1. Trossman, Susan RN

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Ask registered nurses to describe their workplaces and, more often than not, they'll paint a rather grim picture. For example, 75% of nurses who responded to a 2001 American Nurses Association online survey said the quality of nursing care at their facilities had declined over the previous two years. More than half said they would not recommend their profession to their children or friends. Given those percentages and the growing nursing shortage, many hospitals are desperate to find a winning formula for recruiting and retaining nurses.


The outlook, however, is not entirely bleak. Forty-two facilities nationwide have been recognized as "Magnet hospitals" by the American Nurses Credentialing Center (ANCC), an ANA subsidiary, through its Magnet Nursing Services Recognition Program for Excellence in Nursing Services. Started in 1994, the program rewards hospitals and long-term care facilities that place a high premium on nursing services and encourage other facilities to follow suit.


Shirley Nelsen, MEd, RN, a surgery center staff nurse at one such Magnet hospital, the University of Washington Medical Center (UWMC) in Seattle, says she really likes going to work. "I have never worked at a hospital that I liked more," said Nelsen, a nurse since 1957 with experience at hospitals in the Midwest and the Northwest.


"Everyone here wants to be here and is interested in improving patient care, and I feel so good knowing that patients are getting good care," the Washington State Nurses Association member said. "It's also a very affirming place to be. Nursing is respected by all departments."


Staff nurse Cari Copeland, RN, began working on UWMC's medicine unit one-and-a-half years ago, straight out of nursing school. She can't envision switching employers-or careers-any time soon.


"UWMC has a great atmosphere for learning. Every day I see something new, and the staff is great and very supportive of each other," Copeland said. "I never feel alone. There's no such thing as a dumb question. Everybody working here-whether a nurse, an X-ray technician or a dietitian-has a strong commitment to what they do and that helps make nursing easier."


The term "Magnet hospital" comes from a 1983 American Academy of Nursing (AAN) study that examined 41 facilities that were able to attract and retain nurses and provide high-quality care despite the nursing shortage of the early 1980s. And in today's nursing climate, average nurse retention at Magnet hospitals is twice as long as it is at non-Magnet institutions, according to ANCC president Cecilia Mulvey, PhD, RN.


"Magnet-designated facilities don't attract and keep nurses by magic," said Magnet recognition program director Kammie Monarch, JD, RN. "Instead of relying on sign-on bonuses and other short-term recruitment strategies, Magnet facilities focus on creating a positive work environment so they can retain the nurses they have. A key way they accomplish this is by viewing nurses as important contributors to patient care and the health care environment."



The UWMC was one of the hospitals studied by the AAN for its ability to retain nurses in the 1980s and was the first facility to earn Magnet recognition.


"We work very hard to have an environment that's an excellent place for nurses to practice," said UWMC director of Patient Care Services Lorie Rietman Wild, PhD, RN.


That environment, according to Wild, is one in which RNs have autonomy in their practices and can make decisions about patient care without interference. Nurses also are able to use their expertise and influence by participating in professional practice committees at both the unit and institutional levels, as well as in interdisciplinary work groups. For example, nurses are vital participants in a work group creating new sedation protocols for adult patients on mechanical ventilation. And RN committees are focusing on everything from improving patient care procedures to developing nurse recruitment and retention strategies.


At the UWMC, nurses are involved in another critical nursing issue-staffing. Instead of a sole nursing supervisor determining staffing levels, charge nurses from all hospital units meet four times a day to determine staffing needs hospitalwide.


Another major draw for the UWMC is its longstanding commitment to primary nursing, according to Nelsen and Copeland, who both serve on the retention committee.


"UWMC really practices primary nursing," Nelsen said. "It's what attracted me and keeps me here. Primary nursing benefits patients because they get continuity of care and far more individualized care."


For new nurses, the UWMC offers a year-long residency program, which includes a three-month guided orientation, a new graduate symposium to help nurses build advanced critical-thinking skills and respond rapidly to common medical emergencies, and a peer support group.


And finally, the UWMC leadership, as at other Magnet facilities, strongly believes in building a culture that fosters and promotes nursing excellence, according to Catherine Broom, ARNP, CS, a psychosocial clinical nurse specialist and UWMC Magnet program coordinator.


"I've worked at other hospitals, and I prefer it here," Broom said. "Nurses here are treated with respect and as legitimate members of the health care team. Even at the top, the nurse executive sits on par with other hospital executives. And that sets the tone for the entire medical center."


Said UWMC chief nursing officer Susan Grant, MS, RN, "We are proud of our nursing Magnet status. We have devoted significant resources to achieve and maintain this status because we know that nursing professionalism translates into the best patient care possible. It also enhances job satisfaction among our nurses and other staff who work here."



Maryland Nurses Association member Mary S. Tilbury, EdD, RN, CNAA, BC, has been associated with the Magnet program in one role or another since its inception. A University of Maryland-Baltimore assistant professor of nursing, she currently serves as one of the ANCC appraisers who evaluate hospitals' applications for Magnet recognition.


The appraisal process initially involves reviewing the extensive documentation that facilities provide to determine if they are adhering to the ANA's Scope and Standards for Nursing Administrators, as well as other important nursing-care criteria. A team-typically two appraisers-then visits only potential Magnet facilities that meet documented criteria. (Once Magnet status is earned, facilities must reapply for it every four years.)


Tilbury noticed a palpable difference in the professional milieu of hospitals seeking Magnet status. "These nurses are proud of their workplace, and they radiate confidence and security in their roles," she said. "And in this time of a tremendous nursing shortage, it is rewarding to go out and visit facilities that aren't as dramatically affected as others. Magnet hospitals are doing things right, they are being recognized for it, and nurses are responding by coming to these facilities and staying."


Lawmakers and consumers are increasingly demanding accountability in health care and are looking to nursing as essential to high-quality care. Studies have shown that patients in Magnet facilities have better patient outcomes, says Broom.


Broom already fields calls from the public asking about the hospital's Magnet status and receives frequent inquiries from other hospital administrators who are interested in becoming nursing Magnets.


The Magnet program recently was in the national spotlight when Senators Hillary Clinton (D-NY) and Gordon Smith (R-OR) introduced the Nurse Retention and Quality of Care Act. Designed to remedy the nursing shortage, this federal measure would provide grants to health care organizations to develop and implement model practices that the ANCC has identified as making the workplace more attractive.


Wild said that the UWMC is not immune to the impact of the nursing shortage. Like many hospitals nationwide, many of its nurses are approaching retirement, and there are fewer new graduates to replace them. In addition, the UWMC experienced unprecedented growth in the past two years, adding more than 50 beds. But she believes that retention will be crucial to surviving this current nursing shortage; having Magnet characteristics that emphasize a high-quality nursing environment, she says, is vital to retaining high-caliber nurses.


"Nurses here can do nursing," Wild says.


For more information on the Magnet program, call the ANCC at (202) 651-7262 or go to