Patient safety, quality of care, nursing research, nursing excellence—are you working in an organization where these are more than words in the news?

Dean-Barr (2003) was defining Magnet when she wrote, “Research shows that nursing is critical to quality of care and patient safety—so how do we create, maintain, and support an environment that is committed to nursing excellence?” (p. 38). The Magnet Recognition Program® identifies and exemplifies organizations which meet the criteria that answer this question and empower nurses to provide the very best in nursing care (American Nurses Credentialing Center [ANCC], 2005). Is your organization there yet?

Getting to Magnet

The concept of magnet hospitals originated with research commissioned by the American Academy of Nursing during the early 1980s. The sample comprised 41 hospitals known for success in recruiting and retaining professional nurses, even during a national nursing shortage. The investigators discovered common strengths in the areas of nursing administration, professional practice, and professional development in these 41 hospitals and suggested that this triad of strengths led to their success in recruiting and retaining professional nurses (McClure, Poulin, Sovie, & Wandelt, 1983).

This research led to the development of a nursing excellence assessment program based on the research findings and the Standards for Organizational Nursing Services and Responsibilities of Nurse Administrators Across All Settings (American Nurses Association [ANA], 1991). The ANA Board of Directors approved the Magnet Hospital Recognition Program for Excellence in Nursing Services in 1990. The magnet hospital concept became a reality in 1994 after the first hospital met the Magnet standards (Bliss-Holtz, Winter, & Scherer, 2004).

Organizations interested in Magnet status are invited to join nurses from Magnet organizations at the annual National Magnet Nursing Conference. Credentialing information is available online (www.nursecredentialing.org/magnet.html). Even with all the attention given to this program, however, less than 3% of the 5,801 hospitals in the United States have earned Magnet designation.

And it is Magnet, not “magic” (Monarch, cited in Trossman, 2002, p. 21). It takes research, best practices, dedication, teamwork, and hard work to create a Magnet environment, but the rewards are worth it. Like the magnet it is named for, Magnet designation is a strong draw for recruiting (pulling power, attraction, prestige) and retaining (staying power, engagement, loyalty) professional nurses.

Magnet designation creates an organization-wide excitement for nursing and a celebration of nursing value, professionalism, and achievements. When the North Carolina Baptist Hospital of Wake Forest University Baptist Medical Center hospital achieved magnet designation, the president and chief nurse executive took out full-page advertisements in the newspaper and posted large banners outside the hospital announcing the award. Every nurse was given a Magnet badge holder, and flowers and congratulatory balloons were delivered to all areas where nurses worked. The excitement spread throughout the organization as coworkers congratulated nurses and told them how proud they were to share in the pride of being part of a hospital nationally recognized for nursing excellence.

The Forces of Magnetism

In 2002, McClure and Hinshaw reanalyzed the research by McClure, Poulin, Sovie, and Wandelt (1983) and identified 14 characteristics or forces of magnetism that merged into all aspects of the nursing and patient care of Magnet hospitals. In a major revision to the Magnet Recognition Program Application Manual (ANCC, 2005), the Magnet standards are now based on these 14 forces of magnetism:

