Magnet Hospitals Research Articles

Is the Hospital's Magnet Status Linked to HCAHPS Scores?

This study identified a significant link between Magnet hospitals and higher HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) scores across 110 Illinois hospitals. Compared with registered nurse nursing hours per patient-day and registered nurse turnover rate, Magnet status was a stronger contributor to the HCAHPS scores. A moderate to strong, reverse relationship between hospital's percentage of African American patients and HCAHPS scores suggests a need for strengthening culturally sensitive nurse-patient communications.

Determinants of hospital fall rate trajectory groups

Patient falls in acute care hospitals represent a significant patient safety concern. Although cross-sectional studies have shown that fall rates vary widely between acute care hospitals, it is not clear whether hospital fall rates remain consistent over time. The aim of this study was to determine whether hospitals can be categorized into fall rate trajectory groups over time and to identify nurse staffing and hospital characteristics associated with hospital fall rate trajectory groups. We conducted a 54-month (July 2006-December 2010) longitudinal study of U.S. acute care general hospitals participating in the National Database for Nursing Quality Indicators (2007). We used latent class growth modeling to categorize hospitals into groups based on their long-term fall rates. Nurse staffing and hospital characteristics associated with membership in the highest hospital fall rate group were identified using logistic regression. A sample of 1,529 hospitals (mean fall rate of 3.65 per 1,000 patient days) contributed data to the analysis. Latent class growth modeling findings classified hospital into three groups based on fall rate trajectories: consistently high (mean fall rate of 4.96 per 1,000 patient days), consistently medium (mean fall rate of 3.63 per 1,000 patient days), and consistently low (mean fall rate of 2.50 per 1,000 patient days). Hospitals with higher total nurse staffing (odds ratio [OR] = 0.92, 95% confidence interval [CI] [0.85, 0.99]), Magnet status (OR = 0.49, 95% CI [0.35, 0.70]), and bed size greater than 300 beds (OR = 0.70, 95% CI [0.51, 0.94]) were significantly less likely to be categorized in the "consistently high" fall rate group. Over this 54-month period, hospitals were categorized into three groups based on long-term fall rates. Hospital-level factors differed among these three groups. This suggests that there may be hospitals in which "best practices" for fall prevention might be identified. In addition, administrators may be able to reduce fall rates by maintaining greater nurse staffing ratios as well as fostering an environment consistent with that of Magnet hospitals.

Evidence-based practice in a hospital setting in Finland – the organization and activities

Background: Evidence-based practice (EBP) is a major paradigm of health care and policy worldwide. In nursing, the transformation has not been very fast due to the challenges in closing the gap between clinical practice and research; this is the case in Finland, too. There is evidence gained from many research studies in nursing that major factors affecting EBP include lack of knowledge and skills, as well as lack of organization or understanding how to support nurses in EBP. Objective: The aim of this presentation is to describe the development of EBP in nursing; how it has been organized and what the activities are organized and followed as suggested in Magnet Hospitals. Methods: Discussion paper based on an example from one of the five university hospital with 800 beds in Finland. Results: EBP in nursing was organized following Magnet Hospital system in an university hospital with 800 beds. A council for EBP was initiated and formed in 2010. The council consists of frontline clinical nurses, nurse directors, teachers, researchers and representative of the nursing leadership. The purpose of the council is to advance EBP in patient care and management, support the use of research and other evidence by organizing systematic education to nurses and leaders, JBI guidelines, information retrieval, journal clubs and learning from the best practices. EBP tutors and mentors started their work in 2013 in the units. Several activities are on the way, e.g. preventing patients’ falls, pain management, hygiene and continuing education of EBP to nurse leaders and frontline nurses. The council is a part of the hospital's Nursing Development, Teaching and Research Unit (NDTRU) lead by chief nursing officer. Discussion: Organizing EBP in clinical practice should be sysematic and well organized. Conclusion: Since 2010, EBP has evolved and the interest among practicing nurses has increased. Results of the activity should be measured in a reliable way.

