And Patient Outcomes Do Magnet organizations provide a safer work environment with better patient outcomes? By Sandra Gilman, Stephanie Gulledge, Kim Proux & Sueann Unger

 Nursing shortage in the 1980’s  The American Academy of Nursing ▪ Developed a task force to determine why some hospitals were more successful than others in nursing recruitment ▪ Results indicated 41 hospitals had “Magnet” characteristics  So in the 1990’s American Nurses Credentialing Center (ANCC) established Magnet recognition Program American Nurses Credentialing Center. (2012). History of the Magnet recognition program. Retrieved from

14 Standards 5 Components Sources of Evidence 14 Forces

ANCC, 2012 American Nurses Credentialing Center. (2012). Retrieved from:

 392 Magnet Facilities (as of March 2012)  Australia  Lebanon  Singapore  United States ANCC, 2012 American Nurses Credentialing Center. (2012). History of the Magnet recognition program. Retrieved from

Descriptive Summary  Researchers studied and compared Magnet hospitals adoption of safe practice versus Non-Magnet hospitals.  Data collected from 218 Magnet hospitals and 2,308 non-Magnet hospitals. Jayawardhana, J., Welton, J.M., & Lindrooth, R. (2011). Adoption of National Quality Forum Safe Practices by Magnet hospitals. The Journal of Nursing Administration, 41(9), , doi: /NNA.0b013e31822a71a7

Purpose of the study To determine whether Magnet hospitals (MH’s) were more likely to adopt the National Quality Forum (NQF) Safe Practices strategy to improve patient safety over non-Magnet hospitals (NMH’s). Jayawardhana, J., Welton, J.M., & Lindrooth, R. (2011). Adoption of National Quality Forum Safe Practices by Magnet hospitals. The Journal of Nursing Administration, 41(9), , doi: /NNA.0b013e31822a71a7

Study Findings  In 2004 MH’s had higher mean Composite Safe Practice Score (CSPS) of 862 compared with the NMH’s mean CSPS of 794  In 2006 NMH’s improved their CSPS at a greater rate moving to 892, whereas MH’s improved from 862 to 928  It was also determined that MH’s had higher nurse per patient ratio, and had advanced clinical technologies. Jayawardhana, J., Welton, J.M., & Lindrooth, R. (2011). Adoption of National Quality Forum Safe Practices by Magnet hospitals. The Journal of Nursing Administration, 41(9), , doi: /NNA.0b013e31822a71a7

Strengths of this study included the use of:  Use of nationally recognized surveys  Use of appropriate measures to control for bias’ * Saiden Index (weighted measures to adjust for difference in technological services available) *Herfindahl-Hirschman Index (weighted measure to adjust for size of the institution) Limitations of the study included :  Use of only Urban hospitals, rural hospitals were not used  Leapfrog group Survey is voluntary  Reporting of NQF safety practices are voluntary (Heckman Correction Method was used to correct for this) Overall this study was effective at showing a positive correlation between Magnet hospitals and adoption of safe practices

Descriptive Summary  This descriptive design studied and compared patient outcomes between Magnet and non- Magnet hospitals  The sample consisted of 19 Magnet and 35 non-Magnet university hospitals and affiliates and was based on data from Goode, C.J., Belgen, M.A., Park, S.H., Vaughn, T., & Spetz, J. (2011). Comparison of patient outcomes in Magnet and non- Magnet hospitals. The Journal of Nursing Administration, 41(12), , doi: /NNA.0b013e b7c

Purpose of the study  Focusing on:  Patient Outcomes  Staffing in Magnet and Non-Magnet hospitals Goode, C.J., Belgen, M.A., Park, S.H., Vaughn, T., & Spetz, J. (2011). Comparison of patient outcomes in Magnet and non-Magnet hospitals. The Journal of Nursing Administration, 41(12), , doi: /NNA.0b013e b7c

Study Findings  Non-Magnet hospitals had better patient outcomes than Magnet hospitals.  Magnet hospitals had slightly better outcomes for pressure ulcers, but infections, postoperative sepsis, and postoperative metabolic derangement outcomes were worse in Magnet hospitals.  Magnet hospitals also had lower staffing numbers Goode, C.J., Belgen, M.A., Park, S.H., Vaughn, T., & Spetz, J. (2011). Comparison of patient outcomes in Magnet and non- Magnet hospitals. The Journal of Nursing Administration, 41(12), , doi: /NNA.0b013e b7c

 Strengths of this study include: *Solid data from NDNQI (national database nursing quality indicators) *Sufficient sample of 5,388 units in 636 hospitals *Evaluated nurse staffing, hospital Magnet status, and patient falls  Weaknesses of this study include: *Results showed the opposite of what was expected with more LPN and NA hours associated with more falls *Data was from 2004, prior to mandating reporting falls Overall, results were consistent that the fall rate was 5% lower in Magnet hospitals compared to non-Magnet hospitals

Armstrong, K., Laschinger, H., & Wong, C. (2009). Workplace empowerment and Magnet hospital characteristics as predictors of patient safety climate. Journal of Nursing Care Quality, 24(1), 55-62, doi: /NCQ.0b013e31818f5506 Descriptive Study Focus of the study The use of Kanter’s theory of workplace empowerment to improve the work environment and patient safety climate This is a replication of a previous study using a larger more representative sample of nurses..

