Nurses report a healthy culture: results of the Practice Environment Scale (Australia) in an Australian hospital seeking Magnet recognition

The Magnet Recognition Program requires evidence that the nursing practice environment supports staff to provide optimal care, access professional development opportunities and participate in hospital affairs. This research aimed to assess clinical nurses' work environment at a leading private hospital in Sydney, Australia using a version of the Practice Environment Scale of the Nursing Work Index modified for the Australian context. Our results were comparable to Magnet hospitals for two subscales and significantly higher than Magnet results for the remaining three subscales and the composite scale. This was especially pleasing in relation to the hospital's preparation for Magnet recognition. Hospitals across Australasia might find administration of the Practice Environment Scale (modified for use in the Australian context) a useful exercise both as a stimulus to preparation and an indicator of readiness for Magnet recognition.     

Further evidence on the Magnet Recognition program: implications for nursing leaders

Growing evidence indicates that the Magnet Recognition program fosters excellence in nursing services through the development of a professional nursing practice environment. This study of 470 staff nurses from both Magnet and non-Magnet settings supports other recent evidence that nurses in Magnet hospitals demonstrate significantly higher levels of job satisfaction. Findings in this study suggest that this degree of job satisfaction, along with higher levels of satisfaction with key elements in the Magnet work environment, have a positive link to retention. The findings of this study, along with recommendations for developing a professional nursing practice environment through use of the 14 Forces of Magnetism, are timely and applicable to nursing leaders seeking remedies to the national nursing shortage.     

Nursing practice environment: How does one Australian hospital compare with magnet hospitals?

Magnet hospitals are recognized institutions of nursing excellence that provide an environment for the promotion of nursing and high-quality patient care. The Magnet Recognition Program, developed by the American Nurses Credentialing Centre, acknowledges health-care institutions that not only attract and retain nursing staff but also recognize nursing excellence in the delivery of quality patient care. Our study aimed to adapt the existing Practice Environment Scale to the Australian context and to pilot its use in measuring the nursing practice environment at a metropolitan hospital in Sydney, Australia. Nursing staff from four wards at a 400 bed major metropolitan acute general hospital in Sydney, Australia completed a self-administered questionnaire about their practice environment. Data were compared with the published norms from magnet and non-magnet hospitals in the USA, and means of two subscales were not significantly different from magnet hospital means. Hospitals could benefit from undertaking a similar practice environment baseline measure prior to applying for accreditation, thus enabling targeting of pre-identified service gaps and areas for improvement.     

Best quality patient care: a historical perspective on Magnet hospitals

Donabedian's Structure-Process-Outcome paradigm is used to analyze the evolution and research on the concept of magnetism through 4 phases. The identifying foci of the original 1983 study were 4 outcomes. A large number and array of structural features were derived from the identified Magnet hospitals. The quest for excellence in nursing care continued with the Gold Standard of Magnetism case studies utilizing all identified Magnet structures, processes, and outcomes. The advent of the American Nurses Credentialing Center Magnet Recognition Program stimulated much valuable and insightful research related to outcomes associated with the large group of magnetic structures. Magnet hospital staff nurses (SNs) identification of processes/functions most essential to quality patient care highlights the Process phase. Many of the vast array of structural features attributed to Magnet hospital in 1983 are outdated and differentially defined and have not been tested for their relationship to either processes or outcomes. Identification of magnetism from an SN perspective has lagged. Recommendations include updating and clarifying structural criteria; increasing focus on the SN perspective of magnetism by continuing identification of processes; and challenging leadership in Magnet hospitals to initiate multisite evidence-based practice initiatives to link structures with process-enabling outcomes. Now may well be the time for nursing to exert leadership in expanding the Magnet concept to the total patient-care operation in a hospital.     

The relationship between healthy work environments and retention of nurses in a hospital setting

ritter d . (2011) Journal of Nursing Management 19, 27–32
The relationship between healthy work environments and retention of nurses in a hospital setting Aim The purpose of the present paper was to determine the effect a healthy work environment has on the retention of nurses in a hospital setting. Background There is a nursing shortage that has been ongoing and is expected to continue, resulting in challenges for the healthcare system in the United States. The significance of this issue is the impact the nursing shortage will have on healthcare organizations and patients. Evaluation The present paper included an extensive review of the current literature. The literature reviewed encompassed scholarly peer-reviewed journal articles. This article focused on nurses, work environments and the impact of the work environments on retention. Key issues Important issues that emerged from this analysis were the dangers of an unhealthy environment, the impact a healthy work environment has on patient outcomes and retention, the Magnet link to healthy work environments and the manager’s role in creating and sustaining a healthy work environment. Conclusion The literature provided evidence of the link between healthy work environments and the retention of nurses in a hospital setting. Implications for nursing management The implications for management are to implement changes now to create a healthy work environment that will recruit and retain nurses to secure their position in the future.     