• Quality of Nursing Leadership. Nursing leaders are perceived as knowledgeable, strong risk-takers who follow an articulated philosophy in the day-to day operations of the nursing department. Nursing leaders also convey a strong sense of advocacy and support on behalf of the staff (p. 36).
• Organizational Structure. Organizations are characterized as flat, rather than tall, structures in which unit-based decision making prevails. Nursing departments are decentralized, with strong nursing representation evident in the organizational committee structure. The nursing leader serves at the executive level of the organization, and the chief nursing officer reports to the executive level (p. 38).
• Management Style. Organizations and nursing administrators use a participative management style, incorporating feedback from staff at all levels of the organization. Feedback is characterized as encouraged and valued. Nurses serving in leadership positions are visible, accessible, and committed to communicating effectively with staff (p. 40).
• Personnel Policies and Programs. Salaries and benefits are characterized as competitive. Rotating shifts are minimized, and creative and flexible staffing models are used. Personnel policies are created with staff involvement, and significant administrative and clinical promotional opportunities exist (p. 42).
• Professional Models of Care. Models of care are used that give nurses the responsibility and authority for the provision of patient care. Nurses are accountable for their own practices and are the coordinators of care (p. 45).
• Quality of Care. Nurses perceive that they are providing high-quality care to their patients. Providing quality care is seen as an organizational priority as well, and nurses serving in leadership positions are viewed as responsible for developing the environment in which high-quality care can be provided (p. 47).
• Quality Improvement. Quality improvement activities are viewed as educational. Staff nurses participate in the quality improvement process and perceive the process as one that improves the quality of care delivered within the organization (p. 50).
• Consultation and Resources. Adequate consultation and other human resources are available. Knowledgeable experts, particularly advanced practice nurses, are available and used. In addition, peer support is given within and outside the nursing division (p. 52).
• Autonomy. Nurses are permitted and expected to practice autonomously, consistent with professional standards. Independent judgment is expected to be exercised within the context of a multidisciplinary approach to patient care (p. 54).
• Community and the Healthcare Organization. Organizations that are best able to recruit and retain nurses also maintain a strong community presence. A community presence is seen in a variety of ongoing, long-term outreach programs. These outreach programs result in the organization being perceived as a strong, positive, and productive corporate citizen (p. 56).
• Nurses as Teachers. Nurses are permitted and expected to incorporate teaching into all aspects of their practices. Teaching is one activity that reportedly gives nurses a great deal of professional satisfaction (p. 58).
• Image of Nursing. Nurses are viewed as integral to the organization’s ability to provide patient care services. The services provided by nurses are characterized as essential by other members of the healthcare team (p. 60).
• Interdisciplinary Relationships. Interdisciplin-ary relationships are characterized as positive. A sense of mutual respect is exhibited among all disciplines (p. 61).
• Professional Development. Significant emphasis is placed on orientation, in-service education, continuing education, formal education, and career development. Personal and professional growth and development are valued. In addition, opportunities for competency-based clinical advancement exist, along with the resources to maintain competency (p. 63).

Magnet for Rehabilitation

The forces of magnetism are the threads that provide the environment to support, nurture, and inspire nurses in their professional practice. North Carolina Baptist Hospital of Wake Forest University Baptist Medical Center began the quest for Magnet recognition in 1996. The application process required extensive assessment, communication, documentation, hospital-wide preparation, and a site visit by Magnet appraisers. Rehabilitation nurses played significant roles in attaining Magnet designation. In 1999, North Carolina Baptist became the 14th hospital in the country to receive the Magnet Recognition Program Award for Excellence in Nursing Services. The hospital celebrated but continued to review standards and update documentation. The hospital invited Magnet appraisers back for a redesignation site visit and was re-Magnetized in July 2003.

A major characteristic of Magnet facilities is the ability of the nursing leadership team to create an environment that empowers and respects nurses. Magnet organizations showcase quality patient care, better patient outcomes, adequate nurse staffing, nurse autonomy and accountability, clinically competent nurses, nursing control over nursing practice, staff nurse perception of trust and work satisfaction, support for continuing education, positive nurse-physician communication, and visibility of the chief nurse executive (Kramer & Schmalenberg, 2003; Laschinger, Almost, & Tuer-Hodes, 2003; Laschinger, Shamian, & Thomson, 2001; Robinson, 2001; Upenieks, 2003; White & Olson, 2004). These concepts are important to the advancement of rehabilitation nursing.

For instance, the new Timetakers initiative enhances nursing control over nursing practice by improving interdisciplinary service to patients and staff nurses. Nurses are encouraged to call the Timetakers phone number to report occurrences that interfere with nurse efficiency and effectiveness in providing patient care. The line is monitored 24 hours a day, 7 days a week. One nurse reported that noncardiac units could not get emergency electrocardiograms (ECGs) from 6 am to 6:30 am because all ECG technicians were in the cardiac units doing daily ECGs. After being notified of this concern, the Heart Station immediately assigned one experienced ECG technician to be available to all noncardiac units for emergency ECGs from 6 am to 6:30 am, 7 days a week. Rehabilitation nurses soon saw the results if they needed an emergency early morning ECG.

