Magnet hospitals

Magnet hospitals
By /Mahmoud Shaqria
‫شقريه‬ ‫محمد‬ ‫محمود‬

Outlines
o Introduction
o HISTORICAL OVERVIEW OF MAGNET HOSPITALS
o What is a Magnet Hospital
o Importance of magnetism
o The Benefits of Magnet Hospitals
o Fourteen Forces of Magnetism
o The ANCC new model for Forces of Magnetism
o Top ten demands for magnetism
o Prerequisites for magnetism accreditation
o The Magnet Program
o Process of magnetism
o Role of Health Care Organization in magnetic process

Introduction:
Magnet status:
 Is an award given by the American Nurses' Credentialing
Center (ANCC), an affiliate of‫ل‬ ‫ل‬ ‫التابعة‬ the American Nurses
Association, to hospitals that satisfy a set of criteria designed
to measure the strength and quality of their nursing.
 A Magnet hospital is stated to be one where nursing delivers
excellent patient outcomes, where nurses have a high level of
job satisfaction, and where there is a low staff nurse turnover
rate and appropriate grievance‫شكوىل‬ resolution.

HISTORICAL OVERVIEW OF
MAGNET HOSPITALS
 In 1983, American Academy of Nursing (AAN ) organized
affiliation with American Nurse Association selected “Task
Force on Nursing Practice in Hospital”.
 The purpose of this task to identify the work place
characteristics that were successful in recruiting and retaining
nurses staff .
 The task studied 163 hospital in USA based on their reputation
for retaining nurses and for delivery high quality of nursing
care.

 Only 41 hospitals from 163 hospital were described as
being magnet hospitals because:
• There were great similarities between how staff nurses and
directors of nursing identified the attributes/characteristics
that helped create the “Magnetism” so that the hospital
environment was able to attract nurses or retain them.
• These early results established the foundation for the Magnet
Recognition Program :

o Common Attributes/Characteristics
o Contributor management (manager listen to staff and use
two way communication)
o Director of nursing was of high quality and high level of
education
o Decentralized management
o higher number of staff nurses with baccalaureate degrees
o Promotion opportunities, respect, autonomy and
recognition
o Personal policies in form of working schedule was
innovative and considering staff needs

 By 1990, ANA established the ANCC American Nurses
Credentialing Center as separate , nonprofit organization to
serve magnet hospitals.
 Magnet Hospital Recognition Program for Excellence in
Nursing was established and approved by ANA.
 In 2001, a critical study conducted in 14 magnet hospitals to
identify the essentials of magnetism because these hospitals
had lower burnout rates, higher level of job satisfaction and
higher quality of care.

What is a Magnet Hospital
 A Magnet Hospital is one that attracts and retain
nurses who have high job satisfaction because they
can give high quality care .

 Magnet Hospitals are healthcare environments that have
recognized excellence in nursing care.
 These accredited Magnet Hospitals, a term coined in the early
1980’s, were seen to have the ability to attract nurses.
 These hospitals have quantitatively documented greater
patient satisfaction, greater nurse autonomy, lower incidence
of nursing burnout‫توقفل‬ and greater nursing retention.

 As healthcare faces one of its most significant nursing
shortages, Magnet Hospitals illustrate an organizational
and corporate strategy that aims to recognize nursing and
hopefully retain and recruit nurses during this challenging
time.

 A magnet hospital is one that has received Magnet
Recognition Status from the American Nurses Credentialing
Center (ANCC), which is part of the American Nurses
Association (ANA).

 Though declaring ‫إعةن‬ a hospital a magnet hospital is only
way of attesting‫ل‬ ‫يةل‬ to its quality of care, it has been shown
that other hospital rankings often consider magnet
hospitals among some of the best in the country.