Up for the Challenge: Eliminating Peripherally Inserted Central Catheter Infections in a Complex Patient Population

BackgroundIn response to Medicare reimbursement changes related to central line-associated blood stream infection (CLABSI) effective January 2011, a long-term acute care hospital implemented quality improvement measures to reduce these health care-associated infections. Improvements included alcohol-impregnated port protectors, chlorhexidine gluconate barrier dressings, and didactic/hands on training for care and maintenance. During 2010 the peripherally inserted central line (PICC) team at a neighboring Magnet hospital was asked to partner and develop strategies to further decrease CLABSI. MethodsThe PICC team evaluated the effects of an antimicrobial PICC device in an effort to further reduce the incidence of CLABSI. Upon initiation of the evaluation phase, a database was created to track infection/thrombus rate, insertion-related complications, dwell time, diagnosis, tip location, infusate, vein used, and catheter size. Data collection and reporting was managed by the PICC team. ResultsAcross a 2-year period (July 2011-July 2013), 100 devices were inserted with a total of 1,705 line days without any reported CLABSI. The majority of patients received a 4.5F single lumen device (59%). Dwell time ranged from 1 to 57 days with an average of 17 days. To date, no CLABSIs related to this device have been reported at the long-term acute care hospital. ConclusionsBased on 100 insertions yielding no infections this new product appears to improve patient safety and quality of care. Relative to these results sole use of this product has become their institutional standard for long-term intravenous needs.

Designing and Opening a New Hospital With a Culture and Foundation of Magnet®: An Exemplar in Transformational Leadership

Embarking on the ANCC Magnet Recognition Program® journey 1 ANCC Magnet Recognition Program. http://www.nursecredentialing.org/Magnet.aspxDate: 2013 Google Scholar can be challenging for hospitals that are up against resistance to change. Yet, when opening a new hospital with the goal of Magnet Recognition® within 2 years, it is imperative to embed the Magnet model into the framework, design, and opening of the hospital. Regardless of the path taken, the role of the chief nursing officer (CNO) of a Magnet hospital is to be a transformational leader who supports quality patient care and excellence in nursing. Therefore, this is the exemplar journey of 1 CNO utilizing her skills as a transformational leader to propel a vision of nursing excellence into the foundation of a brand- new nonreplacement hospital with the goal of Magnet designation in 2 years. Embarking on the ANCC Magnet Recognition Program® journey 1 ANCC Magnet Recognition Program. http://www.nursecredentialing.org/Magnet.aspxDate: 2013 Google Scholar can be challenging for hospitals that are up against resistance to change. Yet, when opening a new hospital with the goal of Magnet Recognition® within 2 years, it is imperative to embed the Magnet model into the framework, design, and opening of the hospital. Regardless of the path taken, the role of the chief nursing officer (CNO) of a Magnet hospital is to be a transformational leader who supports quality patient care and excellence in nursing. Therefore, this is the exemplar journey of 1 CNO utilizing her skills as a transformational leader to propel a vision of nursing excellence into the foundation of a brand- new nonreplacement hospital with the goal of Magnet designation in 2 years.

