Nursing Work Conditions at ANCC-Rated Hospitals Studied

While American Nurses Credentialing Center Magnet Recognition Program® (MRP) hospitals have been cited for promoting better patient safety and outcomes, they may not necessarily be providing better working conditions for nurses. Particularly in the area of scheduling and job demands, non-MRP hospitals are comparable to MRP-designated hospitals, according to researchers from the University of Maryland School of Nursing.

Nearly 350 healthcare organizations in the U.S. are currently recognized by the ANCC. Over the years, studies have identified attributes of MRP hospitals that attract nurses: high autonomy, decentralized organizational structure, and supportive management.

But MRP hospitals usually focus on the organization rather than the individual nurse, suggesting that personal demands may remain high among nurses providing frontline care at MRP facilities, they said in their study appearing in the July/August issue of the Journal of Nursing Administration.

"[MRP] Hospital tenets do address schedules, although the focus has been on other important issues" such as nurse autonomy and shared governance, says one of the researchers, Alison Trinkoff, ScD, RN, a professor with the School of Nursing. "It may get overlooked."

To examine the issue, a data analysis was conducted using the Nurses Worklife and Health Study with responses from the 837 nurses working in 171 hospitals (14 MRP and 157 non-MRP facilities).

Nurses in the MRP hospitals were found to be less likely to report jobs that included mandatory overtime or on-call, but the hours worked did not actually differ. While these nurses reported significantly lower physical demands, the mean measures for MRP hospital nurses and non-MRP nurses were similar, they said.

What appeared to be a common factor among nurses in MRP and non-MRP facilities were long hours and extensive use of overtime, Trinkoff says.

However, it doesn't need to remain this way: "Because [the program] was originally founded to help retain nurses, it could be an opportunity to think about ways of bringing people back into the workforce," Trinkoff says. "Many people have left because of the schedules....[but] I think there are opportunities to bring people back in?if we're a little more creative or offering choices of the work hours."

It may mean looking for a type of schedule that "brings in a whole new demographic of persons back," Trinkoff says. This could mean trying out more flexible hours and ensuring nurses at least get a break during the day by bringing in a nurse, for instance, from 10 am to 2 pm to relieve them.

"Who wants to work 10 to 2? Well, as it works out, sometimes folks who are older and don't want to work a long sustained day or folks with school-aged children who want to be there in morning or there when they return home,"she says.

Another aspect is getting commitments from hospitals that nurses can get out on time?that they work the hours they are truly scheduled to work," Trinkoff says. "It's already demanding, and adding to that the anxiety of whether ?I'll be able to leave on time? adds to it. It's a concern," she adds.

"It seems like a good thing for everyone?both for retention, satisfaction, performance, and quality?to look at the rest nurses are able to get. Are they able to be away from work and get time to recuperate?and come back fresh," she says. Overall, this is not just a MRP hospital issue but just a hospital issue.

"We know that [the program] has this issue [scheduling] as part of the focus and we just wanted to assess where things are," she says. "Hopefully, all hospitals will move forward. To me, the results suggest this is something that all hospitals could look at."