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The benefits of status

McClay, Rebecca, DC, MS, BSN, RN; Mileski, Michael, DC, MHA, MPH, MSHEd, LNFA

doi: 10.1097/01.NME.0000534115.91012.37

Is working at a Magnet® or Pathway to Excellence® hospital right for you?

Is working at a Magnet® or Pathway to Excellence® hospital right for you?

Rebecca McClay is an ICU/CCU Nurse at Midland (Tex.) Memorial Hospital and an Adjunct Professor at Purdue University Global. Michael Mileski is an Assistant Professor at Texas State University School of Health Administration in San Marcos, Tex.

The authors have disclosed no financial relationships related to this article.



Are you a new nursing graduate looking for your first opportunity? Are you a seasoned professional looking for greener pastures? Or are you simply looking for a change? No matter where you are in your nursing career, there are many factors to consider when choosing a healthcare employer. The traditional reasons—salary, benefits, paid time off, and insurance—are still important considerations, but they're just the beginning for the nurse looking for employment in today's healthcare environment.

With so many options available, there are additional aspects you can consider as part of a career decision. What type of unit do you desire? What's the turnover rate and why do staff leave? What type of governance structure does the facility utilize? Who serves on councils and committees? What kind of autonomy do staff members have? How positive are patient outcomes? What educational benefits and support exist for nurses looking to further their career? Is there upward mobility when an advanced degree is obtained? Are you interested in specialty certification? How about a residency program to change your specialty?

Asking these questions may mean that you choose to look specifically at organizations that have attained Magnet® recognition or Pathway to Excellence® designation. These facilities place a significant focus on operations-level engagement and have a strong dedication to shared governance and processes that bring significant benefits to employees, patients, and the community.

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The programs

The American Nurses Credentialing Center (ANCC) Magnet and Pathway to Excellence programs demonstrate an organization's dedication to staff and patient outcomes. The focus is on increasing employee empowerment and satisfaction, which leads to improved patient care. Programs of excellence challenge organizations to continually evolve and exceed current practices. These programs set rigorous standards for quality management and care. They also create feelings of pride and accomplishment for institutions that demonstrate a culture of responsiveness and uplifting principles.

Both programs promote these high standards through their application approval partnerships. Receiving Magnet recognition or Pathway designation signals to the industry, current and potential employees, and the community that the institution is dedicated to all stakeholders, demonstrating to a nationally established third party that its commitment has been succinctly articulated and consistently exhibited throughout its culture and daily operations.

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Magnet Recognition Program®

The Magnet Recognition Program has five required standards or model components. The first is transformational leadership, which must be demonstrated through leadership focus on transforming the values, beliefs, and behaviors within the organization, rather than the more traditional focus of organizational growth. Structural empowerment focuses on employee empowerment and training that's fully integrated into structural policies. Exemplary professional practice is achieved through implementation of best nursing practices. This type of focus requires implementation of new knowledge, innovations, and improvements, and constant exploration of methods to improve and bring patients the best care possible. Lastly, the tracking and measurement of empirical outcomes are required to ensure top results are being achieved and evaluate changes responsibly.

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Pathway to Excellence® Program

The Pathway to Excellence Program has six standards that must be demonstrated throughout the organization. Shared decision-making encompasses organizational governance, interdisciplinary processes for ethical concerns, engagement in product evaluation and changes in practice, and input into nursing staff hiring and workflow. Leadership by the CNO and nurse managers must encourage clinical nurse collaboration on resource allocation, cost management, and staff/patient advocacy. Safety of patients and staff is developed and revised by interprofessional collaboration, with safeguards to protect professional practice behaviors and staff/patients from violent incidents. Quality is assured through interpersonal collaboration for patient advocacy through strong organizational missions, goals, visions, and values. Well-being of staff is established through work-life balance, with staff members actively engaged in scheduling and improving community services and institutional programs, leading to involved, motivated, and confident staff. Professional development is an all-encompassing plan for staff orientation; safe and effective patient care development; and lifelong learning, with advancement opportunities throughout the organization.

