Do nurses who work in Magnet hospitals really enjoy better working conditions than their peers in non-Magnet facilities? According to a study published in the Journal of Nursing Administration, not really. But what, if anything, do these findings say about the overall value of the Magnet Recognition Program in promoting nursing excellence and improving patient outcomes?
Alison M. Trinkoff, a nurse researcher at the University of Maryland School of Nursing and the lead author of the report, acknowledges that a growing body of evidence suggests that Magnet hospitals have greater nurse retention, autonomy, and shared governance, as well as greater patient safety and better outcomes, but notes that there's uncertainty about whether Magnet hospitals really offer nurses measurably better working conditions. Trinkoff led a team that analyzed data collected in a 2004 survey that was a follow-up to the Nurses Worklife and Health Study, comparing responses of nurses working in Magnet hospitals with those working in non-Magnet hospitals regarding measures of work schedule, job demands, and practice environment.
Both groups reported similar working conditions as measured by the selected variables, but there were some differences. Both worked the same number of hours per day and per week, but the Magnet group was significantly less likely to report mandatory overtime and on-call hours. The Magnet hospital nurses also reported that their duties were physically less demanding, but only slightly so.
One demographic difference between the two groups emerged: the proportion of nurses of color was significantly lower in Magnet hospitals (8.6%) than in non-Magnet facilities (16.1%). However, there were no significant differences in any of the other measures of working conditions, including patient safety culture, nursing practice environment, and overall job satisfaction.
As evidence of the ultimate value of Magnet status, such findings might raise an eyebrow or two, especially when publicized imprecisely in the media. ANA SmartBrief, an e-mail news digest for members of the American Nurses Association (ANA), drew attention to the study with the headline "Magnet status doesn't improve nurses' working conditions." Reacting to the study (and the ANA news item), the American Nurses Credentialing Center (ANCC), a subsidiary of the ANA, issued a statement applauding Magnet research efforts while pointing out the limitations of Trinkoff and colleagues' study design. Karen Drenkard, director of the Magnet Recognition Program at the ANCC, said, "This research seems to imply that non-Magnet hospitals don't exhibit Magnet characteristics, and that's not necessarily true. Just because a hospital doesn't have Magnet status doesn't mean it's not a good hospital. It's a voluntary program." She added that it wouldn't be valid to draw conclusions about the value of the Magnet program from this one study.
Trinkoff and colleagues acknowledge that the study has limitations, including its relatively small sample size. The researchers analyzed responses from 837 nurses who worked in 171 acute care hospitals in Illinois and North Carolina. Only 14 of the hospitals had Magnet designation as of 2005; 157 hospitals didn't. One hundred sixty-two nurses worked in the Magnet facilities; 675 worked in the non-Magnet facilities. (At press time there were 368 Magnet facilities in the United States; four others are in Australia, Lebanon, and Singapore.)
AJN Editor-in-Chief Emeritus Diana J. Mason, Rudin Professor of Nursing and director of the Hunter College Center for Health, Media, and Policy, is concerned that policymakers and hospital administrators might draw the wrong conclusions from findings that don't show obvious differences. "Researchers need to be careful when using Magnet status as a proxy measure, without clarifying that non-Magnet hospitals may also have Magnet-like characteristics but have not pursued Magnet designation." She added, "The Magnet Recognition Program is the best tool we've had for getting hospitals to improve the work environment of nurses. As hospitals seek Magnet status, it really pushes them—and the health care system as a whole—to promote excellence in nursing."
According to Trinkoff, "Now is a good time for all hospitals to look at work schedules and job demands, both of which have a significant impact on nurses' health and performance and are two of the biggest reasons nurses leave their jobs or say they want to leave them. Magnet hospitals have led in many areas, and the whole movement has been very beneficial to nursing; I think they can provide leadership in this area, as well."
For more on the Magnet Recognition Program, visit the ANCC at www.nursecredentialing.org/Magnet.aspx.—James M. Stubenrauch