Magnet Designation is Meaningful, but Not Magical

Research finds that Magnet designation correctly identifies a hospital's level of nursing excellence, but that earning the recognition does not improve surgical patient outcomes.

Hospitals that meet the Magnet Recognition Program's criteria for "quality patient care, nursing excellence, and innovations in professional nursing practice," are considered to be facilities that provide the gold standard in nursing care.

And because they incorporate Magnet Model Components such as transformational leadership and structural empowerment into their nursing practice, Magnet facilities also attract highly skilled RNs and improve patient care, safety, and satisfaction says the ANCC.

That may sound like a ringing endorsement for Magnet recognition. However, it's important to note that Magnet designation is not a panacea for all that ails your hospital. Just 7% of U.S. hospitals have been designated as Magnet facilities by the American Nurses Credentialing Center.

"Professionally, I think what you see are high degrees of professional competence and confidence because Magnet organizations invest in education, training and development," says Barbara R. Medvec, RN, MSN, MSA, NEA-BC, senior vice president and chief nursing officer for the Oakwood Healthcare System in Dearborn, MI.

Medvec says Oakwood Hospital has been incorporating Magnet standards into its nursing practice environment since 2002, but began its official journey towards Magnet designation in 2008.

"The foundations of excellence of continuing to improve practice and the foundations around nurses managing and controlling their professional practice are values that Oakwood has believed in for a long, long time," she says. "We've built the foundations around the Magnet principles because we know it builds a stronger nursing professional practice within the organization."

Why did Oakwood decide to go down the Magnet designation path when it already had incorporated principles of excellence into its nursing practice?

"When you're on the journey, it helps you inspire staff to move forward," Medvec says. "For us to go that next level is really recognizing the excellence that we have and that we built within our program."

A study in the June issue of Health Affairs supports the idea that the Magnet Recognition Program is, in fact, excellent at identifying excellence. But while researchers found the program to be an accurate tool in identifying high-performing hospitals, they also uncovered some surprising nuances about Magnet facilities' surgical outcomes—namely, Magnet recognition alone does not improve surgical patient outcomes.

Study Specifics
"Many of us in the nursing community know that Magnet recognition confers a great deal of benefit to the staff nurses and the nursing leadership that are in those institutions," says Christopher R. Friese, PhD, RN, AOCN, FAAN, assistant professor at the University of Michigan School of Nursing in Ann Arbor.
But "there's been a question as to whether Magnet recognition was also associated with improved patient outcomes."

Friese says through the study, titled "Hospitals In 'Magnet' Program Show Better Patient Outcomes on Mortality Measures Compared to Non-'Magnet' Hospitals," he hoped to delve into how Magnet recognition was related to surgical patient outcomes.

For the published paper, he and his colleagues looked at 13 years-worth of national Medicare data for 1.9 million surgical patients hospitalized from 1998 to 2010 for coronary artery bypass graft surgery, colectomy, or lower extremity bypass. The anonymous data came from 1,000 hospitals across the country and the study was funded by the National Institute of Nursing Research.

According to the study findings, surgical patients treated in Magnet hospitals were "7.7% less likely to die within 30 days of their operation, and 8.6% less likely to die after a post-operative complication, compared with patients in non-Magnet hospitals."

"From the patient point of view, if I have to pick a place to go, I want to pick a Magnet," Friese says.

The Big But
"In this study… what we find is yes, Magnets are better," he says, "but Magnets were better to begin with. They were better many years before they were a Magnet and then during and after their Magnet recognition their [surgical] outcomes don't change."

To help me better understand the findings, Friese gave an example of hospital that first received Magnet designation in 2005.

"The patients treated in that hospital in 1998 and 1999 still had better outcomes than their peers," he says. "So the outcomes were better than their peer institutions way before they had Magnet status, on average." Once the hospital officially embarked on its Magnet journey and then after it received Magnet recognition, surgical outcomes did not continue to improve.

"A patient [at the same facility] in 2007 or 2008, those outcomes were not better than they were in 2005 or 1998," he says, though to be clear, the quality of the outcomes did not decline either.

Advice for Nurse Leaders
Based on his findings, Friese has some words of wisdom for nurse leaders: "They should be encouraged that Magnet does successfully identify high-performing hospitals."

It's important, however, to be cognizant of what goals and outcomes you hope to achieve when you consider taking the Magnet journey.

"If the goal is to improve engagement, satisfaction, and staff retention, Magnet is a very well-established way to do that," Friese says. "If your motivation is, 'We have a problem with our patient outcomes [or] with our care delivery,' pursuing Magnet recognition… may not be the best use of your resources."

A better tactic to help improve patient outcomes would be to create partnerships with institutions that have good outcomes to find out the keys to their successes, Friese says. "I think what we really want to do is create that community where nurse leaders are sharing what they've done to improve outcomes so that everyone benefits from it."