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Why does it matter?

These programs expect and encourage nurse empowerment, accountability, and advancement. Nurse managers in these organizations have hands-on accountability to work with frontline nurses. This increased accountability and cooperation creates an environment where nurses are more engaged with their work and play a part in realizing better patient outcomes.

With either program also comes safety. Magnet and Pathway to Excellence hospitals have significantly fewer safety-related incidents, with increased safety for staff and patients. There are lower rates of on-the-job nurse injuries and decreased rates of needle-sticks and other bloodborne incidents. Patients experience decreased incidence of falls and pressure injuries, and more positive outcomes for many diagnoses, including ischemic stroke and delirium.

Patient experiences are also more positive in Magnet and Pathway hospitals. These organizations have higher scores on Hospital Consumer Assessment of Healthcare Providers and Systems surveys, and research shows that patients perceive their experiences to be more satisfying when receiving care at Magnet and Pathway hospitals.

Improved outcomes and community perception often equate to better financial performance for the hospital. This usually extends to nurses in terms of the job stability that financial performance brings, along with an increased ability to pursue advanced education, which is a requirement of the Magnet and Pathway programs. It can also lead to opportunities for nurses to pursue projects, such as research, committee work, and community outreach.

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Choosing a hospital

Magnet and Pathway to Excellence fit into an institution in different ways. The two programs differ in the types of documentation required, the duration of the recognition/designation, and the potential financial investment.

Magnet recognition requires information that depends heavily on internal research data. There are required facility benchmarks compared with national medians and means for clinical outcomes and indicators, along with nurse education and certification levels, and nurse and patient satisfaction data. There's also a requirement for Magnet facilities to be actively engaged in nursing research. Magnet recognition lasts 4 years before redesignation and interim reporting is required during this time. This can be a heavier cost to the facility, particularly smaller organizations that may not retain staff who can provide this level of data.

Pathway to Excellence designation is also rigorous, but documentation is focused on implementation of practice standards rather than data collection. Pathway designation lasts 3 years and redesignation occurs via review. The confidential staff survey and submission of institutional adherence to the Pathway standards make this a more cost-effective option for organizations that don't have designated research and data analysis staff.

Either program demonstrates a facility's dedication to meeting challenges and striving for continuous improvement, including improving working conditions for interdisciplinary teams and improving patient outcomes. Magnet recognition has been demonstrated to assist facilities in attracting and retaining top talent, while improving patient outcomes of care, safety, and satisfaction. Higher levels of engagement and more career opportunities improve nurse retention and allow growth within the field of healthcare, while remaining part of the institutional and local community. The deeper consideration of an organization's structure, foundational beliefs, and actions makes the Pathway to Excellence journey one of self-actualization.

Both programs advance nursing standards and practice while fostering a collaborative culture. These factors not only improve the perception of the institution and demonstrate quality care, but they also increase financial success and, therefore, improve the community standards of healthcare. Magnet and Pathway hospitals ensure that they continue to grow and evolve in a harmonic and responsive way, with leadership valuing frontline staff insights.

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In the thick

Pursuing a position within a Magnet or Pathway to Excellence hospital may be a great benefit to you. Working in these environments can provide you with ongoing exposure to cutting-edge ideas and technologies. If you're looking to be “in the thick” of nursing, take the time to find out if the facilities you're considering have Magnet recognition or Pathway designation. The most important element is that the facility's focus aligns with your personality and professional nursing practice goals.

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cheat sheet

Program criteria



Magnet® model components

  • Transformational leadership
  • Structural empowerment
  • Exemplary professional practice
  • New knowledge, innovations, and improvements
  • Empirical outcomes

Pathway to Excellence® standards

  • Shared decision-making
  • Leadership
  • Safety
  • Quality
  • Well-being
  • Professional development
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on the web



Magnet Recognition Program®:

Pathway to Excellence® Program:

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      American Nurses Credentialing Center. Pathway to Excellence Program.
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