1. Potera, Carol


An earlier model of Magnet care focused on nurses' work environment, not outcomes.


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Hospitals designated by the American Nurses Credentialing Center as Magnet facilities are considered to be superior to hospitals without Magnet designation, in terms of nursing excellence, quality of care, and innovations in practice. But a new study suggests that, contrary to what researchers expected to find, non-Magnet hospitals have outperformed Magnet hospitals in several outcomes-related areas, including infection control and post-operative sepsis.


The early studies that compared Magnet with non-Magnet organizations mostly focused on the nursing staffs' work environments and job satisfaction-few studies evaluated differences in patient outcomes. Some early research on mortality rates found that Magnet hospitals had lower mortality rates than non-Magnet hospitals, but as researchers expanded their investigations to include sepsis, pressure ulcers, urinary tract infections, failure to rescue, and other clinical end points, studies suggested that there may be no differences between the two types of hospitals. Some even found that outcomes were better at non-Magnet hospitals. To better understand differences in patient outcomes, researchers analyzed data from 19 Magnet hospitals and 35 non-Magnet hospitals (all of the facilities that were enrolled in the 2005 University Health Systems Consortium operational and clinical databases).


Non-Magnet hospitals were better at preventing postoperative sepsis, postoperative metabolic derangements (complications after elective surgery), and infections related to medical care (involving intravenous lines and catheters, for example). Only rates pertaining to pressure ulcers were slightly lower at Magnet hospitals, and there were no differences in rates of death, failure to rescue, or length of stay.


Differences in staff nursing help to explain the surprising results. On general units, non-Magnet hospitals were better staffed than Magnet hospitals, with 30 more RN hours per week. ICUs exhibited similar differences, with non-Magnet units having 29.9 more RN hours weekly.


So should hospitals still strive to become Magnet facilities? "Absolutely," says Colleen Goode, the study's lead author and vice president of patient services at the University of Colorado College of Nursing. "They have led the way for improving work environments, recruitment, and retention." Moreover, data used in the current study came from 2005, when the focus was still on the work environment; the new Magnet model, rolled out in 2008, emphasizes patient outcomes.


Nursing administrators should review outcomes data monthly and examine trends at the unit level. When patient outcomes don't meet benchmark standards, says Goode, "chief nursing officers should pay attention to staffing-both nursing hours per patient day and skill mix." They should also increase the percentage of nurses with bachelor's degrees to improve patient outcomes.


Evidence-based care prevents adverse events, and Goode advises clinical nurses to follow evidence-based protocols and speak up when others don't stick to them. Some Magnet hospitals offer tuition reimbursement to nurses wishing to obtain a baccalaureate, and nurses should take advantage of this, she says, adding that hospital units with a higher proportion of baccalaureate-prepared nurses have better patient outcomes. Overall, she says, the new Magnet model of 2008, with its focus on patient outcomes, "is the pathway we need to follow." -Carol Potera




Goode CJ, et al. J Nurs Admin. 2011;41(12):517-23