What is Magnet Status?

What is Magnet status and how's that whole thing going?

Magnet status is an award given by the American Nurses’ Credentialing Center (ANCC), an affiliate of the American Nurses Association, to hospitals that satisfy a set of criteria designed to measure the strength and quality of their nursing. A Magnet hospital is stated to be one where nursing delivers excellent patient outcomes, where nurses have a high level of job satisfaction, and where there is a low staff nurse turnover rate and appropriate grievance resolution. Magnet status is also said to indicate nursing involvement in data collection and decision-making in patient care delivery. The idea is that Magnet nursing leaders value staff nurses, involve them in shaping research-based nursing practice, and encourage and reward them for advancing in nursing practice. Magnet hospitals are supposed to have open communication between nurses and other members of the health care team, and an appropriate personnel mix to attain the best patient outcomes and staff work environment. We encourage all nurses to learn more about the principles of Magnet certification, and to consider appropriate nursing certification programs for their hospitals. Learn more about Magnet status: eligibility for it, the benefits of it, hospitals that have achieved it, and hospitals that are seeking it on which the ANCC is seeking public comment.

We understand that some nurses are enthusiastic about the program and feel that it promotes the important practices outlined above. However, it is important to be aware that others, notably nursing unions, have been highly critical of the way the Magnet program has been implemented. Some critics, including the California Nurses Association and the Massachusetts Nurses Association, have argued that the Magnet program is primarily a hospital promotion tool that resembles the Joint Commission on Accreditation of Healthcare Organizations in its seemingly incestuous relations with hospital management. Such critics have also asserted that there is little evidence that nurses at Magnet hospitals are really much better off than nurses elsewhere. Suzanne Gordon, in Nursing Against the Odds (2005), says that she regards the Magnet program as an important effort, but she too questions how well it really works, suggesting that many of its voluntary guidelines may offer only the illusion of nurse empowerment. The Center has heard many first-hand reports of some hospitals trumpeting their new Magnet status even as they proceed to betray some of the program's key principles.

To the extent the Magnet program is not effectively promoting its important nurse empowerment goals, we would like to see it strengthened. In general, we hope that all nurses will work for strong, effective nursing credentialing programs to address the nursing crisis and improve patient care.

Frankly, the Center has heard from a number of nurses who are unhappy with the changes at their hospitals since the award of magnet status, and we have not heard from many who are happy. One report was that the nurse who had led the drive for magnet status was fired soon after the hospital received it, and that the magnet reforms quickly began to unravel. Others have said that their hospitals reverted to short-staffing and excluding nurses from decision-making processes soon after receiving magnet certifications. Such reports support the claims that some hospitals are treating magnet status mainly as a promotional tool, and that the program is not effectively monitoring compliance.

The Center's suggestions on how to improve the Magnet Program

In June 2006, the Center for Nursing Advocacy's executive director, Sandy Summers, sat on an expert panel for The World Congress Leadership Summit for Chief Nursing Officers in Chicago, Illinois. In this presentation she encouraged the Magnet Program to incorporate the following ideas:

Safe Facilities

Improve hospital policies to protect and support nurses

Strengthen Nursing

Strengthen Nursing Managers

Staffing

Employee Benefits

Media

Strengthen credentialing process

Collaboration between the professions

Magnet hospitals should be nursing institutions

Magnet hospitals should exist to provide humane care to all patients

Overall changes to the magnet program

Discussion

Safe Facilities

Magnet facilities should not be reservoirs for dangerous organisms such as MRSA. Each magnet facility should:

provide uniforms for all staff who have contact with patients;

wash these uniforms at temperatures sufficient to render them clean;

provide adequate showering facilities for all staff so that all organisms are not brought out into the community and to home to familes;

require that all staff change out of uniforms and shower before leaving the facility.

See our analysis on this issue.

Each Magnet facility should be a safe place for patients and nurses. They should be:

Latex-free facilities

Mercury-free facilities

Free of toxic cleaning chemicals that lead to illness.

Guidelines for creating safe facilities can be found on Sustainable Hospitals and Health care without harm

Improve hospital policies to protect and support nurses

Each institution should have "no lift policies" and appropriate lifting equipment.
Magnet hospitals should have needleless IV systems and safe needles.
There should be zero tolerance for abuse practices and procedures.
Critical incident stress debriefing sessions should be offered to all employees who suffer physical or sexual assault of any kind.
Hospital attorneys should pursue with police and the district attorney, the cases of employees who have been assaulted, physically or sexually, while at the hospital.

