1. Upenieks, Valda V. RN, PhD


Here, review study results that find nurses employed at Magnet hospitals experience enhanced job satisfaction due to greater access to empowerment structures within their practice setting.


Article Content

Unlimited opportunity, resources, and autonomy draw nurses to these empowering facilities.


Despite a severe national health care staffing shortage, a small number of hospitals actually flourished during the down period of the 1980s. The American Academy of Nursing (AAN) identified 41 hospitals that remained successful in recruiting and retaining nurses during these years. 1 The reasons for their success? The hospitals maintained well qualified nurse executives in a decentralized environment, with organizational structures that emphasized open, participatory management. They offered an autonomous, self-managing, self-governing climate that allowed nurses to fully practice their clinical expertise. In addition, they provided flexible staffing, adequate staffing ratios, and clinical career opportunities. 2,3


In the late 1980s, researchers conducted follow-up studies to determine whether Magnet hospitals maintained lower vacancy and turnover rates-and higher levels of job satisfaction-compared to non-Magnet facilities. Specifically, they compared Magnet hospitals against non-Magnet hospitals that enjoyed reputations as desirable places of employment and providers of good nursing care. These studies reaffirmed Magnet hospitals' advantages: decreased turnover rates and increased job satisfaction. 4


Magnet hospitals' success captured everyone's attention. Non-Magnet facilities certainly noticed and implemented some of the Magnet measures, such as flexible nursing schedules and a decentralized administrative structure. 5 Although more than 20 years old, the Magnet hospital concept is as fresh and effective as ever, helping to meet new-hire and veteran nurses' needs by increasing clinical nurses' job satisfaction and providing the structure to deliver quality patient care-even during staffing shortages. 6 To date, 65 Magnet hospitals exist, and this number grows greater every year. 7


Measuring magnetism

This article's researcher set out to prove that clinical nurses employed at Magnet hospitals demonstrate a greater level of job satisfaction and empowerment compared to clinical nurses employed at non-Magnet facilities. Two Magnet hospitals and two comparable non-Magnet hospitals composed the sampling frame; the non-Magnet hospitals closely matched their Magnet counterparts in terms of bed-size, nonprofit status, and city location. Specifically, the researcher chose medical-surgical nurses as participants because they encounter similar morale, influence, and opportunity concerns.


Selected participants completed a questionnaire composed of two surveys, one based on the first Magnet hospital study (the Revised Nursing Work Index [NWI-R]) and the other on Kanter's organizational theory (the Conditions of Work Effectiveness Questionnaire [CWEQ-II]). The higher the NWI-R and CWEQ-II scores, the more empowered an individual is considered. (See "Structural theory of organizational behavior.") A set of additional queries helped determine the participant's age, gender, education history, years of experience, years on present unit, hours and shifts worked, supervisory/charge responsibilities, perception of job security, and overall career outlook. 8 (See "Participant specifics.")


Undeniable appeal

Nurses at Magnet hospitals were more satisfied with their jobs, according to the NWI-R; they were also more empowered, as was suggested by the CWEQ-II. Magnet hospital nurses with resources, support, information, and the opportunity to use their expertise were more satisfied than nurses in non-Magnet hospitals. These results also supported previous studies and suggest that Magnet facility clinical nurses experience more autonomy and control over their practice setting and enjoy better relationships with physicians compared to their non-Magnet colleagues. 9


Strong implications

This study's results reinforce an important responsibility of nurse managers: the need to create work environments with supportive infrastructures. Organizational features such as decentralized decision-making and shared governance models increase nurses' control over their work environment. These models continue to support autonomy, decision-making, and effective nurse-physician-manager interdependent relationships.


Organizational efforts that focus on improving access to opportunity, information, and resources empower staff and foster job satisfaction among nurses. Create opportunity structures by offering advancement positions, clinical ladders, or additional responsibilities that challenge staff members' creative energy. These measures will enable you to attract-and hold onto-competent, fulfilled caregivers.




1. Buchan, J.: "Still Attractive After All These Years? Magnet Hospitals in a Changing Healthcare Environment," Journal of Advanced Nursing. 30( 1): 100-108, 1999. [Context Link]


2. Sigma Theta Tau International:Facts on the Nursing Shortage. Available on-line: [Context Link]


3. Buchan, J.: loc cit. [Context Link]


4. Aiken, L., Havens, D., Sloane, D.: "The Magnet Nursing Services Recognition Program: A Comparison of Two Groups of Magnet Hospitals," American Journal of Nursing. 100( 3): 26-35, 2000. [Context Link]


5. Ibid. [Context Link]


6. Laschinger, H., Wong, C.: "Staff Nurse Empowerment and Collective Accountability: Effect on Perceived Productivity and Self-Rated Work Effectiveness," Nursing Economics. 17( 6): 308-316, 1999. [Context Link]


7. American Nurses Credentialing Center. Available on-line: [Context Link]


8. Gleason-Scott, J., Sochalski, J., Aiken, L.: "Review of Magnet Hospital Research," Journal of Nursing Administration. 29( 1): 9-19, 1999. [Context Link]


9. Ibid. [Context Link]

Participant specifics


Age: At the subject Magnet hospitals, the predominant age group of nurses was 40 to 49 years (45%), followed by 30 to 39 years (21%). At the subject non-Magnet facilities, the primary age group was also 40 to 49 years (33%). At both hospital types, more than 60% of the nurse respondents were 40 or older.


Education: Of Magnet-based respondents, 52% were baccalaureate prepared, compared with 31% from non-Magnet facilities. A higher percentage of non-Magnet respondents held associate degrees (47%).


Experience: On average, respondents from Magnet hospitals worked in nursing for fewer years than those from non-Magnet facilities (37% had 0 to 5 years of experience, compared with 17%, respectively). At Magnet hospitals, 56% of respondents held their current position from 0 to 5 years, compared with 36% in non-Magnets.

Structural theory of organizational behavior

Job-related empowerment personally impacts employees and results in work effectiveness.


Formal power (job definition and recognition) and informal power (connections and alliances) determine opportunity structure. As this increases, so does:


[white diamond suit] self-efficacy


[white diamond suit] motivation


[white diamond suit] organizational commitment


[white diamond suit] perceived autonomy


[white diamond suit] participant management


[white diamond suit] job satisfaction.



The ultimate results?


[white diamond suit] cooperation


[white diamond suit] respect


[white diamond suit] achievement


[white diamond suit] success