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  1. Nelson-Brantley, Heather V. PhD, RN, CCRN-K
  2. Ford, Debra J. PhD
  3. Miller, Karen L. PhD, RN, FAAN
  4. Stegenga, Kristin A. PhD, RN
  5. Lee, Robert H. PhD
  6. Bott, Marjorie J. PhD, RN


OBJECTIVE: The aim of this study was to understand how nurses in a 25-bed critical-access hospital (CAH) led change to become the 1st to achieve Magnet(R).


BACKGROUND: Approximately 21% of the US population lives in rural areas served by CAHs. Rural nurse executives are particularly challenged with limited resources.


METHODS: Staff nurses, nurse managers, interprofessional care providers, the chief nursing officer, and board of directors (n = 27) were interviewed. Observations of hospital units and administrative meetings were done, and hospital reports were analyzed.


RESULTS: Nine themes emerged to support a conceptual model of leading change. The CAH spent 3 years of its 6-year journey establishing organizational readiness. Nurses overcame complex challenges by balancing operational support and fostering relationships. The Magnet journey led to significantly improved nurse and patient outcomes. A new organizational culture centered on shared governance, evidence-based practice, and higher education emerged.


CONCLUSIONS: The journey to Magnet leads to improved nurse, patient, and organization outcomes.