Strengthen nursing

Magnet hospitals should have at least one-year nursing residencies for all new nursing graduates. (One study showed they have a 12% turnover rate for first year grads as compared to a 36-55% turnover rate for first year non-residents.)
Each unit of each hospital should have at least one clinical nurse specialist on duty 24 hours per day, seven days per week.
Magnet hospitals should not recruit nurses from nations with shortages more dire than their own. When hospitals increase staffing by taking nurses from countries that desperately need them, it violates nurses' ethical obligations to the needs of our patients around the globe.
Each nursing manager should be a clinical nurse specialist in a relevant field for his unit.
Each nursing manager should have a full-time administrative assistant to help with paperwork and budgetary duties to allow managers the time to focus on nursing, instead of clerical duties.
Nursing managers should practice clinical nursing on his/her unit at least 16 hours per week.
Over 50% of staff nurses on each unit should be certified in their fields.
Each facility should have at least three centers for nursing professional improvement; one each to strengthen nursing research, nursing clinical practice and nursing education within the hospital.

Strengthen nursing managers

Nursing managers should have significant management training.
The chief nursing officer should have at least a master's degree in nursing.
New nursing manager hires should be interviewed by the staff nurses they will supervise.

Staffing

Charge nurses should be allowed to set the staffing levels on their floors determined by what nurses feel they can take and filled by appropriate mix of nurses based experience and expertise.
Basic minimum nurse-to-patient ratios should be set no higher than those set by the current California legislation, whether or not the institution is located in California.
Nurse-to-patient ratios should be posted very visibly for visitors to see on every unit and updated every shift.

Employee Benefits

Nurses should receive full tuition reimbursement for education that will enable them to stay in nursing or public health.
Hospitals should pay for at least 15 hours of continuing education units for each nurse per year.
All employees, including part-time employees, should be provided with retirement benefits, and health insurance for themselves and their families.

Media

At least half of the public relations officials at Magnet hospitals should be charged with solely promoting nursing.
When a hospital loses its magnet status, the Magnet Credentialing Center should send press releases to at least the two largest newspapers in the area, the four major television networks and local news radio stations regarding the removal of magnet status and the specific reasons why the status was removed.

Strengthen credentialing process

The Magnet Credentialing Center evaluators should come to evaluate hospitals at a surprise time.
The Magnet Credentialing Center should choose hospital staff members they wish to interview--not allow interviewees to be hand-picked by hospital managers.
The Magnet Credentialing Center should separately contact, through home mailing addresses, all nurses who works at the institution to inform them of policies by which they can report infractions by hospitals.
The Magnet Credentialing Center should have an anonymous tip line to report hospital misbehavior.

Collaboration between the professions

The professions should have recurrent training in how to function as a team.
Physicians should be expected to seek nursing input on patient rounds and morbidity and mortality rounds.
Physicians and medical students should follow nurses at work for at least 12 hours per year so that they can understand the value of nursing.

Magnet hospitals should be nursing institutions

At least 51% of the board of trustees should be nurses.
The CEO of the hospital should be a nurse.

Magnet hospitals should exist to provide humane care to all patients

Magnet hospitals should be non-profit institutions. Corporate profits have no ethical place in the delivery of health care.
Uninsured patients should pay no more for any service, procedure or item than the lowest amount accepted by the hospital from any private or government insurance program.
Absolutely no dumping of patients should occur.

Overall changes to the magnet program

The Magnet program should be a government program to which all hospitals adhere.

Discussion

Above is the list of changes and improvements to the Magnet program that our executive director presented to the World Congress of Nurses in June 2006. We would like to hear what all nurses (and patients) think of Magnet hospitals and our suggestions for improvement, especially those who are at magnet facilities.

Please click here to record your experiences on our discussion board.

Thank you!

The list for suggested improvements to the Magnet program expressed herein are those of Sandy Summers, RN, MSN, MPH, the Center's executive director. They do not necessarily reflect those of the Board Members or Advisory Panel of The Center for Nursing Advocacy.

Last updated January 20, 2008