I'm not on the journey I expected. When my husband and I moved to Chicago twenty years ago, I fully intended to fulfill a scholarship work requirement at Rush University Medical Center and then begin working with the underserved in the city. But at each turn, I sensed God directing me in ways that kept me at Rush taking on greater responsibility. My desire to integrate my faith in Christ and my spiritual gifts with my nursing career repeatedly led me to positions with elements of helping to create a caring environment—in which nursing staff feel valued and empowered to perform well.
Although I had limited knowledge of the Magnet program, I accepted the responsibility of being the Magnet Coordinator at Rush and leading the process of obtaining Magnet status from the American Nurses Credentialing Center (ANCC). I believed our institution fit the description of a Magnet hospital, and I believed staff did not realize what a great job they were doing or recognize available resources. The nursing staff struggled with morale and felt they were unable to do all they wanted to for patient care. I hoped that gaining Magnet recognition would help improve morale by enabling the staff to realize that they provide excellent care, even in the midst of challenges. I hoped to deepen their desire to continue to value and provide quality patient care. Furthermore, I hoped I could contribute to enhancing an environment of excellence in which nurses could thrive.
WHAT IS MAGNET RECOGNITION?
What are the qualities that create an environment in which nurses can thrive in their work and provide quality patient care? This question sparked the interest of nurses across the country and became the foundation for the ANCC's Magnet Recognition Program. In 1981, in the midst of a nursing shortage, the American Academy of Nursing, a division of the American Nurses Association, convened a task force in an effort to help solve the shortage. They were charged to “examine characteristics of systems impeding and/or facilitating professional nursing practice in hospitals.”1 The group recognized that in the midst of the shortage, there still were hospitals able to act as magnets, attracting and retaining nurses.
The task force studied a representative group of 41 facilities to learn more about their “magnetic” climate. Through surveys of the staff and managers of these facilities, they identified factors that helped to make these hospitals successful in attracting and retaining staff. Fourteen “Forces of Magnetism” were identified (Table 1).2 The task force recognized that although a good work environment is important for the nurse, its importance is in supporting the nurse to provide quality care.
As subsequent studies investigated the original Magnet facilities in the 1980s, it became clear that these Magnet environments are good not only for the nurse, but also for the patient.
In response to these studies, in 1993, the American Nurses Credentialing Center developed the Magnet Recognition Program to recognize healthcare organizations that provide the very best in nursing care. The Program has four objectives:
- 1. To recognize nursing services that use the Scope and Standards for Nurse Administrators3 to build programs of nursing excellence for the delivery of nursing care to patients.
- 2. To promote quality in a milieu that supports professional nursing practice.
- 3. To provide a vehicle for the dissemination of successful nursing practices and strategies among healthcare organizations using the services of registered professional nurses.
- 4. To promote positive patient outcomes.4
Currently, the Magnet Recognition Program is at the center of many discussions within nursing. It has increasingly made its way into the public domain, appearing in a variety of publications from Reader's Digest5 to the Wall Street Journal.6 Hailed as a benchmark for quality during this current nursing shortage, Magnet recognition is elevating nursing in the eye of the public as people realize that nurses make a difference. Magnet designation is the highest level of recognition a hospital or nursing home can receive for excellence in nursing services. As of June 2006, the Commission on Magnet Recognition Program had recognized only 206 healthcare organizations in forty-one states, and one abroad, for their excellence in nursing service.
A Magnet hospital is defined as one that attracts and retains nurses who have high job satisfaction because they can give quality care.7 The primary purpose of the program is to recognize those facilities that have the characteristics and structures that create a Magnet culture. A secondary and equally important function is to provide direction and examples of best practice for organizations who want to develop a culture of nursing excellence. Recognizing nursing excellence, the Magnet Recognition Program also provides consumers with the ultimate benchmark for measuring the quality of care they can expect to receive. As a natural outcome of this, the program elevates the reputation and standards of the nursing profession.
In 2001, a survey was conducted in facilities that had received Magnet designation. Staffs at these facilities were interviewed to determine what: a) creates the magnetism that attracts nurses to work in a particular hospital, b) provides them with job satisfaction, c) encourages them to give high-quality care and d) makes them want to stay. The purpose was to give an up-to-date picture of what staff nurses identified as important to nursing effectiveness. The study identified eight elements, called the Essentials of Magnetism, which are outlined in Table 2. Despite the numerous changes in healthcare between the original 1981 study and the 2001 study, nurses twenty years apart identified virtually identical elements as important in giving quality patient care. This reinforces the significance of the forces of magnetism.
OUR JOURNEY TO MAGNET
The process of obtaining Magnet recognition is an intense endeavor that Rush needed more than two and a half years to complete (most facilities require two to three years). There are several components to gaining Magnet recognition. The process begins with an in-depth assessment of the organization and its nursing services, including appraisal of both qualitative and quantitative factors in nursing. Existing services and structures are analyzed for compliance with the Magnet standards, and changes are implemented as needed. Standards cover such things as processes for planning, providing and evaluating patient care as well as structures that support communication, collaboration, collegial relationships and education. A multibinder document is created to describe how the facility meets each Magnet standard. The document is scrutinized and graded by Magnet appraisers. If the facility scores in the range of excellence, Magnet appraisers conduct an intensive on-site visit.
