Do Magnet facilitites maintain their “magnetism”?

The Magnet Recognition Program® recognizes healthcare facilities that provide the best nursing care and uphold professional nursing practice. Facilities pursuing Magnet designation must address 14 “forces of Magnetism”—the elements on which the American Nurses Credentialing Center (ANCC) bases its assessment. As facilities prepare their Magnet applications and prepare for site visits, many institute organizational changes to develop or reinforce one or more of these forces.

But in any organization, change is difficult to achieve—and to sustain. Both nurses and consumers may wonder if Magnet facilities are able to sustain their exceptional characteristics after designation.

We undertook research to learn the answer—specifically to find out if Magnet-designated facilities maintain the same level and intensity of nursing care during the seven quarters after designation that the Magnet appraisers found during their site visits.

Our methodology
Data for our analysis came from the National Database of Nursing Quality Indicators (NDNQI®), which collects quarterly data at the unit level for critical care, step-down, medical, surgical, combined medical-surgical, rehabilitation, pediatric and neonatal, and psychiatric units. We focused on four nursing workforce characteristics: (1) total nursing hours per patient day and (2) RN hours per patient day (which indicate the supply of nursing hours and are statistically equivalent to staffing ratios); (3) skill mix (percent of nursing hours supplied by RNs, LPNs, LVNs, and unlicensed assistive personnel); and (4) percent of nursing hours supplied by agency (contract) staff.

Our analysis tracked trends in these four nursing workforce characteristics over 15 quarters. The sample consisted of 41 facilities (with a total of 484 units) that had earned Magnet designation between July 2003 and May 2004 and submitted data to NDNQI® at least seven quarters before and seven quarters after their designation quarter.

Sample characteristics
• More than one-third of the facilities (37%) in our sample had more than 500 staffed beds; just 5% had fewer than 100 staffed beds.
• Of the facilities, 29% were academic medical centers, 32% were other teaching hospitals, and 35% were nonteaching facilities.
• Nearly all (93%) of the facilities were not-for-profit hospitals.
• Units were divided among types as follows: critical care (22%), step-down (17%), medical (25%), surgical (16%), combined medical-surgical (17%), and other (4%).

Key findings
Our analysis showed that in the seven quarters before Magnet designation, 60% of units in these facilities increased the total nursing and RN hours per patient day, while 40% of units decreased nursing hours. After designation, 64% of units increased RN hours per patient day, while 48% increased the total number of nursing hours per patient day. However, these increases generally were small and not statistically significant.

Before the designation quarter, 48% of the units saw increases in the percentage of total nursing hours supplied by RNs, compared with 65% of the units after that quarter. The magnitude of this improvement was statistically significant but small (less than 0.5 percentage point per year), and was concentrated in the postdesignation period.

In the seven quarters before designation, nearly as many units (52%) decreased the percentage of nursing hours supplied by agency staff as increased this percentage. After designation, 77% of units decreased the use of agency staff. However, the decrease was small (0.28 percentage point per year) and was statistically significant only during the predesignation period.

Take-home points
Our results indicate that nursing hours and RN hours per patient day showed no significant change in the seven quarters before and after Magnet designation. But we did find statistically significant improvements in two other nursing workforce characteristics:

• The percent of nursing hours supplied by agency staff declined modestly before designation.
• The percent of nursing hours supplied by RNs increased by a small amount after designation.

We found no evidence that Magnet facilities had made major changes in the four nursing workforce characteristics in preparation for ANCC review or that they failed to maintain these characteristics. Instead, we found a pattern of modest but enduring improvement. These trends indicate a continuing workforce enrichment.

(Note: This research was conducted under contract to the American Nurses Association.)

Selected references

Aiken LH, Havens DS, Sloane DM. The Magnet Nursing Services Recognition Program: A comparison of two groups of Magnet hospitals. Am J Nurs. 2000;100(3):26-35.

American Hospital Association. AHA Annual Survey Database (2003 ed).

Lake ET, Friese CR. Variations in nursing practice environments: relation to staffing and hospital characteristics. Nurs Res. 2006;55(1):1-9.

Nancy Dunton, PhD, is Research Associate Professor at the University of Kansas School of Nursing and Director of NDNQI®. Byron Gajewski, PhD, is Assistant Professor at the University of Kansas Schools of Nursing and Allied Health. Susan Klaus, MSN, RN, is Research Instructor at the University of Kansas School of Nursing. Belinda Pierson, MA, is Data Analyst at the University of Kansas School of Nursing.

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