Magnet status and registered nurse views of the work environment and nursing as a career

OBJECTIVES: To compare how registered nurses view the work environment and the nursing shortage based on the Magnet status of their organizations. BACKGROUND: The upsurge in organizations pursuing and obtaining Magnet recognition provides increased opportunities to investigate whether and how registered nurses who are employed in Magnet organizations and organizations pursuing Magnet status perceive differences in the nursing shortage, hospitals' responses to the shortage, characteristics of the work environment, and professional relationships. METHODS: A nationally representative sample of registered nurses licensed to practice in the United States was surveyed. The views of registered nurses who worked in Magnet organizations, organizations in the process of applying for Magnet status, and non-Magnet organizations were analyzed as independent groups. RESULTS: Significant differences were found. Although there is a clear Magnet difference, there are also identifiable differences that occur during the pursuit of Magnet recognition. CONCLUSION: Many organizations in the process of applying for Magnet status rated higher than Magnet organizations, indicating that there is much to do to maintain the comparative advantages for Magnet hospitals.     

A road map for creating a Magnet work environment

OBJECTIVE: The authors examine the relationship between working environment and the developmental level of the workforce, against the backdrop of the American Nurses Credentialing Center Magnet Recognition Program, to provide a road map for creating a positive work environment. BACKGROUND: With the daily demands on nurse managers, there is a need to identify focused strategies to achieve a Magnetized, high-performing work environment. METHODS: The American Nursing Association Magnet survey was administered to nurses at a large healthcare system. Patient units at each hospital were categorized as reactive, responsive, proactive, or high performing. Similar categories of units across all 6 hospitals were analyzed. Analysis of variance was performed on each Force of Magnetism by developmental level. RESULTS: Mean scores measuring the Forces of Magnetism were statistically significant between reactive and responsive units. Likewise, mean scores between responsive and proactive units were also statistically significant. Between reactive and responsive units, there were 3 statistically significant forces of Magnetism: organizational structure, management style, and interdisciplinary relations. These are labeled primary priority forces. Between responsive and proactive units, there were 6 statistically significant forces of Magnetism labeled secondary priority forces: policies and programs; professional models of care; quality of care; consultation and resources; autonomy; and interdisciplinary relations. CONCLUSIONS: Nursing staff perceive the "Magnetism" of the work environment differently, depending on the developmental level of the unit. Nurse managers with reactive units should focus on the 3 Forces of Magnetism identified as the primary priority forces, in order to help develop their unit to the next level of responsive. Once a responsive level has been achieved, the next 6 forces should be addressed.     

An evaluation of the nursing practice environment and successful change management using the new generation Magnet Model

grant b ., colello s ., riehle m . & dende d . (2010) Journal of Nursing Management 18, 326–331
An evaluation of the nursing practice environment and successful change management using the new generation Magnet Model Aim To discuss the new Magnet Model as it relates to the successful implementation of a practice change. Background There is growing international interest in the Magnet Recognition Programme. The latest generation of the Magnet Model has been designed not only as a road map for organizations seeking to achieve Magnet recognition but also as a framework for nursing practice and research in the future. Evaluation The Magnet Model was used to identify success factors related to a practice change and to evaluate the nursing practice environment. Key issues Even when proposed changes to practice are evidence based and thoughtfully considered, the nurses’ work environment must be supportive and empowering in order to yield successful and sustainable implementation of new practice. Conclusion Success factors for implementation of a practice change can be illuminated by aligning environmental characteristics to the components of the new Magnet Model. Implications for nursing management The Magnet Model provides an exceptional framework for building an agile and dynamic work force. Thoughtful consideration of the components and inter-relationships represented in the new model can help to both predict and ensure organizational vitality.     

Advancing the Magnet Recognition Program in master's education through service-learning

Research evidence supports the important benefits of Magnet status, but only 102 US hospitals have achieved this qualitative designation. Faculty can showcase this international effort to enhance nurses' work environments and patient outcomes. Service-learning is a philosophy and method which facilitates student learning about the Magnet Recognition Program within the complexities of an actual hospital. This article describes a service-learning project designed to produce authentic written applications for Magnet recognition and implemented by 3 groups of Nursing Administration MSN students partnering with 3 hospitals. Qualitative reflection data are used to describe outcomes from the students, faculty, partnering hospitals, university, and community. Service-learning is a demanding pedagogy, but it expands all stakeholders' perspectives on national quality initiatives and it provides a frame of reference for assessing local hospital-based nursing care. After the service-learning project, the nursing staff at 1 of the project hospitals applied and was granted Magnet status.     