Receiving Magnet status gives external validation and recognition to an internal environment of excellence. The primary advantage is working in a culture of excellence. Research indicates several additional benefits: better patient outcomes, higher nurse satisfaction, increased RN skill mix and improved RN perception of the quality of care provided.8 One of our staff commented,
“Working in a Magnet hospital reaffirms my commitment to excellence in nursing. Receiving this award means I work in a hospital dedicated to providing excellent patient care. It means nursing has a voice in determining its practice. It's a great feeling to be recognized for the high quality of care nurses provide. And it's a feeling of pride to know I work with so many dedicated nurses who make a difference in patients' lives.”
The experience at Rush University Medical Center mirrors the experience of other facilities. Achieving Magnet recognition has been a boost to our nursing staff. Nurses are choosing to interview for positions at Rush because of its Magnet status, and vacancy rates have dropped. During our journey, we chose to highlight examples of excellence regularly so that all the staff could glean the information.
As we prepared for our site visit, we invited each unit to prepare a poster of something their unit was proud of. Staff frequently say that since receiving the recognition, they are proud to be a nurse and proud to work at Rush. One nurse said, “Achieving Magnet recognition has been a nursing career highlight. It makes me proud to have chosen nursing as a profession.” Staff say they feel recognized and valued for the work they do every day. They express how important it has been to them to be nationally recognized and to have nursing recognized for excellence.
Achieving Magnet recognition is the ultimate goal of most institutions that start on the journey, but not every hospital will achieve it. However, any effort an organization makes to improve its nursing services is beneficial. By conducting a thoughtful examination of its nursing services against the Magnet standards, an organization can move closer to having an environment in which the forces of magnetism are alive. Recertification, which requires many of the same elements as initial certification, is done every four years, and only eighty-six percent of institutions receive Magnet redesignation. In late June 2006, Rush University Medical Center received word that we had received a redesignation as a Magnet institution.
EXCELLENCE IN NURSING
We are taught in Scripture that whatever we do, we are to work at it with all our heart because, literally, we work for Jesus (Col 3:23). Jesus said that what we do for others, we do for him (Mt 25:40). Coordinating Rush's efforts to achieve Magnet recognition has provided a way for me to uphold biblical values of excellence, values that have been integral to my nursing practice for more than twenty years. Moreover, I have had a part in helping nurses celebrate excellence in their own practice.
What are values of excellence in nursing? To provide excellent care, I need to bring compassion and quality care to the bedside. I need to use evidence-based practice, stay current through continuing education and look for ways to improve care through quality improvement activities. This means personal responsibility in improving the practice environment for my patients and coworkers. I need to take the initiative to make changes when I see a problem and to encourage others in being the best they can be. These are the foundations of being a Magnet nurse. Each of us can bring excellence to our work setting. This honors God and builds the profession so that every patient can receive compassionate and quality care.
Leading the Magnet effort, which is an ongoing part of my job, has taken considerable time and effort, but the journey has been invaluable. Watching the pride grow in the staff, hearing outstanding examples of nursing care and being a part of something this significant are personal highlights. In the midst of the journey, the enormity of the task was always present. There was no guarantee that we would gain the recognition (approximately sixty-eight percent of those that apply achieve recognition).
Although I expected to be working directly with the underserved, I believe God has led my career in a different direction. But in following his lead, he has allowed me to influence a broader group, empowering others to care. Magnet status is similar to the biblical concept of Colossians 3:17: “And whatever you do, whether in word or in deed, do it all in the name of the Lord Jesus, giving thanks to God the Father through him.” This means doing my job in an excellent way and giving it my best effort. I feel a responsibility to do what I can to help create an environment in which nurses thrive, in which patients are well cared for and in which new nurses want to stay. In helping to uphold standards of excellence in my facility, and now in working with other institutions who desire to do the same, I believe I can honor God and bring excellence to nursing.
1 Margaret McClure, “Magnet Hospitals: Attraction and Retention of Professional Nurses” in Magnet Hospitals Revisited: Attraction and Retention of Professional Nurses
, eds. Margaret McClure and Ada Sue Hinshaw, 1 (Washington, DC: American Nurses Publishing, 2002).
2 Linda Urden and Kammie Monarch, “The ANCC Magnet Recognition Program: Converting Research Findings Into Action” in Magnet Hospitals Revisited: Attraction and Retention of Professional Nurses
, eds. Margaret McClure and Ada Sue Hinshaw, 103–115 (Washington, DC: American Nurses Publishing, 2002).
3 American Nurses Association, Scope and Standards for Nurse Administrators
, 2nd ed. (Washington, DC: American Nurses Publishing, 2004).
4 American Nurses Credentialing Center, ANCC Magnet Recognition Program—Recognizing Excellence in Nursing Services
Accessed June 20. 2006 at
5 John Pekkan, “Condition: Critical,” Reader's Digest
(September 2003): 88–92.
6 Wall Street Journal, “How Patients Adjust to Inadequate Nursing Care,” Wall Street Journal
(March 2, 2001).
7 Marlene Kramer and Claudia Schmalenberg, “Staff Nurses Identify Essentials of Magnetism” in Magnet Hospitals Revisited: Attraction and Retention of Professional Nurses
, eds. Margaret McClure and Ada Sue Hinshaw, 26 (Washington, DC: American Nurses Publishing, 2002).
8 Linda Aiken, “Superior Outcomes for Magnet Hospitals: The Evidence Base.” In Margaret McClure and Ada Sue Hinshaw. Magnet Hospitals Revisited: Attraction and Retention of Professional Nurses
(Washington, DC: American Nurses Publishing, 2002), 61–81.