1. Graystone, Rebecca MS, MBA, RN, NE-BC


It has been more than 35 years since an enterprising team of nurse researchers evaluated the nursing shortage of the 1980s and unearthed findings that led to the creation of the American Nurses Credentialing Center's Magnet Recognition Program(R). Today, the Magnet(R) credential stands as the highest international acknowledgment of nursing excellence in healthcare organizations.


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As we confront another crippling nursing shortage, why do Magnet(R) organizations have less trouble attracting and retaining top RN talent? The answer lies in the Magnet framework, which has evolved over time and promotes high levels of job satisfaction, autonomy and respect in practice, shared governance structures, effective use of staff and resources, and more. Three decades later, it is still an effective model for nurse retention.

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Around the world, organizations face mounting pressure to improve nurse satisfaction and retention, practice protocols, unit effectiveness, the work environment, and patient results. Leaders from Magnet-designated organizations share their insights about how this credential provides the framework to meet these challenges and more.


Historical Development

In the early 1980s, hospitals throughout the United States faced a worsening nursing shortage. They were able to attract new nurses but were unable to keep them for any length of time. A group of intrepid nurse researchers set out to determine why. Rather than chronicling what was wrong at hospitals with high nurse turnover, they focused on what was right at hospitals where nurse vacancy and turnover were low. These institutions were dubbed "Magnet hospitals" because of their ability to attract and retain well-qualified nurses.1


The groundbreaking findings led the American Nurses Association to develop a nationwide credentialing program to validate the highest-level nursing standards within hospitals. In 1990, the Magnet Recognition Program(R) was born.


Fast forward to 2018. The American Nurses Credentialing Center's Magnet Recognition Program now stands as the premier international acknowledgment of nursing excellence. It provides a research-based framework to move beyond quick fixes and implement long-term, sustainable structures that retain exceptional RNs. The Magnet Recognition Program has evolved over time to reflect changes in clinical nursing practice and the work environment. In 2014, standards were revised to reflect 50% outcomes and 50% structure and process.2 In the 2019 revision,3 outcomes remain the majority of the standards, and evidence of superior nurse satisfaction remains.


As healthcare organizations face another predicted nursing shortage, Magnet shines as the beacon for nurse retention, providing the basis to address the challenges inherent in the evolving environment.


At The Ohio State University Comprehensive Cancer Center (OSUCCC), the Magnet journey contributed to a significant drop in nurse turnover, currently at 9%. The hospital routinely draws 3 times the number of applicants for every opening. "There's a huge interest in working here, and Magnet designation is a big reason," says Kristopher Kipp, MSN, RN, executive director, Patient Services, and chief nursing officer (CNO). "The journey has raised nursing's status in the hospital and stimulated enculturation of our professional practice model, evidence-based research, innovation, professional development, and interdisciplinary activity, which impacts our culture and our work. Magnet drives culture and thus recruitment, which drives local, state, and national reputation." Kipp adds that Magnet's influence is felt throughout OSUCCC as ancillary departments adopt the shared governance model to boost engagement and retention.


When David Bailey, MSN, MBA, RN, CCRN-K, NEA-BC, FACHE, CNO at Santa Monica UCLA Medical Center and Orthopaedic Hospital, asks nurses, "Why did you choose us?" they often cite the culture. "They recognize we are different here," he says. "There's autonomy and respect in practice. We allow them to do what they do best; we offer multiple educational resources, including one of the foremost nurse residency programs in the country; and we give them local, regional, and national exposure to share their work-all of this is the result of our Magnet environment."


Nurses understand the value of Magnet designation and flourish in organizations where standards are high and their worth is appreciated. Memorial Sloan Kettering Cancer Center (MSK) is fortunate to benefit from a worldwide reputation that attracts nurses, but it is the culture that retains them. "Nurses don't look to leave an organization living a Magnet environment," says Elizabeth Nelkin McCormick, MSN, RN, CENP, senior vice president and CNO. "They find a sense of professional fulfillment when they have the resources and autonomy to practice at their best. They seek employment at MSK for the quality setting and stay because of the camaraderie that develops when nurses enjoy the work they do and the excellent outcomes they can achieve."


At Cancer Treatment Centers of America-Midwestern Hospital, senior vice president of Patient Care Services and CNO Jacklynn Lesniak, MS, BSN, RN, believes Magnet's culture of shared decision making empowers nurses and keeps job satisfaction high. "Having a say in their practice is a huge retention tool for us," says Lesniak. "Shared decision making provides a career path for nurses who wish to remain clinical but also want leadership opportunities. They work alongside top clinical talent and professional leaders with a common belief in how care should be delivered." Lesniak adds that Magnet's focused methodology for continuous improvement has put nursing-sensitive indicators in the top decile nationwide.


The Magnet Recognition Program is equally effective in international settings. At the American University of Beirut Medical Center, designation has moved the organization forward. "It promotes an environment of accountability where nurses use evidence-based practice and research to achieve optimal patient outcomes," says director of Nursing Iman Bashir Al Koualty, MPH, BSN, RN. "We've significantly decreased our nurse turnover rate, enhanced RN satisfaction with the work environment, and increased length of service for direct-care nurses."


Across Europe, where the nursing shortage is acute, many countries show a high interest in the Magnet Recognition Program, says Paul Van Aken, MSN, BSN, RN, Antwerp University Hospital CNO. When Van Aken's hospital sponsored an international meeting about their journey to nursing excellence, demand was so great that they ran out of space. "The labor market for nurses is a burning platform, and Magnet recognition offers a competitive advantage," he says. "The original 'Forces of Magnetism' that researchers cited in the 1980s1 are concepts that continue to keep nurses loyal to our organization, especially those in the millennial generation. Nursing students, who practice in different hospitals, are the 1st to recognize that a Magnet environment makes a difference. The fact that the program is research based strengthens our ability to attract and retain nurses."




1. Kramer M. The Magnet hospitals. Excellence revisited. JONA. 1990;20(9):35-44. [Context Link]


2. American Nurses Credentialing Center. Magnet Application Manual. Silver Spring, MD: American Nurses Credentialing Center; 2014. [Context Link]


3. American Nurses Credentialing Center. 2019 Magnet Application Manual. Silver Spring, MD: American Nurses Credentialing Center; 2017. [Context Link]