As another example, the chief of professional services attends orientation for interns, speaks with pride about the hospital’s nurses, and tells the new physicians that they are entering a workplace nationally recognized for excellence in nursing services where nurses are treated with respect. If this respect is violated, the offending physician will soon be in the chief’s office confirming that it will not happen again.

Magnet enriches the nursing care and the lives of rehabilitation nurses who work in organizations that reflect their recognition for nursing excellence. Magnet empowers nurses to govern their own practice and patient care challenges. In addition to their primary responsibilities of assessing, planning, and providing care to adolescents and adults in need of comprehensive rehabilitation services, the hospital’s nurses participate in the shared governance process. Rehabilitation staff nurses serve on each of the five nursing shared governance councils—leadership, practice, quality, research, and professional development. They take active roles in determining best practices, rehabilitation policies, quality indicators, nursing schedules, unit routines, capital equipment needs, and the interdisciplinary team operations.

Because they are so involved at so many levels, the hospital’s rehabilitation nurses say they think they have a voice that is heard and respected. They practice autonomously and collaboratively in anticipating and meeting the needs of rehabilitation patients and their families. Recognizing new CRRNs and nominating nurses for hospital employee of the month, the hospital Nursing Excellence award, The Great 100 Nurses of North Carolina, Sigma Theta Tau International community leader membership, and the Winston Salem Mayor’s Council for Persons with Disabilities Volunteer of the Year award all contribute to keeping staff members energized.

Quality of care is important to rehabilitation nurses, and Magnet status ensures an invitation to participate in the nursing research process and in quality benchmarking. Magnet hospitals submit data quarterly to the National Database for Nursing Quality Indicators (NDNQI Project Staff, 2004). Data on staff skill mix, nursing hours per patient day, pressure ulcers, falls and fall injury rate, nursing education degrees, and national certification are benchmarked against the data of all rehabilitation units in the NDNQI database. Rehabilitation nurses collect the data, discuss the findings, report at Quality Council, and display the results on unit Quality Improvement boards. They serve on the Nursing Research Council and the Medical Center Institutional Review Board and are involved in suggesting, conducting, disseminating, and utilizing research to change nursing practice (Weeks & Satusky, 2005).

One tenet of Magnet recognition is that staff nurses must have access to resource specialists, especially advanced practice nurses. Our staff nurses collaborate daily with the rehabilitation clinical nurse specialists and rehabilitation nurse practitioners. Rehabilitation staff nurses are encouraged to consult with wound/ostomy nurses and the neuroscience, neurosurgery, orthopedic, pulmonary, psychiatric, geriatric, and pediatric clinical nurse specialists. Nurses also seek best practices in the medical center library, in rehabilitation books on the unit, and via computers with free internet access on the unit.

A Magnet environment encourages nurses to pursue national certification and become involved in professional nursing organizations. Nurses earning national certification in this Magnet facility are reimbursed for the examination, and 50% of the hospital’s rehabilitation nurses are proud to say they are Certified Rehabilitation Registered Nurses (CRRN®). Nurses attend the annual Association of Rehabilitation Nurses Conference, hold regional rehabilitation leadership roles, and are active in planning educational activities for rehabilitation nurses. Nurses are encouraged to and assisted with submission of manuscripts for publication and abstracts for conference presentations. Registration, travel, and hotel expenses are paid in full for nurses invited to present at national conferences. This year, the hospital’s Professional Development Council is sponsoring a Certification Challenge with several prizes for newly certified nurses. They will also be drawing the names of two certified staff nurses and offering them all-expense paid trips to the 2005 National Magnet Nursing Conference in Miami Beach, FL. One of the winners may be a rehabilitation nurse.

Is Your Organization There Yet?

