1. Lal, M. Maureen DNP, RN
  2. Pabico, Christine G. PhD, RN, NE-BC


This month's Magnet(R) Perspectives column examines American Nurses Credentialing Center's Magnet Recognition Program(R) and Pathway to Excellence(R) Program as partners for nursing excellence. We explore the differences between the programs, how they complement one another, and how they can be combined to impact a host of key measures, including nurse engagement, interprofessional collaboration, and patient safety. Nursing leaders at 2 dual-designated hospitals share their decision to pursue both credentials and ways in which the combined designation adds value for nurses and the patient care environment. They discuss how the essential elements of a Magnet and Pathway culture contributed to a nimble, innovative response to the COVID-19 pandemic and strategies nursing leaders can employ to create and sustain an environment where change flourishes and nurses thrive.


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The American Nurses Credentialing Center's Pathway to Excellence(R) Program and Magnet Recognition Program(R) have helped hundreds of healthcare organizations around the world build the framework necessary to create a culture of safety, excellence, and innovation. Research shows that these elite credentials can improve a host of key measures, including nurse engagement, nurse retention, interprofessional collaboration, patient safety, quality, and outcomes.1


Magnet(R) and Pathway are 2 distinct programs with a complementary focus. Pathway to Excellence is the premier global credential for positive practice environments that support nurses' needs and promote high standards. Pathway-designated organizations demonstrate a commitment to establishing the foundation of a healthy workplace for staff. The framework centers on the 6 evidence-based standards that promote an environment where nurses' well-being is safeguarded, nurses have a voice, and nurses are highly engaged, satisfied, and motivated, leading to better results.2 These standards include shared decision-making, leadership, safety, quality, and well-being.3 Each reflects foundational elements for safe patient care and a positive environment for delivering quality nursing services.


The Magnet Recognition Program designates organizations worldwide where nursing leaders successfully align their nursing strategic goals to improve patient outcomes. Those who have taken the Magnet journey see meaningful, measurable gains in recruitment, retention, satisfaction, quality imperatives, and empirical outcomes. Research shows that these benefits translate to lower operational costs, especially in the areas of patient outcomes, nurse turnover, and length of stay.1 The framework is driven by the Magnet Model, which focuses on the components of transformational leadership, structural empowerment, exemplary professional practice, and new knowledge, innovations, and improvements.4


The Value of Dual Designation

At Lyndon B. Johnson Hospital (LBJ) in Houston, dual designation as both a Pathway and Magnet hospital means every patient who walks through the doors receives the highest quality care from the best nurses in the city. Part of the Harris Health System, LBJ serves the communities of northeast Houston, a medical desert where residents have limited access to healthcare. LBJ initially achieved the Pathway to Excellence credential in 2010 and has been redesignated 3 times since. In September 2020, the hospital received its 1st Magnet designation.


Nursing leaders opted to pursue Magnet as the next logical step in the hospital's quest to become a high-reliability organization (HRO). Thanks to the Pathway framework, processes were in place to move forward. "We began with a crosswalk to examine our Pathway-driven accomplishments and see how they overlapped with Magnet, especially among quality initiatives," says Derek Curtis, DNP, MA, RN, NEA-BC, associate administrator and chief nursing officer (CNO). "We had some amazing achievements, such as 3 years CLABSI-free and 2 years CAUTI-free. Our direct care nurses were contributing innovations at the bedside. We knew we were ready."


Jerry Johnson, MSN, RN, CPHQ, NEA-BC, director of Nursing Strategic Initiatives, says the Magnet journey produced additional benefits. "Four Pathway designations had given us a strong shared governance structure and practice environment, but Magnet added a research focus on top of that," she says. "Where once they were wary, our nurses now embrace a robust research agenda and evidence-based practice, which pushes the hospital even closer to the HRO gold standard."


Likewise, quality improvement and innovation are now continuous processes. This helped the hospital quickly respond to the COVID-19 pandemic with creative, staff-driven solutions from the bedside. "Whether it is innovative care practices or new ways to protect patients and staff, LBJ's nurses have a voice and lead that change," Dr Curtis says. "They are proud to work where quality and patient outcomes are number one."


Mapping a Long-term Strategy

Ben Taub Hospital, also part of Harris Health, was 1st designated a Pathway organization in 2009. Nursing leadership at the 444-bed acute care hospital in Houston initially pursued the credential to create a supportive practice environment and establish a robust shared governance structure that nurses value. After being redesignated multiple times, the hospital felt it had the foundation to embark on the Magnet journey. It received the credential in November of 2020. "We knew we had a lot of good experience behind us, especially in our culture of nursing support," says Matthew Schlueter, PhD, MBA, RN, NE-BC, PHN, CNO. "This was especially evident at the onset of the COVID-19 crisis when our nurses had direct access to leaders to innovate rapid changes in care delivery and care environments. Nurses valued all the ways in which leaders were listening to them and quickly providing what they needed."


For CNOs thinking about dual designation, Dr Schlueter recommends they begin with Pathway to establish a good foundation. It takes years to develop the culture and structure necessary to generate the empirical outcomes and meet the threshold for Magnet. He suggests mapping out a long-term plan that focuses on what is in place and what needs to be developed. Although the credentials are not the same, they do have common themes and elements, including interprofessional collaboration, a supportive practice environment, patient safety, and good quality outcomes. "Culture is key to being successful, a culture that appreciates nurses, ensures their voices are heard, and gives them the opportunity to excel," Dr Schlueter says. "It takes time and consideration to put that in place. But culture is where it starts."




1. Accessed December 20, 2020. [Context Link]


2. Accessed December 22, 2020. [Context Link]


3. Pathway to Excellence(R) and Pathway to Excellence in Long-Term Care(R) Application Manual. Silver Spring, MD: American Nurses Credentialing Center; 2020. [Context Link]


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