This past summer, the Magnet Recognition Program got high accolades from two governmental authorities. In late July, Congress passed the "Nurse Reinvestment Act," which, among other measures, includes grants to encourage facilities to implement Magnet criteria for excellence in nursing services. Just days after President Bush signed that legislation into law, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) released a report on the nursing shortage that recommended that facilities adopt the characteristics of Magnet hospitals to foster a workplace that empowers and is respectful of nursing staff.

"We're pleased to see the growing attention given to the Magnet Recognition Program," said Kammie Monarch, MS, RN, JD, director of accreditation and Magnet programs at the American Nurses Credentialing Center (ANCC), a subsidiary of the ANA that administers the Magnet program. "Magnet nursing facilities attract and retain nursing staff, even when widespread shortages exist. Through Magnet-designated organizations, the Magnet program contributes to the complex solution needed to effectively address the nurse staffing crisis and ensure quality patient care. It's gratifying to see the program gaining stature in health care."

The roots of the Magnet Recognition Program stretch back to 1983, when the ANA published results of a study conducted by the American Academy of Nursing, an ANA subsidiary, that identified variables that created an environment that attracted and retained well-qualified nurses who promoted quality patient care. It was their ability to attract and retain professional nurses that deemed a number of hospitals as "magnets."

In 1993, ANCC formalized the "magnet" concept by establishing the Magnet Hospital Recognition Program for Excellence in Nursing Services. The program recognizes organizations that have exhibited a sustained level of excellence and is based on the ANA Scope and Standards for Nurse Administrators.

Known today as simply the Magnet Recognition Program, it is the only international program recognizing excellence in the delivery of care to patients. A growing body of research indicates that the program is making a positive difference for nurses, their patients, and employers. For example, studies indicate that patients experience lower mortality rates, shorter lengths of stay and increased satisfaction in Magnet facilities, while nurses also have increased satisfaction, as well as increased perceptions of productivity and the quality of care given. Employers benefit, too, as studies indicate that Magnet facilities have lower incidence of needlestick injuries, lower nurse burnout rates and higher retention rates, increased ability to attract new nurses, and higher JCAHO scores.

"Average nurse retention in Magnet facilities is twice as long as that of non-Magnet facilities," said ANCC President Cecilia Mulvey, PhD, RN. "The Magnet program uses model practices with a proven track record."

The first Magnet hospital, University of Washington, was designated in 1994. Today, there are 57 organizations that are designated as Magnet hospitals in the United States and the United Kingdom. At these Magnet organizations, the average RN vacancy rate is 8.19 percent and the average length of employment among RNs is 8.94 years.

Facilities achieve Magnet status through a lengthy process that involves soliciting feedback from a number of sources, including six representatives from the community, individual community members, the applicable ANA constituent member association, the state chapter of the Organization of Nurse Executives, the state board of nursing, state-based consumer protection organizations, state health departments, the U.S. Department of Labor and the Occupational Safety and Health Administration, and the National Labor Relations Board.

In addition to gathering feedback, the Magnet appraiser team conducts a site visit, visiting nursing units and interviewing randomly selected patients, their significant others, staff nurses, charge nurses, nurses working in expanded roles, other health care professionals, vendors and the hospital's leadership team. To get as full a picture as possible about a facility, appraisers even ask individuals whom they interact with on the way to the facility (such as taxi drivers and hotel staff) if they are familiar with the facility, have any experience with the facility they'd like to share and can identify how the facility has contributed to the community.

"The appraiser team does a very thorough assessment of a facility on both the inside and from the outside," Monarch said. "The Magnet designation is a top honor and we believe its integrity must be protected, so applicant facilities are subject to intense scrutiny."

While achieving Magnet status is a milestone celebrated by facilities, they must annually demonstrate they adhere to the program's standards during their four-year designation period. If the ANCC Commission on Magnet Recognition determines that a facility is not adhering to program standards, it will withdraw Magnet status from that facility to protect the integrity of the program.

To demonstrate continued adherence to the Magnet program's standards, facilities must:

* submit annual monitoring reports

* participate in ANA's quality indicator study coordinated by the National Center for Nursing Quality

* notify the Magnet Recognition Program office if any of the following occurs:
a significant increase in staff turnover
a significant increase in the nurse vacancy rate
a significant decrease in nurse decision-making positions/activities
a significant negative change in the organization's nurse-patient ratio
a significant negative change in the licensed/unlicensed ratio of nursing staff
a significant increase in the organization's nurse absentee rate
a significant amount of mandatory overtime is worked by nurses reporting to the Department of Nursing
Nursing-Sensitive Quality Indicator data that fall significantly below the threshold established by the Magnet organization
Nursing-Sensitive Quality Indicator data that fall significantly below the national average as determined by the National Database of Nursing Quality Indicators.

The Commission on Magnet Recognition reviews the annual information filed by Magnet facilities. Organizations that fail to provide the annual reports, to cooperate with post-award site visits or to submit reports confirming that Magnet standards are being met will have their Magnet status revoked. In addition, the Commission investigates any complaints about a Magnet facility. To share a concern or complaint, contact (202) 651-7262 or Magnet@ana.org. Complaints may be anonymous and are kept confidential. Magnet facilities are required to respond to the complaint, and an immediate site visit is scheduled and investigation launched when the complaint involves a health and safety threat to patients or nurses.

For more information about the Magnet Recognition Program and a list of Magnet facilities, go to www.nursecredentialing.org and click on Magnet Recognition Program, email Magnet@ana.org or call (202) 651-7262.

New American Nurses Publishing book explores Magnet's impact

A new book on the Magnet Recognition Program observes that the Magnet concept has endured for more than two decades as the single most successful organizational reform to attract and retain highly qualified professional nurses in hospital practice. Magnet hospitals, according to book editors Margaret L. McClure, EdD, RN, FAAN and Ada Sue Hinshaw, PhD, RN, FAAN, are living evidence that creating professional nurse practice environments is one solution to the flight of nurses from hospital practice.

The evidence base reported in Magnet Hospitals Revisited: Attraction and Retention of Professional Nurses shows that the Magnet Recognition Program is a successful product for adoption by hospitals searching for a solution to the nursing shortage. The book notes that Magnet status also guides nurses in selecting their place of employment.

In the book, the editors make it clear that Magnet designation to those institutions that meet program standards of excellence is more than a reward to the facilities and their nurses -- it also provides consumers with valuable information that enables them to select good hospitals. McClure and Hinshaw conclude that Magnet hospitals -- in comparison to other hospitals -- consistently show evidence of significantly better patient outcomes; that is, fewer complications, lower mortality rates and higher patient satisfaction.

The book also makes the point that hospitals and other settings face recruitment and retention issues related to almost every type of employee, not just nurses. Pharmacists, physical therapists, social workers, housekeepers and security guards are also in short supply, and there is great concern that patient care will be adversely affected. An exciting outcome of Magnet studies is the indication that the disciplines and departments within Magnet organizations benefit from excellent and enlightened management, and therefore all the workers find the hospital a rewarding place in which to be employed. Though the work to date has focused on nurses and nursing, this larger positive outcome is one of several discussed in Magnet Hospitals Revisited that has implications for organizations and their patients.

Extending the Magnet concept from its origins in a 1983 study, this work offers strategies for creating Magnet environments and directing further research. To order the book (Pub# MHR22tan), which costs $24.95, $19.95 for members of ANA constituent members associations, go to www.NursesBooks.org or call (800) 637-0323.