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Understanding the Role of the Professional Practice Environment on Quality of Care in Magnet® and Non-Magnet Hospitals

Stimpfel, Amy Witkoski PhD, RN; Rosen, Jennifer E. MPH, MSN; McHugh, Matthew D. PhD, JD, MPH, RN, FAAN

JONA: The Journal of Nursing Administration: January 2014 - Volume 44 - Issue 1 - p 10–16
doi: 10.1097/NNA.0000000000000015

OBJECTIVE: The aim of this study was to explore the relationship between Magnet Recognition® and nurse-reported quality of care.

BACKGROUND: Magnet® hospitals are recognized for nursing excellence and quality patient outcomes; however, few studies have explored contributing factors for these superior outcomes.

METHODS: This was a secondary analysis of linked nurse survey data, hospital administrative data, and a listing of American Nurses Credentialing Center Magnet hospitals. Multivariate regressions were modeled before and after propensity score matching to assess the relationship between Magnet status and quality of care. A mediation model assessed the indirect effect of the professional practice environment on quality of care.

RESULTS: Nurse-reported quality of care was significantly associated with Magnet Recognition after matching. The professional practice environment mediates the relationship between Magnet status and quality of care.

CONCLUSION: A prominent feature of Magnet hospitals, a professional practice environment that is supportive of nursing, plays a role in explaining why Magnet hospitals have better nurse-reported quality of care.

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Author Affiliations: Assistant Professor (Dr Witkoski Stimpfel), College of Nursing, New York University; Graduate Student (Ms Rosen) and The Rosemarie Greco Term Endowed Associate Professorship in Advocacy, Center for Health Outcomes and Policy Research (Dr McHugh), School of Nursing, University of Pennsylvania, Philadelphia.

Funding was provided by the National Institute of Nursing Research (R01-NR-004513, Linda Aiken, primary investigator [PI]), National Institute of Nursing Research training grant “Advanced Training in Nursing Outcomes Research” (T32-NR-007104, Linda Aiken, PI), and Robert Wood Johnson Foundation Nurse Faculty Scholars program (Dr McHugh).

The authors declare no conflict of interest.

Correspondence: Dr Witkoski Stimpfel, College of Nursing, New York University, 726 Broadway, 10th Fl, New York, NY 10003 (

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