Importance of magnetism
 The practice environment becomes more supportive of
nursing and professionalism
 Staff education is emphasized more
 Magnet status encourages lower turnover, higher retention,
improved recruitment
 Magnet status leads to better nurse-patient and nurse
physician Relation
 Working with nurses who are clinically competent
 Nurse autonomy and accountability
 Control over nursing practice

 Nurse manager support
 Support for education
 Adequate nurse staffing
 Nurses have control over their practice
 Trusting atmosphere allows nurses to feel safe and
supported in their decisions
 Rules do not impede delivery of patient care
 Opportunity for professional nurses to participate in
decisions that affect their practice and work environments

The Benefits of Magnet Hospitals
 Magnet Hospitals have better outcomes
 Lower mortality rates
 Lower morbidity rates
 Higher patient satisfaction
 Higher staff job satisfaction
 Lower overall costs

 Attract and retain nurses who are skilled at their jobs
and who get adequate support from management
and other staff
 A lower percentage of human error in nursing care
 Decreased length of stay
 Decreased risk of falls, medication errors, and post
procedure complications
 Reduced family complaints
 High quality of nursing care

Fourteen Forces of Magnetism
 There are fourteen separate areas that are assessed as part of
determining whether a hospital deserves magnet:-
Quality of Nursing Leadership Organizational Structure
Personnel Policies & Procedures Nurses as Teachers
Image of Nursing Collegial Nurse/Physician Relationship
Management Style Quality of Care
Autonomy Quality Improvement
Consultation & Resources Community Involvement
Professional Development Professional Models of Care

Force 1:Quality of Nursing
Leadership
 Nurse-leaders are perceived as strong, knowledgeable risk
takers who follow a well-articulated‫ل‬ ‫,واضةة‬ strategic, and
visionary philosophy.
 They convey‫ل‬ ‫توصة‬ clearly their sense of the obligation to
advocate on behalf‫ل‬ ‫لمصةحة‬ of the patient, and to provide
staff members with needed support.

Force 2:Organizational Structure
 Organizations are dynamic, decentralized
structures characterized by a functioning and
productive system of shared decision making.
 The Chief Nursing Officer has a seat at the
executive ‫إلارى‬ level of the hospital.

Force 3:Management Style
 Administrators employ a management style that
encourages and values feedback from staff
members at all levels.
 Nurse-leaders are visible, accessible and
committed to being effective communicators.

Force 4:Personnel Policies and
Programs
 Salaries and benefits are competitive.
 Creative and flexible staffing models are used to promote a
safe and healthy work environment.
 Personnel policies are formulated with input from staff
members, and support professional nursing practice, work-life
balance and the delivery of quality care.
 There are significant opportunities for professional
advancement .

Force 5:Professional Models of
Care
 Models of care vest nurses with authority, responsibility
and accountability, and provide for continuity of care
across the continuum.
 They take into consideration each patient’s unique needs
and provide the skilled nurses and other resources needed
to bring about desired outcomes.

Force 6 : Quality of Care:
 Nurses see themselves as providing high-quality
care to their patients.
 This is also perceived as being a priority for the
entire organization.
 Nurse-leaders are held responsible for fostering an
environment in which high-quality care can be
provided.

Force 7: Quality Improvement
 Quality-improvement activities are viewed as
educational.
 Staff nurses participate in the quality-improvement
process and credit it with producing worthwhile
results.

Force 8:Consultation and
Resources
o Adequate access is given to consultants and other human resources.
o Advanced practice nurses and other experts are available and sought
out.
o Support is provided from peers both inside and outside the Nursing
Department.
o The organization promotes involvement of nurses in professional
organizations.

Force 9: Autonomy
 Nurses are permitted (and indeed expected) to
practice autonomously, consistent with professional
standards.
 There is an organizational mandate ‫ةةوي‬‫ة‬‫تف‬ that
independent judgment will be exercised within the
context of a multidisciplinary approach to patient
care.

Force 10 : Community and the
Healthcare Organization
o The organizations best able to recruit and retain nurses also
maintain a strong presence in the community.
o This is expressed through a variety of ongoing , long-term
outreach programs.
o These programs create a perception of the organization as a
strong, positive, and productive corporate citizen.