Magnet hospitals are a magnet for higher survival rates at adult trauma centers

Little is known about nursing care's impact on trauma outcomes. The Magnet Recognition Program recognizes hospitals for quality patient care and nursing excellence based on objective standards. We hypothesized that Magnet-designated trauma centers would have improved survival over their non-Magnet counterparts. All 2009 to 2011 admissions to Pennsylvania's Level I and II trauma centers with more than 500 admissions during the study period (10 Magnet and 17 non-Magnet hospitals) were extracted from the Pennsylvania Trauma Systems Foundation State Registry. A logistic regression model with mortality as the dependent variable included the following variables: Magnet status, age, sex, admitting temperature, logit transformation of mortality probability predicted by the Trauma Mortality Prediction Model (TMPM-ais), systolic blood pressure, mechanism of injury, paralytic drug use, and Glasgow Coma Scale motor (GCSm) score. A total of 73,830 patients from the Pennsylvania Trauma Outcome Study database met inclusion criteria for this study. The Magnet and non-Magnet hospital groups were statistically indistinguishable with respect to level of designation, medical school association, surgical residency programs, in-house surgeons, and urban locations. Patients admitted to a Magnet hospital had a significantly decreased odds of mortality when compared with their non-Magnet counterparts (odds ratio, 0.83; 95% confidence interval, 0.70-0.99; p = 0.033), when controlling for numerous factors. Overall, the model has outstanding discrimination with a receiver operating characteristic curve of 0.93. Admission to a Magnet-designated hospital is associated with a 20% reduction in mortality. We believe that the Magnet program's attention to nursing competence has important consequences for trauma patients, as reflected in the improved survival rates in trauma patients admitted to Magnet-designated hospitals. Epidemiologic/prognostic study, level III. Care management study, level IV.

Nurses' Perspective Of Magnet Features In Selected Hospitals At Mansoura

AbstractBackground: There is a considerable evidence to show the success of magnet hospitals in attracting and retaining nursing staff. Aim: The aim of this study is to investigate the magnet features in selected hospitals from the perspective of nurses. Design: Descriptive comparative design was utilized in this study. Methods: Study was conducted in two hospitals namely: Mansoura General Hospital as ministry of health sector and Gastroenterology center as University sector. A purposive convenient sample of 177 staff nurses working in the previous mentioned hospitals were constituted the study sample. Data for the present study was collected through utilizing Nursing Work Index developed by Joyce&Crookes (2007 ) based on The original NWI that was developed by Kramer and Hafner (1989) from the research on magnet hospitals for the purpose of capturing a clear measure of the organizational attributes of a professional practice environment. Results: findings of the present study revealed that nurses working in university hospital have positive perception of magnet features which contributes to better working conditions than those nurses working in ministry of health sector. Statistical significant differences in nurses' perception regarding educational opportunity, control over nursing practice and shared governance subscales of magnet features in the selected hospitals. Recommendations : Nursing leaders' efforts to create empowering work environments can influence nurses' ability to practice in a professional manner, ensuring excellent patient care quality and positive organizational outcomes. Efforts must be made to improve nurses' working conditions in governmental and ministry of health sectors in order to retain nurses in the system and encourage new recruits to the profession.

Is There a Business Case for Magnet Hospitals? Estimates of the Cost and Revenue Implications of Becoming a Magnet

Although Magnet hospitals (MHs) are known for their better nursing care environments, little is known about whether MHs achieve this at a higher (lower) cost of health care or whether a superior nursing environment yields higher net patient revenue versus non-MHs over an extended period of time. To examine how achieving Magnet status is related to subsequent inpatient costs and revenues controlling for other hospital characteristics. Data from the American Hospital Association Annual Survey, Hospital Cost Reporting Information System reports collected by Centers for Medicare & Medicaid Services, and Magnet status of hospitals from American Nurses Credentialing Center from 1998 to 2006 were combined and used for the analysis. Descriptive statistics, propensity score matching, fixed-effect, and instrumental variable methods were used to analyze the data. Regression analyses revealed that MH status is positively and significantly associated with both inpatient costs and net inpatient revenues for both urban hospitals and all hospitals. MH status was associated with an increase of 2.46% in the inpatient costs and 3.89% in net inpatient revenue for all hospitals, and 2.1% and 3.2% for urban hospitals. Although it is costly for hospitals to attain Magnet status, the cost of becoming a MH may be offset by higher net inpatient income. On average, MHs receive an adjusted net increase in inpatient income of $104.22-$127.05 per discharge after becoming a Magnet which translates to an additional $1,229,770-$1,263,926 in income per year.

