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


The link between healthy work environments and patient safety, nursing satisfaction, and quality outcomes is well established, yet many nurses work in environments that are unsafe and uncivil. What are the essential elements that contribute to a healthy practice environment? How can we create roles and working conditions that enable nurses to be fulfilled and happy in their careers? This month's Magnet Perspectives column explores the relationship between a healthy practice environment and better outcomes and examines how the Journey to Magnet Excellence(R) leads to higher nurse satisfaction and retention, improved interdisciplinary collaboration, excellent patient care, and exemplary patient results.


Article Content

Creating a workplace that is supportive, collaborative, and empowering is at the heart of the Magnet(R) journey. Built on principles such as practice autonomy, shared decision making, trustworthy leadership, and innovation, Magnet offers a framework to establish and sustain a safe, supportive environment where nurses can thrive. The link between healthy work environments and patient safety, nursing satisfaction, and quality outcomes is well established,1,2 yet many nurses work in environments that are unsafe and uncivil. The nurse practice environment is a critical factor in improving the quality and safety of hospital care. No matter how diligently we work to enhance the patient experience, improve health, and reduce costs, we cannot truly optimize health system performance without equal attention to workforce engagement and workplace safety.

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We know that a happy and engaged nursing workforce leads to a more engaged patient population with better health and better outcomes.1,2 To realize their full potential, nurses must practice in an environment that is safe, empowering, and satisfying. Today's nursing profession suffers from high rates of burnout and turnover.3 Issues such as workplace injury, workplace violence, and bullying are on the rise.4-6 These problems impact not only nurses; our healthcare system and patients may suffer as a result. Creating an environment where nurses are safe, physically and psychologically, should be a high priority for every healthcare organization.


A Framework for Change

So how do you get there from here? American Nurses Credentialing Center's Magnet Recognition Program(R) provides an evidence-based framework for building and sustaining an optimal work environment. Magnet recognition is a continuous journey that creates culture change. The credential's value proposition centers on the link between a positive work environment and improved outcomes for nurses and patients. Magnet is focused on the key elements that contribute to a healthy practice environment-elements such as communication, collaboration, leadership, nurse autonomy and empowerment, appropriate staffing, and clinical resources. Magnet organizations have these traits in common. They employ nurses who are active partners in formulating and delivering care. They have strong, accessible nursing leaders. Their decentralized structures encourage shared decision making and interdisciplinary relationships. They maintain a laser-like focus on excellence and continuous quality improvement. And they provide deep-seated support, both in staffing and resources. In addition, Magnet organizations sustain work environments that are healthy, respectful, healing, and humane. Nurses feel valued and know their voices are essential in achieving optimal patient outcomes. Patients and families recognize they will receive care in safe settings that provide competence, collaboration, and quality.


When the Magnet Program began in the 1990s, it centered on structure and process. As it evolved, the emphasis shifted to outcomes, patient satisfaction, and a stronger focus on the workplace environment. Organizations that pursue the Magnet credential build practice settings that promote greater nurse autonomy and responsibility, participatory decision making, clinical collaboration, and increased opportunities for professional development and education.


Research reveals that Magnet hospitals promote the characteristics of a healthy practice environment. Not only is nurse satisfaction higher,7 but also patient outcomes are better. Significantly, there is lower risk of patient mortality, fewer infections, and fewer patient falls.8-11


The Essential Ingredients

The Magnet journey encourages nurses to embrace their vital contribution in the design and delivery of care. As outlined in the 2019 Magnet Application Manual,12 the knowledge, skills, and resources that have been identified by the nursing staff as necessary to practice are the foundation for the care delivery system; therefore, they are consistently available in the practice environment. Competency assessment and peer evaluation ensure that nurses deliver safe, ethical, and evidence-based nursing care.


Likewise, strong nursing leaders provide support and mentoring, while promoting a culture of teamwork that underscores a commitment to care delivery excellence and a safe, respectful environment. Nurses perceive that their voices are heard, their input is valued, and practice is supported. They are empowered to identify and bring forth concerns without fear of retribution. Magnet standard EP15EO12 specifically addresses safety and security in the practice environment. Included in the appraisal for Magnet recognition, organizations must show how they have improved a workplace safety outcome for nurses. In an increasingly fragmented delivery system, interprofessional collaboration is critical. The Magnet environment not only advances the fundamental principles that enhance nurse-to-nurse interaction, but also enriches nurses' relationships with all members of the healthcare team.


Around the world, Magnet unleashes the power of nurses to practice to their highest potential and deliver the best possible patient care. We believe it is a journey worth taking.




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3. Holdren P, Paul DP, Coustasse A. Burnout syndrome in hospital nurses. Paper presented at BHAA International; Chicago, IL; March 2015. 2015. Accessed June 22, 2018. [Context Link]


4. Occupational Safety and Health Administration. 2016. Workplace violence in healthcare. OSHA3826. Accessed June 22, 2018. [Context Link]


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6. The Joint Commission. Quick Safety. June 2016, Issue 24. Accessed June 22, 2018. [Context Link]


7. Hickson J. New nurses' perceptions of hostility and job satisfaction: Magnet versus non-Magnet. J Nurse Adm. 2013;43(5):293-301. [Context Link]


8. Barnes H, Rearden J, McHugh MD. Magnet(R) hospital recognition linked to lower central line-associated bloodstream infection rates. Res Nurs Health. 2016;39(2):96-104. [Context Link]


9. Everhart D, Schumacher JR, Duncan RP, Hall AG, Neff DF, Shorr RI. Determinants of hospital fall rate trajectory groups: a longitudinal assessment of nurse staffing and organizational characteristics. Health Care Manage Rev. 2014;39(4):352-360. [Context Link]


10. McHugh MD, Kelly LA, Smith HL, Wu ES, Vanak JM, Aiken LH. Lower mortality in Magnet hospitals. Med Care. 2013;51(5):382-388. [Context Link]


11. Missios S, Bekelis K. Association of hospitalization for neurosurgical operations in Magnet hospitals with mortality and length of stay. Neurosurgery. 2018;82(3):372-377. [Context Link]


12. 2019 Magnet(R) Application Manual. Silver Spring, MD: American Nurses Credentialing Center; 2019. [Context Link]