focused on HACRP scores.

Effects of magnetic hospital concept in nursing management of Operating Room

Objective To explore the effects of magnetic hospital concept in nursing management of Operating Room. Methods From January to December 2018, this study selected 60 nurses in Department of Anesthesia Operation of Maoming People's Hospital of Guangdong Province by cluster sampling. All of nurse were divided into control group and observation group with the method of random number table, 30 cases in each group. Control group carried out the routine management model of Operating Room, while observation group implemented the nursing management model of Operating Room based on magnetic hospital concept. Working satisfaction and working pressure of nurses between two groups were compared. Results The working satisfaction of nurses in observation group was higher than that in control group; the scores of working pressure of nurses in observation group were lower than those in control group with statistical differences (P<0.05) . Conclusions The magnetic hospital concept-based nursing management model of Operating Room can reduce nurses' working pressure and improve their working satisfaction which is worthy of popularization. Key words: Operating Room; Nursing administration; Magnetic hospital; Working pressure; Satisfaction

Staffing Trends in Magnet and Non-Magnet Hospitals After State Legislation.

Evidence suggests that Magnet and non-Magnet hospitals differ with respect to quality of care. Our study examined registered nurse (RN) staffing over time in Magnet and non-Magnet hospitals using unit-level, publicly available data in New Jersey. A secondary analysis of longitudinal RN staffing data was conducted using mandated, publicly reported data of 64 hospitals representing 12 nursing specialties across 8 years (2008-2015). Staffing ratios were trended over time to compare RN staffing changes in Magnet and non-Magnet hospitals. Staffing was comparable in Magnet and non-Magnet hospitals for 9 of 12 specialties. On average, from 2008 until 2015, RN staffing slightly increased, with a greater percent increase in Magnet hospitals (6.9%) than in non-Magnet hospitals (4.7%). Over 8 years in New Jersey, RN staffing improved in Magnet and non-Magnet hospitals. Although there was a slight increase for Magnet hospitals, there was no meaningful difference in staffing for all 12 specialties.

Nurse Continuity at Discharge and Return to Hospital.

Promoting continuity of nurse assignment during discharge care has the potential to increase patient readiness for discharge-which has been associated with fewer readmissions and emergency department visits. The few studies that examined nurse continuity during acute care hospitalizations did not focus on discharge or postdischarge outcomes. The aim of this research was to examine the association of continuity in nurse assignment to patients prior to hospital discharge with return to hospital (readmission and emergency department or observation visits), including exploration of the mediating pathway through patient readiness for discharge and moderating effects of unit environment and unit nurse characteristics. In a sample of 18,203 adult, medical-surgical patients from 31 Magnet hospitals, a correlational path analysis design was used in a secondary analysis to evaluate the effect of nurse continuity on readmissions and emergency department or observation visits within 30 days after hospital discharge. The mediating pathway through discharge readiness measured by patient self-report and nurse assessments was also assessed. Moderating effects of unit environment and nursing characteristics were examined across quartiles of unit environment (nurse staffing hours per patient day) and unit nurse characteristics (education and experience). Analyses were adjusted for patient characteristics, unit fixed effects, and clustering at the unit level. Continuous nurse assignment on the last 2 days of hospitalization was observed in 6,441 (35.4%) patient discharges and was associated with a 0.85 absolute percentage point reduction (7.8% relative reduction) in readmissions. There was no significant association with emergency department or observation visits. Sensitivity analysis revealed a stronger effect in patients with higher Elixhauser Comorbidity Indexes. Readiness for discharge was not a mediator of the effect of continuity on return to hospital. Unit characteristics were not associated with nurse continuity. No moderation effect was evident for unit environment and nurse characteristics. Continuity of nurse assignment on the last 2 days of hospitalization can reduce readmissions. Staffing for continuity may benefit patients and healthcare systems, with greater benefits for high-comorbidity patients. Nurse continuity prior to hospital discharge should be a priority consideration in assigning acute care nurses to augment readmission reduction efforts.