The Cleveland Clinic's magnet experience

The awarding of Magnet Status by the Magnet Nursing Services Recognition Program of the American Nursing Credentialing Center is acknowledged as the achievement of Excellence in Nursing. In this article, The Cleveland Clinic shares insights from its experience in becoming the 72nd Magnet hospital. Questions to ponder when conducting a readiness assessment before embarking on the Magnet journey, techniques to engage the staff in the application process, and writing and organizing tips are shared.     

Enhancing the work environment of staff nurses using targeted interventions of support

Nurse executives continue to search for ways to support their staff nurses through enhancing their work environment to promote professional practice environments. Given that not all hospitals have the intensive resources necessary to pursue Magnet Recognition certification or the Texas Nurses Association's Texas Nurse-Friendly Hospital program designation, this does not prohibit them from pursuing specific components adapted for their own institution. The authors discuss 3 programs to enhance the work environment through increased professional practice. The rationale for these programs, preimplementation and postimplementation are explained.     

Revising the Essentials of Magnetism tool: there is more to adequate staffing than numbers

In the Essentials of Magnetism (EOM) study, staff nurses in 9 of 16 hospitals known to have excellent staffing structures, ie Magnet hospitals, perceived staffing on their units as less than adequate. These hospitals did not fit the Magnet profile when compared to 26 Magnet, Magnet-aspiring, and non-Magnet hospitals. In the EOM study, the process "perception of adequacy of staffing" (PAS) was measured with a single-item indicator. A multi-item scale incorporating the results of a delivery system survey reported here, as well as other factors known to affect PAS, was constructed and evaluated. Results indicate that the 6-item PAS Scale is valid and reliable and is a more accurate measure of PAS than is a single-item indicator. The Magnet hospitals scored significantly higher on all 6 items of the scale than did the comparison hospitals. The 2 Magnet hospitals that did not score in the Magnet profile in the EOM study scored similarly to the Magnet hospital that scored very high in the Magnet profile. Measurement of the PAS process indicates whether staffing structures are viable and enabling and may account for the mixed results seen in some studies assessing the impact of staffing structures on patient outcomes. Discussion includes suggestions on how to promote smooth handoffs and accountability with flex delivery models, and emphasizes the need to evaluate the relationship between staff nurses' perceptions of adequate staffing and patient outcomes.     

Achieving Magnet accreditation in the UK: a case study at Rochdale NHS Trust

AIMS: This study explored the Magnet accreditation process in the first health care organization outside the USA to attempt to gain the award, Rochdale NHS Trust United Kingdom. The development was supported by the American Nurses Credentialing Center as a pilot project and the research conducted as a case study in organizational response to the requirements of a new accreditation system. METHOD: Information was collected via 23 face-to-face and three telephone interviews carried out with 11 senior figures at Rochdale during the 2-year period of the Magnet project, from field notes of meetings attended by the researchers and from analysis of documents associated with the project. RESULTS: The work of applying for Magnet accreditation built upon a previous 2-3 year programme of shared governance and clinical leadership throughout the Trust which senior staff felt had been an essential foundation for the Magnet project. The process enabled staff to assemble evidence which held up a mirror to their practice and contributed to other quality-related initiatives. The experience at Rochdale suggests that Magnet enables care areas to identify and celebrate examples of good practice and for lessons to be learned and shared within the organization. Although the Magnet concept is primarily nursing oriented, medical and allied health professionals were able to contribute and benefit. The application was successful and Rochdale was awarded Magnet status in April 2002. CONCLUSIONS: The Magnet project at Rochdale was essentially a process of collecting evidence to formally recognize previous leadership initiatives and their effects within the organization. The emergent approach to implementing the Magnet project was one which attempted to integrate and utilize existing systems and resources. The project provides evidence that Magnet can be transferred to non-US health care systems. The principal issues associated with this transfer were the costs incurred, the interpretation of terminology and the engagement of medical and allied health professionals.     

The road to excellence: Magnet designation, the Beacon Award, and primary nursing

The potential to have a unit based on excellence is within every manager's reach. The ability to submit for the Beacon Award and Magnet hospital designation are two avenues to fulfill that potential. Successes from University of California Davis Medical Center are shared in this article in the hope of inspiring other managers and their staff.     

Becoming a Magnet hospital: the role of the perianesthesia nurse.

In today's health care environment, nurses often feel that the care they are giving is below the level of quality that they would like to see. The Magnet Recognition Award is a nonbiased, positive acknowledgment of quality care and excellent patient outcomes. Nursing needs that third-party seal of approval. The purpose of this article is to educate the reader, to explore what becoming a Magnet hospital means to nursing, and to also encourage perianesthesia nurses to expand their involvement in such house-wide projects.     