Force 11 : Nurses as Teachers
o Nurses are permitted (and indeed expected) to
incorporate teaching in all aspects of their practice.

Force 12 : Image of Nursing
o Nurses are viewed as indispensible to the organization’s ability
to deliver patient care.
o Nurse-leaders are perceived as strong, knowledgeable risk
takers who follow a well-articulated, strategic, and visionary
philosophy.
o They convey clearly their sense of the obligation‫ل‬ ‫ة‬‫ة‬‫الواج‬ to
advocate on behalf of the patient, and to provide staff
members with needed support

Force 13:Interdisciplinary
Relationships
 Interdisciplinary relationships are viewed as positive.
 Interaction among the various disciplines is
characterized by mutual respect.

Force 14:Professional
Development
o Significant emphasis is placed on orientation, in-
service education, continuing education, formal
education, and career development.
o Personal and professional growth and development
are valued.
o In addition, opportunities for competency-based
clinical advancement exist, along with the resources
to maintain competency

The ANCC new model for
Forces of Magnetism

1. Transformational leadership, which includes strategic
planning, advocacy, visibility, accessibility and
communication.
2. Structural empowerment, which includes professional
engagement, professional development, teaching and role
development, commitment to community involvement and
recognition of nursing.

3. Exemplary professional practice, which includes a
professional practice model, care delivery systems,
staffing/scheduling/budgeting, interdisciplinary care,
accountability, ethics, diversity, safety and quality care
monitoring.

4. New knowledge, innovations and improvements, which
includes research, evidence-based practice and
innovation.
5. Empirical outcomes, which includes a shift from
structure and process to a greater focus in the areas of
clinical, community, workforce and organizational
outcomes.

Top ten demands for magnetism
Here’s list of the top 10 reasons to be a part of a Magnet
hospital:
1. Strong supportive environment and constant encouragement
2. Delivery of a high standard of care
3. Multidisciplinary approach to patient care
4. Shared governance
5. Superior nursing care to all patients
6. Opportunity to learn and teach
7. Mentorship ‫اإلستشاره‬
8. Dedication‫تفانىل‬ of the nursing staff
9. Cohesive ‫تماسك‬ work environment
10. Overall excellence of the nursing Staff

Prerequisites for magnetism
accreditation:
 Begin the Magnet journey
 Understand eligibility requirements
 Submit the Magnet application
 Arrange a site visit
 Follow interim monitoring guidelines
 Apply for Magnet redesignation

Begin the Magnet journey
 Before applying for the Magnet Recognition Program, most
hospitals benefit from undergoing a self-assessment.
 By analyzing staff, facilities and procedures, hospitals can
better understand how they compare to the top-ranked
facilities in the nation, and where there are opportunities for
improvement.

Understand eligibility requirements
 Organizations must meet certain eligibility requirements
to be considered for the Magnet Recognition Program. To
be eligible, the ANCC states the facility must comply with
federal laws pertaining to nurses in the workplace.

Submit the Magnet application
 Individual organizations and healthcare systems may
submit a Magnet Recognition Program online application
and its corresponding fee at any time, according to the
ANCC website.
 Facilities may submit required written supporting
documentation as an email attachment on dates specified
by the ANCC throughout the year.

Arrange a site visit
 in addition to submitting a written application and
supporting documentation, all facilities must complete a
site visit with an ANCC appraisal team.
 This site visit enables program representatives to confirm
the information included in the application and to assess
practice operations.
 After the site visit, the appraisal team submits a report to
the Commission on Magnet, which makes the final
decision on whether to grant Magnet recognition.

Follow interim monitoring
guidelines
 The ANCC awards Magnet recognition status for four-year
terms. Upon receiving Magnet designation, however,
hospitals must continue to follow program guidelines and
complete interim monitoring requirements established by
the ANCC.
 By predetermined annual deadlines, facilities must submit
Demographic Data Collection Tool Reports.

 During the second interim year, facilities must submit
an Interim Monitoring Report and complete a series of
phone conversations with a Magnet analyst.
 If facilities no longer meet program guidelines and
standards, the Magnet Commission may require a site
visit or additional data.