Promotion of Evidence-Based Practice Skill and Attitude Among Advanced Nurses

In response to the call by both the Institute of Medicine and Centers for Medicare and Medicaid Services for increased evidence-based practice (EBP) competence and activity by nurses, healthcare institutions worldwide face the challenge of including quality educative content for effective EBP training (Llasus et al., 2014). The purpose of this evidence-based improvement project is to investigate and address current levels of EBP skill and attitude among nursing professional development specialists in a Magnet hospital and provide data for continued improvement of EBP promotion initiatives for nurses. Conclusions synthesized from a review of literature highlight common barriers and facilitators to EBP implementation among nursing professionals and point to the importance of continued efforts to provide EBP instruction to nurses at all levels, emphasizing a need for institutional support and development of advanced nurses as EBP champions.Keywords: Evidence-based practice, EBP, EBP knowledge, EBP attitudes, EBP instruction

Development of magnet hospitals in foreign countries and its enlightenment to China

This study introduces the development of magnetic hospital at home and abroad, the certification process and the significance of magnetic hospital certification, and puts forward some suggestions for establishing the working environment of magnetic hospital in China: reasonable allocation of nursing human resources, improvement of nursing leadership, improvement of nurses' autonomy, enhancement of team cohesion, provision of a good working environment, focus on the professional development of nurses. It provides a reference for our hospital to explore magnetic certification. Key words: Review; Nursing care; Magnet hospitals; Certification; Work environment

El análisis de la calidad asistencial desde la perspectiva de la satisfacción y la experiencia del paciente: una mirada enfermera

El artículo pretende describir dos grandes aspectos: la satisfacción y la experiencia del paciente, y cómo medirlos y analizarlos en los campos de la gestión sanitaria, la gestión clínica y los servicios sanitarios. Dichos elementos están inmersos en el abordaje en seguridad del paciente y permiten que la enfermería se relacione con temas como la calidad de los cuidados, la satisfacción del usuario, su experiencia dentro del sistema, los cambios y la implementación de mejoras así como sus formas de medición y análisis dentro del vasto campo de la gestión clínica y sanitaria. El artículo aporta conceptos de reciente aparición como Healthcare Improvement Science (mejora de la ciencia de la salud), centrado en la mejora de la calidad del cuidado de la salud y la reducción de daños a los usuarios de los servicios y sus familias; Magnet Hospital (hospital magnético), que relaciona la satisfacción de los profesionales con la calidad de los cuidados, y Patient Experience Officer (director de la experiencia del paciente), nuevo perfil laboral creado en Estados Unidos, centrado en la mejora continua de la calidad a partir de la experiencia del paciente. Todos estos conceptos han sido desarrollados por instituciones e investigadores reconocidos en la materia. En conclusión, en este artículo se resumen algunas de las cuestiones clave que se deben tener en cuenta a la hora de analizar la experiencia del paciente, que es un elemento importante para la mejora y el mantenimiento de la calidad en la atención sanitaria.

The Influence of Appropriate Staffing and Healthy Work Environments on Patient and Nurse Outcomes.

The Influence of Appropriate Staffing and Healthy Work Environments on Patient and Nurse Outcomes.

Sharon Pappas, PhD, RN, NEA-BC, FAAN

Sharon Pappas, PhD, RN, NEA-BC, FAAN (seated, center), is chief of the Nurse Executive Team for Emory Healthcare in Atlanta, Georgia.

