Journal of Nursing Administration:
State of the Science Related to Nurse Work Environments, Safe Practices, and Organizational Outcomes
Luzinski, Craig MSN, RN, NEA-BC, FACHE; Lundmark, Vicki PhD
Director, Magnet Recognition Program® American Nurses Credentialing Center (ANCC)
Director, Institute for Credentialing Research American Nurses Credentialing Center (ANCC)
The authors declare no conflict of interest.
The Magnet Recognition Program® was developed by the American Nurses Credentialing Center (ANCC) more than 20 years ago to recognize healthcare organizations for quality patient care, nursing excellence, and innovations in professional nursing practice.1 The program has evolved over the years, from the 41 reputable hospitals cited by the American Academy of Nursing in 1993,2 to 395 organizations in mid-2012.3 In addition, the program has expanded beyond designation of individual hospitals to recognition of entire healthcare systems, including the addition of 5 international healthcare organizations.
The ANCC is pleased to partner with JONA on this special supplement that is devoted to research investigating the relationship of Magnet® designation to the impact on the nurse work environment, safe practices, and organizational outcomes. The 7 reprinted articles selected for this special issue highlight transformational leadership in Magnet organizations and the relationship of Magnet characteristics to outcomes for patients, organizations, and nurses. The 1st article presents the results from a survey of chief nursing officers in Magnet-recognized organizations, which found “enabling others to act” and “modeling the way” to be among their top leadership practices.4 Next, a study of 665 hospitals in 4 states found that lowering patient-to-nurse ratios improved patient outcomes in the better work environments typical of Magnet-recognized organizations but not in the organizations with poor environments.5 In the 34-state survey study by Djukic et al,6 employment in a Magnet-recognized hospital was positively related to RN ratings of patient care quality.
The studies by Hughes et al7 and Jayawardhana et al8 illustrate the relationship of Magnet environments to better organizational outcomes in the areas of safety climate and safety practices. The study of Hughes et al7 found that nurses in Magnet-recognized organizations were more likely to communicate about errors and participate in error-related problem solving; they also reported greater managerial commitment to safety.7 Jayawardhana et al8 found higher adoption rates of National Quality Forum safe practices among the Magnet-recognized hospitals.
Finally, the studies by Kelly et al9 and Wilkins and Shields10 demonstrate the influence of Magnet environments on nurse outcomes. The large survey study conducted by Kelly et al9 found that nurses in Magnet-recognized hospitals were significantly less likely to report job dissatisfaction and high burnout.
On a national level, sources directed at consumers, such as US News & World Report, utilize Magnet designation as a primary competence indicator in its annual assessment of almost 5000 hospitals to rank and report the best medical centers in 16 specialties.1 This year, 12 of the 17 medical centers on the exclusive US News Best Hospitals in America Honor Roll, and all 12 of the US News Best Children’s Hospital Honor Roll, are ANCC Magnet-recognized organizations.1 In the Leapfrog Hospital survey, the nation’s oldest survey comparing hospital performance in safety, quality, and efficiency, Magnet designation automatically earns full credit for Safe Practice #9 Nursing Workforce.1 This section scores hospitals on their commitment to staffing with highly trained nurses and putting nurses in leadership positions, allowing for substantial input on patient safety issues.1
Today’s healthcare industry is complex, challenging, and ever evolving. To keep pace in the highly competitive marketplace, research indicates healthcare organizations must consistently evaluate their nurse work environment, retention rates, practice protocols, and organizational outcomes. Moreover, they must be more demanding of themselves than their consumers. Leaders in Magnet-recognized organizations are well positioned to advance the enculturation of these fundamental principles. They must guide the philosophy and support the innovative processes that provide the framework for transformation that advances them to new levels of service and sustainability. As national imperatives to improve the quality and safety of the delivery of healthcare move forward, the Magnet Recognition Program will continue to endorse the criterion standard for nursing environments, patient care, and organizational outcomes—1 Magnet-recognized organization at a time.
2. Drenkard K. The Magnet® imperative. J Nurs Adm. 2009; 39 (suppl 7-8): S1–S2.
4. Clavelle JT, Drenkard K, Tullai-McGuinness S, Fitzpatrick JJ. Transformational leadership practices of chief nursing officers in Magnet® organizations. J Nurs Adm. 2012; 42 (4): 195–201.
5. Aiken LH, Cimiotti JP, Sloane DM, Smith HL, Flynn L, Neff DF. Effects of nurse staffing and nurse education on patient deaths in hospitals with different nurse work environments. Med Care. 2011; 49 (12): 1047–1053.
6. Djukic M, Kovner CT, Brewer CS, Fatehi FK, Cline DD. Work environment factors other than staffing associated with nurses’ ratings of patient care quality [published online ahead of print November 2, 2011]. Health Care Manag Rev. 2011. doi: 10.1097/HMR.0b013e3182388cc3.
7. Hughes LC, Chang Y, Mark BA. Quality and strength of patient safety climate on medical-surgical units. Health Care Manage Rev. 2009; 34 (1): 19–28.
8. Jayawardhana J, Welton JM, Lindrooth R. Adoption of National Quality Forum safe practices by Magnet® hospitals. J Nurs Adm. 2011; 41 (9): 350–356.
9. Kelly LA, McHugh MD, Aiken LH. Nurse outcomes in Magnet® and non-Magnet hospitals. J Nurs Adm. 2011; 41 (10): 428–433.
10. Wilkins K, Shields M. Employer-provided support services and job dissatisfaction in Canadian registered nurses. Nurs Res. 2009; 58 (4): 255–263.
© 2012 Lippincott Williams & Wilkins, Inc.