The Magnet Recognition Program and evidence-based practice.

From the original Magnet study (1981) to now, health care organizations have begun to embrace the Magnet Recognition Program in record numbers. A visit to the Magnet web site (http://nursingworld.org/ancc/magnet.html) listed 186 Magnet hospitals, with many more healthcare facilities currently under review. As the Magnet Recognition Program has grown, so has the development of evidence-based practice (EBP). In fact, EBP is one of the cornerstones of the Magnet Recognition Program, as well as the involvement of staff nurses in research and/or EBP activities. This article will give a brief introduction of the Magnet Recognition Program and suggest activities that will involve staff nurses in EBP.     

The role of the clinical nurse specialist in promoting evidence-based practice and effecting positive patient outcomes

Clinical nurse specialists (CNSs) are vital members of the healthcare delivery leadership team. The knowledge and expertise of the CNS is germane to the quality of care a patient receives. More than 50 CNSs practice at Massachusetts General Hospital (the state's first Magnet hospital), where they share their clinical skills, mentor staff through difficult situations, identify learning needs, and implement innovative approaches to patient care. This article presents a brief history of the CNS role and describes how the CNS role is operationalized at Massachusetts General Hospital and its impact on unit-based and organizational outcomes. In addition, several programs and interventions identified by the CNSs in response to results of the Staff Perception of the Professional Practice Environment Survey are discussed. How the CNS influences the professional development of staff and potential implications for the future role of the CNS are described. An exemplar is included depicting a typical work day of a CNS on an acute adult medical unit.     

Nurse outcomes in Magnet® and non-magnet hospitals

The important goals of Magnet hospitals are to create supportive professional nursing care environments. A recently published paper found little difference in work environments between Magnet and non-Magnet hospitals. The aim of this study was to determine whether work environments, staffing, and nurse outcomes differ between Magnet and non-Magnet hospitals. A secondary analysis of data from a 4-state survey of 26,276 nurses in 567 acute care hospitals to evaluate differences in work environments and nurse outcomes in Magnet and non-Magnet hospitals was conducted. Magnet hospitals had significantly better work environments (t = -5.29, P < .001) and more highly educated nurses (t = -2.27, P < .001). Magnet hospital nurses were 18% less likely to be dissatisfied with their job (P < .05) and 13% less likely to report high burnout (P < .05). Magnet hospitals have significantly better work environments than non-Magnet hospitals. The better work environments of Magnet hospitals are associated with lower levels of nurse job dissatisfaction and burnout.     

Magnet Hospital attributes in European hospitals: A multilevel model of job satisfaction

Background

The Magnet Recognition Program in the USA has been based on 14 hospital characteristics that were common in hospitals that were “magnets” for professional nurses. While the program has expanded to other countries, no research has explored how the concept translates to other cultures and healthcare systems, nor have multilevel approaches been used.

Objective

The primary aim of this study was to explore the presence of Magnet Hospital attributes in hospitals in two European countries. In addition, the relationship between Magnet Hospital attributes and nurses’ job satisfaction was examined at both the nurse and the hospital level.

Design

A secondary data analysis with cross-sectional design was conducted. A multilevel approach was taken to account for the hospital effect due to the nested nature of the data.

Settings

Nurses practicing in acute care hospitals in Germany (16) and Belgium (15) were examined. Hospitals that had less than five respondents were excluded.

Participants

Survey responses from 2303 registered nurses (RNs) from Belgium and 2646 RNs from Germany were included. Non-RN providers, RNs with administrative positions, and those working in non-inpatient areas were excluded. The final sample was 3182 staff nurses working in acute care hospitals.

Methods

Magnet Hospital attributes that might be represented in NEXT survey items were reviewed by an expert panel before psychometric testing. Only six Magnet Forces could be measured. Latent constructs of these forces and job satisfaction were established. The measurement models and structural regression models were estimated using multilevel modeling in Mplus 4.21.

Results

Six Magnet Forces were validated by two-level confirmatory factor analyses, with good fit to the data as demonstrated by the fit indices. All six Magnet Forces significantly predicted job satisfaction at the nurse level, with personnel policies having the strongest effect (b = 0.96). At the hospital level, management style had the strongest effect (b = 0.84) in predicting job satisfaction, followed by professional development, interdisciplinary relationship, and autonomy.

Conclusions

Magnet Hospital attributes are evident in hospitals in two European countries and were found to be associated with job satisfaction. Further multilevel research should explore these attributes particularly at the nursing unit-level where work environment is experienced.