Effect of Implementing Discharge Readiness Assessment in Adult Medical-Surgical Units on 30-Day Return to Hospital

The downward trend in readmissions has recently slowed. New enhancements to hospital readmission reduction efforts are needed. Structured assessment of patient readiness for discharge has been recommended as an addition to discharge preparation standards of care to assist with tailoring of risk-mitigating actions. To determine the effect of unit-based implementation of readiness evaluation and discharge intervention protocols on readmissions and emergency department or observation visits. The Readiness Evaluation and Discharge Interventions (READI) cluster randomized clinical trial conducted in medical-surgical units of 33 Magnet hospitals between September 15, 2014, and March 31, 2017, included all adult (aged ≥18 years) patients discharged to home. Baseline and risk-adjusted intent-to-treat analyses used difference-in-differences multilevel logistic regression models with controls for patient characteristics. Of 2 adult medical-surgical nursing units from each hospital, 1 was randomized to the intervention and 1 to usual care conditions. Using the 8-item Readiness for Hospital Discharge Scale, the 33 intervention units implemented a sequence of protocols with increasing numbers of components: READI1, in which nurses assessed patients to inform discharge preparation; READI2, which added patient self-assessment; and READI3, which added an instruction to act on a specified Readiness for Hospital Discharge Scale cutoff score indicative of low readiness. Thirty-day return to hospital (readmission or emergency department and observation visits). Intervention units above median baseline readmission rate (>11.3%) were categorized as high-readmission units. Among the 33 intervention units, 17 were low-readmission units and 16 were high-readmission units. The sample included 144 868 patient discharges (mean [SD] age, 59.6 [17.5] years; 51% female; 74 605 in the intervention group and 70 263 in the control group); 17 667 (12.2%) were readmitted and 12 732 (8.8%) had an emergency department visit or observation stay. None of the READI protocols reduced the primary outcome of return to hospital in intent-to-treat analysis of the full sample. In exploratory subgroup analysis, when patient self-assessments were combined with readiness assessment by nurses (READI2), readmissions were reduced by 1.79 percentage points (95% CI, -3.20 to -0.40 percentage points; P = .009) on high-readmission units. With nurse assessment alone and on low-readmission units, results were mixed. Implemented in a broad range of hospitals and patients, the READI interventions were not effective in reducing return to hospital. However, adding a structured discharge readiness assessment that incorporates the patient's own perspective to usual discharge care practices holds promise for mitigating high rates of return to the hospital following discharge. ClinicalTrials.gov Identifier: NCT01873118.

Magnet hospital recognition in hospital systems over time.

Magnet hospitals are recognized for nursing excellence and high-value patient outcomes, yet little is known about which and when hospitals pursue Magnet recognition. Concurrently, hospital systems are becoming a more prominent feature of the U.S. health care landscape. The aim of the study was to examine Magnet adoption among hospital systems over time. Using American Hospital Association surveys (1998-2012), we characterized the proportion of Magnet hospitals belonging to systems. We used hospital level fixed-effects regressions to capture changes in a given system hospital's Magnet status over time in relation to a variety of conditions, including prior Magnet adoption by system affiliates and nonaffiliates in local and geographically distant markets and whether these relationships varied by degree of system centralization. The proportion of Magnet hospitals belonging to a system is increasing. Prior Magnet adoption by a hospital within the local market was associated with an increased likelihood of a given system hospital becoming Magnet, but the effect was larger if there was prior adoption by affiliates (7.4% higher likelihood) versus nonaffiliates (2.7% higher likelihood). Prior adoption by affiliates and nonaffiliates in geographically distant markets had a lesser effect. Hospitals belonging to centralized systems were more reactive to Magnet adoption of nonaffiliate hospitals as compared with those in decentralized systems. Hospital systems take an organizational perspective toward Magnet adoption, whereby more system affiliates achieve Magnet recognition over time. The findings are relevant to health care and nursing administrators and policymakers interested in the diffusion of an empirically supported organizational innovation associated with quality outcomes, particularly in a time of increasing hospital consolidation and system expansion. We identify factors associated with Magnet adoption across system hospitals and demonstrate the importance of considering diffusion of organizational innovations in relation to system centralization. We suggest that decentralized system hospitals may be missing potential benefits of such organizational innovations.

Mıknatıs Hastanelerin Hemşire Sonuçlarına Etkisi: Sistematik Derleme

Mıknatıs Hastanelerin Hemşire Sonuçlarına Etkisi: Sistematik Derleme