Achieving Magnet Status: Demonstrating Nursing Excellence

Kansas Nurse, Aug 2005 by Cox, Karen S, Carroll, Cathryn, Sexton, Kathleen

An Overview of the Magnet Recognition Program

The Magnet Recognition Program, introduced in the 1980s by the American Nurses' Credentialing Center (ANCC), an arm of the American Nurses Association (ANA), evaluates an organization's support of nurses and the quality of the patient care environment. While the Magnet Recognition Program focused on hospital nurses initially, ANCC now offers the recognition opportunity to long-term and other patient care organizations in the United States and Internationally. There are currently more than 150 organizations with Magnet Recognition. Eligibility is clear cut. A nursing organization must be a subset of a healthcare organization. The Chief Nursing Officer (CNO) must be in (his/her) position for 12 calendar months prior to submission of the application with approved education and tenure. CNO leadership is subject to intense scrutiny and there must be evidence of active participation at the executive level in decision-making, professional oversight and planning.

Although the achievement of the final Magnet Recognition designation is important, the ultimate benefit of the program can be found in activities surrounding the documentation and evaluation of an organizations proximity to the Magnet standards. This documentation and evaluation process engages nurses at all levels of the organization facilitating communication and dialogue that may not have occurred prior to the Magnet application process. Evaluation criteria for earning Magnet status are described in the American Nurses Association's Scope of Standards for Nurse Administrators (ANA, 2004). Successful attainment of the criteria contained within this report are believed to ensure that organizations have demonstrated excellence in (1) the delivery of nursing care to patients; (2) the development of support systems for nursing professionals; (3) the conduct and dissemination of research to share best practices and (4) enhanced patient care outcomes.

Children's Mercy Hospitals and Clinics Benefit from Magnet Review and Recognition

Organizational assessment is the first of several phases in the quest for Magnet designation. Prior work by the authors indicates that benefits in nurse perceptions of the work environment can accrue to organizations that implement readiness evaluations. Several tools are available to hospitals of all sizes and locations to assess an organizations proximity to the standards advanced through the Magnet Recognition Program. Such tools include the Kramer and Schmalenberg Essentials of Magnetism Evaluation, the Nursing Work Index (NWI) tool and the Individual Workload Perception Scale (IWPS). Both the Essentials of Magnetism Evaluation and the IWPS evaluation are free to organizations interested in assessing Magnet readiness. The Kramer and Schmalenberg tool evaluates eight organizational attributes reported to be essential to quality care: support for education, working with other nurses that are clinically competent, positive nurse/physician relationships, autonomy in nursing practice, an organizational culture that values concern for the patient, control of and over nursing practice, adequacy of nurse staffing and high quality nurse-manager support (Kramer and Schmalenberg, 2004) (a); (Kramer and Schmalenberg, 2004) (b). The Nursing Work Index, originally developed in the 1980's, has also been used to assess the work environment for nursing professionals. The Individual Workload Perception Scale (IWPS) is an alternative mechanism to assess one objective of the Magnet Recognition Program-nursing support (Cox, 2003). IWPS, as an assessment tool, differentiates magnet and non-magnet organizations from the perspective of the nurses and the level of support they perceive. It is common for organizations to improve nurse perceptions in the process of preparing for Magnet Recognition.

When an organization has identified and corrected areas identified for improvement, it may move onto the next steps of the application process. The general process requires completion of the Magnet Recognition Program application, payment of fees based upon institution bed size and submission of data to support the quality of nursing care and patient outcomes. The organizations documentation is reviewed by a panel of experts that either recommend a site review or seek additional information relevant to the application before a decision regarding site review can be made. Upon successful review of the documentation, an onsite survey by ANCC experts occurs. Based upon a thorough review of all of the data collected as part of the Magnet Recognition program, a final approval or denial is recommended for the institution.

Today, over 150 hospitals across the United States and abroad have sought and obtained Magnet Recognition Status. Several factors can lead nursing leadership to consider engaging in the Magnet Recognition program. In general, hospitals have participated in the review process as a mechanism to identify and remove barriers to retention, nurse satisfaction and quality patient outcomes. Even in the absence of the achievement of the final Magnet designation, efforts to address all of these issues deserve consideration on the part of nursing leadership for hospitals large and small. Other indirect benefits of the program include increased communication between staff level nurses and nursing leadership that occur through the evaluation process. The development of staff nursing relationships between and among various departments and units can be an additional benefit that occurs through the increased flow of communication during the evaluation process. The Magnet Recognition Program empowers nurses to establish the practice standards to achieve the desired outcome for themselves and their patients.