In the early 1980s, the American Academy of Nursing (AAN) board summoned me and 3 other AAN fellows, Drs Margaret McClure, Margaret Sovie, and Mabel Wandelt, to conduct a study of the nursing shortage that continued to plague the nation. The problem was this: although hospitals were able to attract new nurses, they were unable to keep them for any length of time. More than 100 000 nursing positions were vacant, which equated to inadequate staffing in 80% of US hospitals.1 This produced a crippling effect on day-to-day operations, which in turn impacted patient care.
The AAN wanted fresh ideas to tackle this complex problem. The board made it clear-the focus of the research would be ours. At our initial meeting, we had to decide: Did we want to produce another white paper filled with statistics? There were so many studies about the nursing shortage-did we really need another one? After much discussion, we opted for an innovative approach. Rather than chronicle what was wrong at hospitals with high nurse turnover, we would focus on what was right at hospitals where RN vacancy and turnover were low. How did these hospitals attract and keep nurses? What were the factors at play that supported retention and recruitment?
We thought we had a pretty good premise, but AAN board members were skeptical. This was their 1st research endeavor, and they were naturally cautious about how to proceed. They asked us to leave the room so they could discuss our proposal. A few hours later, they invited us back and said, "We think you may have something here[horizontal ellipsis]." To their credit, they were willing to take a risk and let us move forward.
A National Focus
From the beginning, we cast a wide net to ensure a national focus. We divided the United States into 8 geographic regions and nominated 165 hospitals with the identified characteristics. Of these, 155 consented to be studied, and 46 qualified for inclusion. In the end, 41 participated.
Conducting this type of study on a national scale was a significant departure from most research projects, which typically concentrated on small cohorts. National studies normally took years to complete. We had a shorter time frame but wanted to be sure that our findings reflected a broad cross-section of hospitals. By including the whole country, we felt confident we'd achieved this goal.
The rest, as they say, is history. We completed our research and submitted our report, which identified Magnet(R) hospitals across the country that successfully attracted and retained professional nursing staff in a time of shortages. We also identified the characteristics that shaped environments of excellence. Once we had turned in our report, our work was finished, and we returned to our regular jobs. From there, we watched as our theories were tested, our report was published, and the Magnet Recognition Program(R) took shape.
Winning Hearts and Minds
I think it is fair to say that the program has grown much bigger and broader than any of us ever anticipated. It has expanded well beyond our findings to make a significant impact on nurses, the nursing profession, and healthcare delivery around the world. Although we never could have predicted this result, we believe our original research unearthed nuggets of truth that speak to the needs and desires of the staff nurse.
When AAN took our findings and tested them in the hospital setting, the reaction from nurses was overwhelmingly positive. It was the 1st time anyone had taken the time to determine what was important to them-things such as practice autonomy and clinical authority, professional development opportunities, shared decision making and interdisciplinary relationships, abundant clinical resources, and a commitment to excellence and continuous quality improvement. Our findings moved beyond the typical figures and cost analyses to focus on things nurses actually do every day on the job. This grassroots approach rang true then and continues to resonate among nurses today.
Collective Success
Our efforts at inclusion also paid off. Because we opted to go national with our research, we were able to involve directors of nursing and staff nurses from as many different parts of the country as possible. So many people participated, all with a vested interest in the Magnet initiative. They really helped move our research along. It was not only 4 researchers who did this. When people come together and communicate and cooperate, they can do a lot. That is exactly how the Magnet Recognition Program came about-because of all the people who participated and shared their insights.
When I stop to consider how much the program has progressed, I cannot get over it. It has been a remarkable evolution that now includes hundreds of healthcare organizations around the world and the largest annual nursing conference in the United States (see Figure, Supplemental Digital Content 1, http://links.lww.com/JONA/A504). A few years ago, Dr Margaret McClure and I attended our 1st ANCC National Magnet Conference(R). Thousands of nurses filled the hall. They gave us a standing ovation! I turned to Margaret and said, "Would you ever have expected this? When we completed our research all those years ago, did you have any idea it would have this impact?" We are proud to be part of such a successful program that advances the nursing profession and promotes high-quality care for patients throughout the world.
Note: On the basis of the work of these early nursing research pioneers, as of December 2016, there are 448 Magnet-designated organizations.
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