Brenda Kelly, RN BSN MA CNAA BC, chairman of the ANCC’s Commission on Magnet Recognition, notes that “A Magnet organization incorporates the components of the forces of magnetism into all areas of patient care. These components are not unique to acute care. They are engrained in our culture and are evident in the day to day practice of the rehabilitation nurse” (B. Kelly, personal communication, February 20, 2005).

Rehabilitation nurses at the Wake Forest University Baptist Medical Center are empowered by the forces of magnetism. Is your organization there yet? Magnet attracts and retains excellent nurses because it ensures a practice environment that empowers professional nurses to provide high-quality patient care in a collaborative working relationship with physicians and other members of the healthcare team. If your organization is not there yet, vow now to make Magnet more than a word in the news. Get in on the action and help your institution get Magnetized!

About the Authors

Sandra Kenney Weeks, MSN RN CRRN CNAA, is director of medicine and oncology services at Pardee Hospital, Hendersonville, NC.

Barbara Custard Smith, MSN RN BC CNAA, is Magnet coordinator and director of nursing at North Carolina Baptist Hospital of Wake Forest University Baptist Medical Center, Winston Salem, NC.

Elizabeth Hubbartt, MSN RN CRRN, is a rehabilitation clinical nurse specialist at North Carolina Baptist Hospital of Wake Forest University Baptist Medical Center, Winston Salem, NC.

Direct correspondence to Sandra Kenney Weeks, MSN RN CRRN CNAA, Director, Medicine and Oncology Services, Pardee Hospital, Hendersonville, NC 28791, or via e-mail to sandy.weeks@pardeehospital.org

References

American Nurses Association. (1991). Organized Nursing Services and Responsibilities of Nurse Administrators Across All Settings. Washington, DC: American Nurses Publishing.

American Nurses Credentialing Center. (2005a). Magnet Recognition Program Application Manual 2005. Silver Spring, MD: Author.

Bliss-Holtz, J., Winter, N., & Scherer, E. M. (2004). An invitation to Magnet accreditation. Nursing Management, 35(9), 36–43.

Dean-Barr, S. (2003). Magnet recognition illuminates nursing roles. Rehabilitation Nursing, 28, 38.

Kramer, M., & Schmalenberg, C. E. (2003). Magnet hospital nurses describe control over nursing practice. Western Journal of Nursing Research, 25(4), 434–452.

Laschinger, H. K. S., Almost, J., & Tuer-Hodes, D. (2003). Workplace empowerment and Magnet hospital characteristics. Journal of Nursing Administration, 33(7/8), 410–422.

Laschinger, H. K. S., Shamian, J., & Thomson, D. (2001). Impact of Magnet hospital characteristics on nurses’ perceptions of trust, burnout, quality of care, and work satisfaction. Nursing Economics, 19(5), 209–219.

McClure, M. L., & Hinshaw, A. S. (2002). Magnet Hospitals Revisited: Attraction and Retention of Professional Nurses. Washington, DC: American Nurses Publishing.

McClure, M., Poulin, M., Sovie, M., & Wandelt, M. (1983). Magnet hospitals: Attraction and retention of professional nurses. american academy of nursing task force on nursing practice in hospitals. Kansas City, MO: American Nurses Association.

National Database of Nursing Quality Indicators Project Staff. (2004). NationalDatabase of Nursing Quality Indicators guidelines for data collection and submission on quality indicators. Kansas City, KS: Kansas University School of Nursing.

Robinson, C. A. (2001). Magnet nursing services recognition: Transforming the critical care environment. AACN Clinical Issues, 12(3), 411–423.

Trossman, S. (2002). Nursing magnets: Attracting talent and making it stick. Nevada RNformation, 11(2), 21.

Upenieks, V. V. (2003). The interrelationship of organizational characteristics of Magnet hospitals, nursing leadership, and nursing job satisfaction. Health Care Manager, 22(2), 83–98.

Weeks, S. K., & Satusky, M. J. (2005). Demystify nursing research. Nursing Management, 36(2), 42–47.

White, M. J., & Olson, R. S. (2004). Factors affecting membership in specialty nursing organizations. Rehabilitation Nursing, 29, 131–137.