Understanding the Role of the Professional Practice Environment on Quality of Care in Magnet® and Non-Magnet Hospitals

The aim of this study was to explore the relationship between Magnet Recognition® and nurse-reported quality of care. Magnet® hospitals are recognized for nursing excellence and quality patient outcomes; however, few studies have explored contributing factors for these superior outcomes. This was a secondary analysis of linked nurse survey data, hospital administrative data, and a listing of American Nurses Credentialing Center Magnet hospitals. Multivariate regressions were modeled before and after propensity score matching to assess the relationship between Magnet status and quality of care. A mediation model assessed the indirect effect of the professional practice environment on quality of care. Nurse-reported quality of care was significantly associated with Magnet Recognition after matching. The professional practice environment mediates the relationship between Magnet status and quality of care. A prominent feature of Magnet hospitals, a professional practice environment that is supportive of nursing, plays a role in explaining why Magnet hospitals have better nurse-reported quality of care.

Improving the culture of evidence-based practice at a Magnet® hospital.

Evidence-based practice (EBP) is the foundation of quality care, but EBP is not widely adopted. This study evaluated the impact of a hospital-wide EBP nursing project on the organizational culture of a Magnet hospital. Results of pre- and postintervention surveys suggest the intervention increased the nurses' confidence in the hospital's EBP environment. Belief in EBP was related to confidence in implementing EBP in practice.

From Magnet-Hospital to the Hospital of the Future

In the United States the Magnet Recognition Program® is an established nursing-oriented organizational model. Accredited Magnet hospitals succeeded in attract and retention of qualified nurses. This demonstrated the future potential of this model. However, a direct transfer of the model to European conditions seemed to be limited. It raised the question concerning a European model that could give hints to organize the hospital of the future. This exploratory and descriptive study attempted to create a European framework in order to made recommendations for the hospital of the future. Following recommendations were made: 1. Designation of nursing as connecting health profession, 2. In-depth structural integration of nursing into the hospital organization, 3. Lived professionalism and quality.

Factors associated with adherence to fecal occult blood testing for colorectal cancer screening among adults in the Republic of Korea

PurposeRepeated participation in fecal occult blood testing (FOBT) is one of the major factors affecting the long-term success of population-based colorectal cancer screening programs. The aim of this study is to explore strong factors linked to repeated participation in FOBT in the prior decade (2002–2011) among adults using the Health Belief Model (HBM) after controlling for other covariates. MethodsData were obtained from South Korean adults, aged 50 years and over, who visited a national health screening center within a magnet hospital (N = 237). A pilot test was conducted to investigate the internal consistency of the HBM instruments and the clarity of survey questions. Sample characteristics and rates of adherence to FOBT screening were examined using means and frequencies. Important factors associated with adherence to FOBT were examined using multivariate logistic regression analysis. ResultsAbout 44% of the respondents were adherent to FOBT screening over the prior decade. Four out of the six HBM-driven factors (perceived susceptibility, severity, and barriers, and health motivation) were statistically significant. Those with greater levels of susceptibility and health motivation and lower levels of severity and barriers were more likely to adhere to FOBT. ConclusionsHealth professionals should focus more on the four modifiable HBM-related factors to encourage adults to adhere to FOBT. Intervention programs, which lower perceived severity and barriers and increase susceptibility and health motivation, should be developed and implemented.

Review: Measuring perceptions of shared governance in clinical practice: psychometric testing of the RN-focused Index of Professional Governance (IPNG)

