1. Lal, M. Maureen DNP, MSN, RN


As one of the world's oldest occupations, nursing has seen, inspired, and innovated a host of changes. The evolution has been especially evident for the last 39 years. Since the 1980s, a growing focus on autonomy, research, and evidence-based practice has transformed nursing from a job to a profession. Concepts such as shared governance, interprofessional collaboration, and frontline engagement have transformed nurses from doctors' assistants to empowered and independent clinicians directly impacting patient outcomes and the healthcare environment. As the 30th anniversary of the American Nurses Credentialing Center comes to an end and the original Magnet(R) research celebrates a 39th birthday, we take a closer look at how the Magnet framework reflects these changes and how Magnet-designated organizations continue to advance nursing practice with innovation, knowledge, and leadership.


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Nursing has changed dramatically for the last 40 years. Where once nurses were taught task-oriented skills, we now meet specific and rigorous academic qualifications. Where once nurses were expected to defer to doctors, we now collaborate with physicians and other healthcare disciplines as equal partners. Where once we did things because we were told to do them, or because "we have always done it that way," we now have the knowledge and judgment to make decisions on our own. We have autonomy over our practice, take ownership of our actions, and understand how those actions impact our patients. The principles of evidence-based practice, shared decision making, interdisciplinary collaboration, frontline engagement, and ownership and accountability have transformed what was once a task-oriented job into a profession.

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The Rise of Evidence-Based Practice

Nurses entering the profession today may think of evidence-based practice as a long-standing fixture of nursing culture, but the truth is, it has not been around for very long. The term "evidence-based" was coined by engineer and physician David Eddy, MD, in the 1980s1 at about the same time 4 intrepid nurse researchers were studying nursing shortages in hospitals and what would become the groundwork for the creation of American Nurses Credentialing Center Magnet Recognition Program(R). A few years later, Dr David Sackett defined evidence-based medicine as "the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of the individual patient. It means integrating clinical expertise with the best available external clinical evidence from systematic research."2 As other healthcare professions adopted this model, it was renamed evidence-based practice.


Fueled by research, evidence-based practice has exploded for the last 20 years and is now a key component of exceptional patient care. The integration of evidence into practice influences and shapes the nursing profession. It has given nurses at all levels the data and tools to own our practice and pinpoint effective care strategies that can help our patients.


Magnet(R) hospitals are the pacesetters. They have infrastructure and resources in place to support the advancement of evidence-based practice in all clinical settings. Magnet nurses are investigators, encouraged not only to ask questions but also to answer them, driving hospital-wide improvements.3


Evolving Practice Autonomy

Shared governance in nursing was popularized in the mid-1980s when researchers defined it as "a structural model through which nurses can express and manage their practice with a higher level of professional autonomy."4 In the 4 decades since, shared governance has dramatically changed the nursing landscape.


A well-established shared governance model promotes autonomy, ownership, and accountability. It gives nurses direct involvement in decisions that impact every aspect of their practice and the care environment. Shared governance is a cornerstone of the Magnet framework and a hallmark of Magnet-recognized organizations around the world. In a 2016 study published in The Journal of Nursing Administration, researchers found that it increases nurse engagement and retention, improves patient outcomes, and promotes high-quality care.5 Shared governance also promotes an environment of support and encouragement, keeping nurses connected, not only to their coworkers but also to the organization's bigger perspective.6


39 Years of Magnet

Today, Magnet concepts of evidence-based practice, research, shared governance, scholarship, interprofessional collaboration, and frontline engagement drive nursing practice, innovation, and advancements. For the last 4 decades, these principles have evolved to create an environment in which nurses can flourish and patient care excellence can thrive.




1. Taking the guesswork out of medicine, Phillips Exeter Academy Blog, July 30, 2018. Accessed September 16, 2021. [Context Link]


2. The pitfalls and potential of precision health, big data, and evidence-based medicine, University of Michigan blog, April 30, 2018. Accessed September16, 2021. [Context Link]


3. Ives Erickson J, Pappas S. The value of nursing research. J Nurs Adm. 2020;50(5):243-244. doi:. [Context Link]


4. Kutney-Lee A, Germack H, Hatfield L, et al. Nurse engagement in shared governance and patient and nurse outcomes. J Nurs Adm. 2016;46(11):605-612. doi:. [Context Link]


5. Walker ML. Shared governance for nursing: a creative approach to professional accountability. AORN J. 1986;44:468. doi:. [Context Link]


6. Kutney-Lee A, Germack H, Hatfield L, et al. Nurse engagement in shared governance and patient and nurse outcomes. J Nurs Adm. 2016;46(11):605. doi:. [Context Link]