Purpose of the study The purpose of the study was to provide nurse leaders with ideas for improving the patient safety climate by improving the quality of nurse’s work environments Armstrong, K., Laschinger, H., & Wong, C. (2009). Workplace empowerment and Magnet hospital characteristics as predictors of patient safety climate. Journal of Nursing Care Quality, 24(1), 55-62, doi: /NCQ.0b013e31818f5506

Study Findings  Overall empowerment was positively related to overall Magnet hospital characteristics  Total empowerment was significantly positively related to perceptions of patient safety climate  Most strongly related to patient safety climate were nursing foundation for care, manager ability, and nursing participation in hospital affairs  Combination effect of increased access to empowerment structures and higher levels of Magnet hospital characteristics were significantly related to higher perceived patient safety climate Armstrong, Laschinger, & Wong, 2008 Armstrong, K., Laschinger, H., & Wong, C. (2009). Workplace empowerment and Magnet hospital characteristics as predictors of patient safety climate. Journal of Nursing Care Quality, 24(1), 55-62, doi: /NCQ.0b013e31818f5506

 Strengths of this study include: *Adequate sample size * questionnaire was previously tested, validated and cost effective * Limitations of this study include: *Concern for bias because a questionnaire was used Kanter’s theory of organizational empowerment was found to be reinforced by this study due to the relationship between nursing practice environments and patient safety

Descriptive Summary  The relationship between hospital Magnet status, nursing unit staffing and patient falls were examined in a cross-sectional study using 2004 National Database of Nursing Quality Indicators (NDNQI)  Data was obtained from 5,388 units in 108 Magnet and 528 non-Magnet hospitals Lake, E.T., Shang, J. Klaus, S., & Dunton, N. (2010). Patient falls: Association with hospital Magnet status and nursing unit staffing. Research in Nursing & Health, 33(5), , doi: /nur.20399

Purpose of the study  To compare the relationships of nurse staffing, RN composition, hospitals’ Magnet status and patient falls Lake, E.T., Shang, J. Klaus, S., & Dunton, N. (2010). Patient falls: Association with hospital Magnet status and nursing unit staffing. Research in Nursing & Health, 33(5), , doi: /nur.20399

Study Findings  Bivariate results showed average fall rates were 8.3% lower in Magnet than non-Magnet hospitals  Multivariate models showed fall rate was 5% lower in Magnet than non-Magnet hospitals  An additional registered nurse hour per patient day resulted in 3% lower fall rate in ICU’s  An additional licensed practical nurse or nursing assistant hour was associated with a 2-4% higher fall rate in non-ICU’s  Patient safety may be improved with the creation of Magnet or Magnet-like hospital standards Lake, E.T., Shang, J. Klaus, S., & Dunton, N. (2010). Patient falls: Association with hospital Magnet status and nursing unit staffing. Research in Nursing & Health, 33(5), , doi: /nur.20399

 Strengths of this study include: *Accuracy of total hours per patient day and skill mix *Use of a database to separate productive and non- productive hours *Sample consisted of only teaching hospitals  Limitations included: *small sample size of Magnet hospitals and the sample composition of teaching hospitals Overall the study proved that pressure ulcers were lower in Magnet hospitals, but the study found that non-Magnet hospitals have better outcomes in all other areas than Magnet hospitals.

 Magnet recognized hospitals have the highest standard of excellence including nursing quality, professional work environment, evidence-based practice and positive patient outcomes.  Results of our collation of research studies reveal  Magnet hospitals were more likely to achieve higher rates of National Quality Forum safe practices than non-Magnet hospitals  Little difference was found in patient outcomes between Magnet and non-Magnet designation  Staff empowerment was positively related to Magnet status and patient safety outcomes are the result  Patient fall rates were 5% lower in Magnet credentialed hospitals and patient safety may be improved by creating a magnet-like environment

 Patient falls and pressure ulcers are nurse sensitive indicators, there are current standards in place at most institutions to decrease the incidence of both  Some of us are from a Magnet institution or an institution that is in their Magnet journey. Evidence that we currently use is: *Nursing Empowerment, which does seem to have an impact on patient outcomes, as nurses are involved in the improvement of patient care process *As a nurse who was part of the Magnet journey, we can say from personal perspective that there has been a positive correlation in patient outcomes and satisfaction. Overall, the evidence given is useful for institutions to determine if there is a benefit to their staff and patients to pursue Magnet designation.

Nursing Care Nursing Care Evidence Based Practice Improved Patient Care Research Evidence Generated Great Outcomes

 Patient outcome evidence is limited  Research is prior to Magnet focus change  Currently there are new Magnet designation requirements  Nurse Outcomes  Workforce Outcomes  Patient Outcomes  Clinical Outcomes Ponte, P. & Luzinski, C. (2012). Letter to the editor: Comparison of patient outcomes in Magnet and non-Magnet hospitals. The Journal of Nursing Administration, 42(2), 65-66, doi: /NNA.0b013e318244bdc0

 More studies that focus on patient outcomes are needed  Researchers need to enhance sample sizes, strengthen data collection and analysis methods along with identify key variables to explain findings.  The evidence presented in this paper shows promise of the impact Magnet hospitals can have on positive patient outcomes but needs to be enhanced with additional research studies. Ponte, P. & Luzinski, C. (2012). Letter to the editor: Comparison of patient outcomes in Magnet and non-Magnet hospitals. The Journal of Nursing Administration, 42(2), 65-66, doi: /NNA.0b013e318244bdc0