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Changes in Patient and Nurse Outcomes Associated With Magnet Hospital Recognition

Kutney-Lee, Ann PhD, RN*; Stimpfel, Amy Witkoski PhD, RN; Sloane, Douglas M. PhD*; Cimiotti, Jeannie P. PhD, RN; Quinn, Lisa W. PhD, RN§; Aiken, Linda H. PhD, RN*

doi: 10.1097/MLR.0000000000000355
Original Articles

Background: Research has documented an association between Magnet hospitals and better outcomes for nurses and patients. However, little longitudinal evidence exists to support a causal link between Magnet recognition and outcomes.

Objective: To compare changes over time in surgical patient outcomes, nurse-reported quality, and nurse outcomes in a sample of hospitals that attained Magnet recognition between 1999 and 2007 with hospitals that remained non-Magnet.

Research Design: Retrospective, 2-stage panel design using 4 secondary data sources.

Subjects: One hundred thirty-six Pennsylvania hospitals (11 emerging Magnets and 125 non-Magnets).

Measures: American Nurses Credentialing Center Magnet recognition; risk-adjusted rates of surgical 30-day mortality and failure-to-rescue, nurse-reported quality measures, and nurse outcomes; the Practice Environment Scale of the Nursing Work Index.

Methods: Fixed-effects difference models were used to compare changes in outcomes between emerging Magnet hospitals and hospitals that remained non-Magnet.

Results: Emerging Magnet hospitals demonstrated markedly greater improvements in their work environments than other hospitals. On average, the changes in 30-day surgical mortality and failure-to-rescue rates over the study period were more pronounced in emerging Magnet hospitals than in non-Magnet hospitals, by 2.4 fewer deaths per 1000 patients (P<0.01) and 6.1 fewer deaths per 1000 patients (P=0.02), respectively. Similar differences in the changes for emerging Magnet hospitals and non-Magnet hospitals were observed in nurse-reported quality of care and nurse outcomes.

Conclusions: In general, Magnet recognition is associated with significant improvements over time in the quality of the work environment, and in patient and nurse outcomes that exceed those of non-Magnet hospitals.

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

New York University College of Nursing, New York, NY

University of Florida College of Nursing, Gainesville, FL

§Massachusetts General Hospital Institute of Health Professions, Boston, MA

Supported by grants from the American Nurses Foundation (Margretta Madden Styles Credentialing Research Award and Sayre Memorial Scholarship (Kutney-Lee, PI)), NINR R01-NR-004513(Aiken, PI), T32-NR007104 (Aiken, PI), and the Robert Wood Johnson Foundation.

This study was reviewed and approved by the University of Pennsylvania Institutional Review Board.

The authors declare no conflict of interest.

Reprints: Ann Kutney-Lee, PhD, RN, Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing, 418 Curie Blvd. Claire M. Fagin Hall, Room 385, Philadelphia, PA 19104. E-mail:

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