The engagement of staff with the running of a healthcare organisation is considered to be critical to its success, with staff empowerment identified as a key feature of High Reliability Organisations (Weick and Sutcliffe, 2007). More specifically, Laschinger and Leiter (2006) describe a clear link between nurse engagement and patient safety outcomes. Staff engagement was also found to be linked to recruitment and retention of nurses in ‘magnet hospitals’ in the United States (Scott et al., 1999). One route to high staff engagement is the enactment of shared governance, a system that was articulated by the American Association of University Professors, the American Council on Education and the Association of Governing Boards of Universities and Colleges’ in their 1966 Statement on government of Colleges and Universities (AAUP, 1966). They assert that while financial authority ultimately lies with the governing body of an institution, professionals have the right, indeed the primary responsibility for decision-making within their areas of expertise. This approach has been adopted by a number of professional groups including nursing departments as far back as the 1970s (Christman, 1976). Proponents claim that it gives nursing staff control over their professional practice and development while also making a genuine contribution to the wider corporate agenda; however, there is a world of difference between the rhetoric and the practice of shared governance. Conceptual ambiguity remains and changes in workplace jurisdictions can be challenging to other staff groups, leading to organisational resistance. Early implementation in the UK was found to be ‘both methodologically flawed and lacking in any critical edge’ by Gavin et al. (1999) and it has failed to establish a foothold here in the way it has in North America.

Lower Mortality in Magnet Hospitals

Background Although there is evidence that hospitals recognized for nursing excellence—Magnet hospitals—are successful in attracting and retaining nurses, it is uncertain whether Magnet recognition is associated with better patient outcomes than non-Magnets, and if so why.

An Advanced Look at Surgical Performance under Medicare's Hospital-Inpatient Value-Based Purchasing Program: Who is Winning and Who is Losing?

The Centers for Medicare and Medicaid Services (CMS) is beginning to shift from paying providers based on volume to more explicitly rewarding quality of care. The hospital value-based purchasing (VBP) program is the first in a series of mandatory programs to financially reward and penalize US hospitals based on quality measure performance. Our objective was to identify the characteristics of hospitals that perform well (and those that perform poorly) on the surgical measures in CMS' hospital VBP program. Using 2008 to 2010 performance data from CMS' Hospital Compare website and the 2009 American Hospital Association annual survey, we examined surgical measure performance for all acute care general hospitals in the US. Outcomes were determined by a composite surgical performance score indicating the percentage of eligible surgical performance points that a hospital received. There were 3,030 hospitals included in our study. Composite surgical performance scores were 15.6% lower at public hospitals than at for-profit hospitals (p < 0.01). Additionally, there were significant differences in the routes by which hospitals achieved points, with smaller hospitals, for-profit hospitals, Magnet hospitals, and NSQIP hospitals all more likely to obtain points via the achievement route. The results of our study indicate that public hospitals perform worse on the surgical measures in the hospital VBP program. This study raises important questions about the impact that this new, mandatory program will have on public hospitals, which serve an important safety-net role and appear to be disadvantaged in the hospital VBP program. This issue should continue to be investigated as these mandatory quality programs are updated in future years.

The diffusion of Magnet hospital recognition

Background Magnet recognition is promoted by many in the practice community as the gold standard of nursing care quality. The Magnet hospital population has exploded in recent years, with about 8% of U.S. general hospitals now recognized. Purpose The purpose of this study was to identify the characteristics that distinguish Magnet-recognized hospitals from other hospitals within the framework of diffusion theory. Methodology/approach We conceptualize Magnet recognition as an organizational innovation and Magnet-recognized hospitals as adopters of the innovation. We hypothesize that adoption is associated with selected characteristics of hospitals and their markets. The study population consists of the 3,657 general hospitals in the United States in 2008 located in metropolitan or micropolitan areas. We used logistic regression analysis to estimate the association of Magnet recognition with organizational and market characteristics. Findings Empirical results support hypotheses that adoption is positively associated with hospital complexity and specialization, as measured by teaching affiliation, and with hospital size, slack resources, and not-for-profit or public ownership (vs. for-profit). Adopters also are more likely to be located in markets that are experiencing population growth and are more likely to have competitor hospitals within the market that also have adopted Magnet status. A positive association of adoption with baccalaureate nursing school supply is contrary to the hypothesized relationship. Practice implications Because of its rapid recent growth, consideration of Magnet program recognition should be on the strategic planning agenda of hospitals and hospital systems. Hospital administrators, particularly in smaller, for-profit hospitals, may expect more of their larger not-for-profit competitors, particularly teaching hospitals, to adopt Magnet recognition, increasing competition for baccalaureate-prepared registered nurses in the labor market.