The Magnet Program :
 The Magnet Program incorporate the following ideas:
 Safe Facilities
 Improve hospital policies to protect and support nurses
 Strengthen Nursing
 Strengthen Nursing Managers
 Staffing
 Employee Benefits
 Media
 Strengthen credentialing process
 Collaboration between the professions
 Magnet hospitals should be nursing institutions
 Magnet hospitals should exist to provide humane care to all patients
 Overall changes to the magnet program

Safe Facilities
Magnet facilities should not be reservoirs for dangerous
organisms .
Each magnet facility should :
 provide uniforms for all staff who have contact with patients
 wash these uniforms at temperatures sufficient to render them
clean
 provide adequate showering facilities for all staff so that all
organisms are not brought out into the community and to
home to families
 Create health care environments using evidence-based designs
to promote better patient outcomes and less stress on nurses.

For guidance
Require that all staff change out of uniforms and shower
before leaving the facility .
Each Magnet facility should be a safe place for patients
and nurses.
They should be :
Latex-free facilities
Mercury-free facilities
Free of toxic cleaning chemicals that lead to illness .

Improve hospital policies to
protect and support nurses
o Each institution should have "no lift policies" and appropriate
lifting equipment.
o Magnet hospitals should have needleless IV systems and safe
needles.
o There should be zero tolerance for abuse practices and
procedures.
o Critical incident stress debriefing sessions should be offered to
all employees who suffer physical or sexual assault of any
kind .

 Hospital attorneys should pursue with police and the district
attorney, the cases of employees who have been assaulted‫,هاجمل‬
physically or sexually, while at the hospital .
 Adequately address nurse fatigue .

Strengthen nursing
o Magnet hospitals should have at least one-year nursing
residencies for all new nursing graduates.
o (One study showed they have a 12% turnover rate for first
year grads as compared to a 36-55% turnover rate for first
year non-residents(.
o Each unit of each hospital should have at least one clinical
nurse specialist on duty 24 hours per day, seven days per
week .

o Magnet hospitals should not recruit nurses from nations
with shortages more dire than their own.
o When hospitals increase staffing by taking nurses from
countries that desperately need them, it violates nurses'
ethical obligations to the needs of our patients around the
globe .
o Each nursing manager should be a clinical nurse specialist
in a relevant field for his unit .

o Each nursing manager should have a full-time administrative
assistant to help with paperwork and budgetary duties to
allow managers the time to focus on nursing, instead of
clerical duties .
o Nursing managers should practice clinical nursing on his/her
unit at least 16 hours per week .
o Over 50% of staff nurses on each unit should be certified in
their fields .

o Each facility should have at least three centers for nursing
professional improvement; one each to strengthen nursing
research, nursing clinical practice and nursing education
within the hospital .

Strengthen nursing managers
o Nursing managers should have significant management
training .
o The chief nursing officer should have at least a master's
degree in nursing .
o New nursing manager hires should be interviewed by the
staff nurses they will supervise .

Staffing
o Charge nurses should be allowed to set the staffing levels
on their floors determined by what nurses feel they can
take and filled by appropriate mix of nurses based
experience and expertise .
o Nurse-to-patient ratios should be posted very visibly for
visitors to see on every unit and updated every shift .

Employee Benefits
 Nurses should receive full tuition reimbursement‫ل‬ ‫لع‬ ‫تعوي‬ for
education that will enable them to stay in nursing or public
health .
 Hospitals should pay for at least 15 hours of continuing
education units for each nurse per year .
 All employees, including part-time employees, should be
provided with retirement benefits, and health insurance for
themselves and their families.

Media
 At least half of the public relations officials at Magnet
hospitals should be charged with solely promoting nursing .
 When a hospital loses its magnet status, the Magnet
Credentialing Center should send press releases to at least the
two largest newspapers in the area, the four major television
networks and local news radio stations regarding the removal
of magnet status and the specific reasons why the status was
removed .

