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Lower Mortality in Magnet Hospitals

McHugh, Matthew D., PhD, JD, MPH, RN*; Kelly, Lesly A., PhD, RN; Smith, Herbert L., PhD; Wu, Evan S., BA§; Vanak, Jill M., MSN, RN§; Aiken, Linda H., PhD, RN§

doi: 10.1097/MLR.0b013e3182726cc5
Original Articles

Background: Although there is evidence that hospitals recognized for nursing excellence—Magnet hospitals—are successful in attracting and retaining nurses, it is uncertain whether Magnet recognition is associated with better patient outcomes than non-Magnets, and if so why.

Objectives: To determine whether Magnet hospitals have lower risk-adjusted mortality and failure-to-rescue compared with non-Magnet hospitals, and to determine the most likely explanations.

Method and Study Design: Analysis of linked patient, nurse, and hospital data on 56 Magnet and 508 non-Magnet hospitals. Logistic regression models were used to estimate differences in the odds of mortality and failure-to-rescue for surgical patients treated in Magnet versus non-Magnet hospitals, and to determine the extent to which differences in outcomes can be explained by nursing after accounting for patient and hospital differences.

Results: Magnet hospitals had significantly better work environments and higher proportions of nurses with bachelor’s degrees and specialty certification. These nursing factors explained much of the Magnet hospital effect on patient outcomes. However, patients treated in Magnet hospitals had 14% lower odds of mortality (odds ratio 0.86; 95% confidence interval, 0.76–0.98; P=0.02) and 12% lower odds of failure-to-rescue (odds ratio 0.88; 95% confidence interval, 0.77–1.01; P=0.07) while controlling for nursing factors as well as hospital and patient differences.

Conclusions: The lower mortality we find in Magnet hospitals is largely attributable to measured nursing characteristics but there is a mortality advantage above and beyond what we could measure. Magnet recognition identifies existing quality and stimulates further positive organizational behavior that improves patient outcomes.

*Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing, Philadelphia, PA

Arizona State University, Phoenix, AZ

Department of Sociology, Population Studies Center

§Center for Health Outcomes and Policy Research, University of Pennsylvania, Philadelphia, PA

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Supported by the American Nurses Foundation (L.A.K.), National Institute of Nursing Research (R01-NR-004513, P30-NR-005043, T32-NR007104, L.H.A.), and the Robert Wood Johnson Foundation Nurse Faculty Scholars program (M.D.M.).

The authors declare no conflict of interest.

Reprints: Matthew D. McHugh, PhD, JD, MPH, RN, Robert Wood Johnson Foundation, Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing, 418 Curie Blvd., Philadelphia, PA 19104-4217. E-mail:

© 2013 Lippincott Williams & Wilkins, Inc.