Clinical supervision at a magnet hospital: A review of the preceptor-facilitator model

Background : The demand for clinical placements and quality clinical supervision for nursing students remains an international issue. In light of on-going concerns related to recruitment and retention of nurses and constraints on fiscal resources both in education and healthcare, the aim of this review was to compare the “preceptor-facilitator” clinical supervision model used at a Magnet hospital against the “preceptor” and “facilitator” clinical supervision models frequently used in the clinical learning environment in Australia. Methods : A qualitative-descriptive review was undertaken using first, second and third year undergraduate nursing student evaluations (n = 93). Evaluations were completed during the last three days of students’ clinical placement using an electronic questionnaire. The questionnaire tool used open and closed questions to examine three main concepts: student-preceptor supervision; student-facilitation supervision; and the clinical learning environment. Findings : Three main themes emerged from the review. Firstly, how undergraduate nursing students highly valued the facilitator-student relationship; secondly, the importance of “support” as being an integral part of students’ clinical learning experience and thirdly; the recognition of students being considered as part of the health care team and a valued contributor towards patient care. Conclusion : The preceptor-facilitation model described and evaluated in this review offers an excellent clinical supervi- sion framework to support, nurture and foster a positive clinical learning environment for nursing students. This model of clinical supervision strategically aims not only to provide nursing students with high quality clinical supervision but offers nurses a supportive environment as preceptors and professional development opportunities through clinical facilitation. This review does highlight that there is a need for more research regarding the use of the preceptor-facilitator model to include the perspectives of both education and healthcare providers.

Environmental and Organizational Influences on Magnet Hospital Recognition

This article reports on research studying the influence of environmental and organizational factors on the adoption of the magnet hospital concept. Although research has been reported on the adoption of innovations by healthcare organizations, research on factors influencing the adoption of administrative advances remains an important area to investigate. Logistic regression was used to determine both the significance and direction of the association of environmental and organizational factors with innovation adoption. In addition, the size and type of the hospitals in the sample was used as a control variable. It was found for environmental factors that environmental complexity and community resources were associated with innovation adoption and that competition and network externalities were not. For the organizational factors examined, it was found that organizational complexity and control of domain were associated with innovation adoption. Slack resources and external communications were not associated with adoption. The findings from this study contribute to healthcare management research by enhancing the understanding of the innovation adoption process. The results have important implications for both healthcare providers and policy makers.

PRACTITIONER APPLICATION: Environmental and Organizational Influences on Magnet Hospital Recognition

Robert Wood Johnson Foundation executive nurse fellow and chief nursing officer, Texas Health Presbyterian Dallas, Texas

Staff Nurse Perceptions of the Magnet® Journey

The objective of this study was to compile a rich description of the phenomenon Magnet journey by registered nurses in clinical settings who provide direct patient care in community healthcare systems recently receiving Magnet designation. Evidence supports that Magnet designation leads to improved nursing, patient, and organizational outcomes. Descriptions abound regarding the organizational and cultural transformation during the time leading up to the Magnet designation, commonly referred to as the Magnet journey. There are no published reports regarding the impact of this transformational process on staff nurses. Focus groups were conducted at recently designated Magnet hospitals; data were transcribed, reviewed, coded, and themed. The 58 subjects represented various work areas, specialties, and practice sites. Key themes emerged consistent with components of the Magnet model: relationships with leaders, professional accountability, staff voice, Magnet continuum, professional relationships, professional development, and resources/supports. Overall, staff nurses emphasized the positive impact of the transformation that occurred during the journey and the resultant Magnet designation on stakeholders. Results from this study offer guidance for Magnet project directors, chief nursing officers, managers, advanced practice nurses, and staff nurses involved in or considering the Magnet journey. "Magnet slippage" emerged as a new concept.