Strengthen credentialing process
 The Magnet Credentialing Center evaluators should come to
evaluate hospitals at a surprise time .
 The Magnet Credentialing Center should choose hospital staff
members they wish to interview--not allow interviewees to be
hand-picked‫التقاطل‬ by hospital managers .

 The Magnet Credentialing Center should separately
contact, through home mailing addresses, all nurses who
works at the institution to inform them of policies by which
they can report infractions by hospitals.
 The Magnet Credentialing Center should have an
anonymous tip line to report hospital misbehavior .

Collaboration between the professions
 The professions should have recurrent training in how to
function as a team.
 Physicians should be expected to seek nursing input on
patient rounds and morbidity and mortality rounds .
 Physicians and medical students should follow nurses at
work for at least 12 hours per year so that they can
understand the value of nursing .

 Magnet hospitals should be nursing institutions
 At least 51% of the board of trustees should be nurses .
 Magnet hospitals should exist to provide humane care to
all patients
 Magnet hospitals should be non-profit institutions.
Corporate profits have no ethical place in the delivery of health
care .
 Uninsured patients should pay no more for any service, procedure
or item than the lowest amount accepted by the hospital from any
private or government insurance program .
 Absolutely no dumping ‫إغراقل‬ of patients should occur .

Overall changes to the magnet
program
 The Magnet program should be a government program to
which all hospitals adhere .
 Process of magnetism
 If a hospital wishes to become a magnet hospital, they must
go through a lengthy application and review process.
 The first step of this process is applying for the program.
 Hospitals then must submit significant documentation to
show how they implement excellence in nursing care.

 This is followed by a several days’ visit from reviewers in
the program, and finally a review of all documents and the
visit by Magnet officials.
 Should the hospital meet all standards, they may earn
magnet hospital stature, which generally allows them to
claim this award of excellence for four years.

Role of Health Care Organization
in magnetic process:
 Clearly request how school of nursing can support the
development of the Excellence environment
 Involve faculty as nursing advisors to health care
organization
 Participate as adjunct faculty
 Engage in creative partnerships to facilitate staff’s
continued education

Role of Faculties
• Support professional practice environments
• Provide service to organizations
• Support nurses in quest for continued education
• Guide implementation of evidence based nursing
• Provide consultation for nursing research
• Facilitate learning environment
• Provide consumer feedback.

Roles for Students
•Interact with health care organization for evidence
based nursing projects
•Engage in a mutually beneficial relationship with staff
•Conduct & present graduate school projects
•Encourage staff who want to continue education.

References
Armstrong K, Laschinger H. Structural empowerment, Magnet hospital characteristics and patient safety
culture: making the link. J Nurs Care Qual.2006;20(27):124–132
Aiken L, Havens DS, Sloane D. The Magnet nursing services recognition program: a comparison of two
groups of Magnet hospitals. Am J Nurs.2000;100:26–36.
nurse autonomy
McClure ML, Hinshaw AS. Magnet Hospitals Revisited: Attraction and Retention of Professional Nurses.
Washington, DC: American Nurses Publishing;2002.
presence
Armstrong K, Laschinger H Workplace Empowerment and Magnet Hospital Characteristics as Predictors
of Patient Safety Climate J Nurs Care Qual .2008,(30),19:54
Margaret L. McClure, E, (2005)Magnet Hospitals Insights and Issues Nurs Admin Vol. 29, No. 3, pp. 198-
201.
Chitty KK (2006). Professional nursing, concepts and challenges, 5th ed., W.B. Saunders Co.,
Philadelphia, P. 223.
Cherry B; Jacob SR (2005). Contemporary nursing issues, trends and management, 2nd ed., Mosby, St.
Louis, P.P. 490-507.
Kirkley, D., Johnson, P. & Anderson, M. 2004. Technology Support of Nursing Excellence: The Magnet
Connection. Nursing Economics. 22 (2) 94-98.
Upenieks, V. What Constitutes Effective Leadership. 2003. JONA. 33 (9) 456-467.

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