In the subset of patients who experienced a postoperative complication ,; Of the hospitals studied, Magnet hospitals were larger than non-Magnet hospitals median staffed beds: versus beds , and a larger share of Magnet hospitals had transplant programs Compared to non-Magnet hospitals, Magnet facilities had better nurse staffing in terms of adjusted registered nurse hours per patient day , were less likely to be in an urban location, and had fewer teaching programs.
However, these differences were not significant. Thirty-day mortality rates were significantly lower in Magnet hospitals than in matched controls 5. A similar difference was observed for failure to rescue. In multivariable analyses, after patient and hospital characteristics were controlled for, we found that patients treated in Magnet hospitals were 7. And patients treated in Magnet hospitals were 8.
With the exception of two years, Magnet hospitals had lower thirty-day mortality and failure to rescue rates than matched control hospitals Exhibit 3. The rates of thirty-day mortality and failure to rescue for Magnet Hospitals are higher than matched controls in and , respectively. However in linear mixed models that include all study years, Magnet hospitals had significantly lower rates of risk-adjusted thirty-day mortality and failure to rescue throughout the study period.
We next examined whether outcomes in Magnet hospitals improved after initial Magnet recognition, and we compared outcomes with matched controls for the four years before and three years after initial recognition Exhibit 4.
For both Magnet hospitals and their matched controls, outcome rates did not differ significantly over time. NOTE hospitals were excluded from this analysis due to insufficient years of data for analysis.
No noteworthy improvements in outcomes were observed for Magnet hospitals after their first recognition. A final analysis that included only the Magnet hospitals found no significant differences in risk-adjusted thirty-day mortality or failure to rescue rates, according to whether or not patients received their operations during a year in which the hospital's Magnet recognition was active.
During a thirteen-year period, surgical patients treated in hospitals recognized by the ANCC Magnet Recognition Program were less likely to experience all-cause mortality within thirty days of admission or failure to rescue death after a postoperative complication.
These results persisted despite adjustments for year of operation, patient severity of illness, and hospital characteristics. Results were also adjusted for hospital nurse staffing, a variable frequently associated with patient mortality. Our work confirms the findings of previous cross-sectional studies[ 12 — 14 ] and extends the understanding of how organizational factors affect surgical patient outcomes.
The study[ 12 ] used the original cohort of Magnet hospitals that were identified by reputation, not the current formal review process. Using a matched control sample, the researchers found that risk-adjusted mortality rates were lower in Magnet hospitals. However, these original Magnet hospitals had better nurse staffing ratios than non-Magnet hospitals. Our study shows that independent of nurse staffing levels, Magnet hospitals have lower rates of thirty-day mortality and failure to rescue.
It confirms the findings of two studies conducted in convenience samples, with comparable effect sizes. Patients across three surgical conditions benefited from receiving their care in Magnet hospitals.
Previous work has demonstrated that Magnet hospitals reduce organizational hierarchy, create structures and processes to increase the autonomy of staff nurses, measure and benchmark nursing-sensitive quality indicators, and have more satisfied nursing staff.
Overall outcomes were improved for patients treated in Magnet hospitals than in non-Magnet facilities, but for Magnet hospitals, outcome rates did not differ before and after recognition. Additional organizational factors likely contribute to the favorable outcomes observed in Magnet hospitals.
In a recent study,[ 14 ] a survey-derived measure of nursing quality was significantly associated with lower mortality, independent of Magnet recognition. Our findings can inform the deliberations of the Institute of Medicine's commission on credentialing research in nursing. Studying Magnet hospitals in greater depth is one important strategy for uncovering how nursing care delivery affects performance. When our results are considered in the context of the literature, the following important messages emerge.
Patients are well-served in choosing Magnet hospitals for their surgical care. It does not appear to matter whether hospitals are newly recognized or have been recognized for some time. Hospital leaders should appreciate the benefits to staff when pursuing Magnet recognition but should not expect improvements in patient outcomes after recognition has occurred. Finally, policy makers should support efforts to study how high-performing hospitals achieve their results.
Surgical outcomes are better for patients treated in hospitals recognized by the Magnet Recognition Program of the American Nurses Credentialing Center. Hospitals that obtain Magnet recognition have additional organizational features that confer benefits on patient outcomes.
To further motivate quality improvements, researchers must study how well-performing hospitals achieve better outcomes than hospitals with subpar performance. The authors thank Marie-Claire Roberts for her assistance in verifying Magnet hospital recognition. John Birkmeyer is the founder of and holds an equity interest in ArborMetrix, a health care software company. The company had no role in the research described in this article.
The other authors have no disclaimers. National Center for Biotechnology Information , U. Health Aff Millwood. Author manuscript; available in PMC Jun 1. Christopher R. Author information Copyright and License information Disclaimer. Correspondence To: Christopher R. Copyright notice. The publisher's final edited version of this article is available at Health Aff Millwood. See other articles in PMC that cite the published article. Associated Data Supplementary Materials Appendix.
Abstract Hospital executives pursue external recognition to improve market share and demonstrate institutional commitment to quality of care. Study Data And Methods We analyzed Medicare inpatient claims files for the years — to assemble three cohorts of surgical patients: those who had coronary artery bypass graft surgery, colectomy, or lower extremity bypass. Patient Characteristics For Risk Adjustment Diagnosis and procedure codes and demographic variables were used for severity of illness adjustment.
Statistical Analysis We linked the list of Magnet hospitals to the patient claims and hospital characteristics data by matching Medicare provider identifier and year. Patient-Level Analyses For thirty-day mortality, we analyzed the sample of 1,, patients. Hospital-Level Analyses We analyzed patient outcomes across hospitals to assess hospital outcomes over time and to determine whether outcomes improved after hospitals received Magnet recognition.
Sensitivity Analyses To increase confidence in our presented findings, we conducted seven sets of sensitivity analyses. Limitations This study has several limitations. Study Results Of the 1,, patients, , Open in a separate window. Magnet Recognition And Patient Mortality Thirty-day mortality rates were significantly lower in Magnet hospitals than in matched controls 5.
Exhibit 2 figure. Hospital Outcomes Over Time With the exception of two years, Magnet hospitals had lower thirty-day mortality and failure to rescue rates than matched control hospitals Exhibit 3. In an environment rife with controversy about patient safety in hospitals, medical error rates, and nursing shortages, consumers need to know how good the care is at their local hospitals.
The purpose of the current study is to examine whether hospitals selected for recognition by the ANCC application process—ANCC-accredited hospitals—are as successful in creating environments in which excellent nursing care is provided as the original AAN magnet hospitals were.
We found that at ANCC-recognized magnet hospitals nurses had lower burnout rates and higher levels of job satisfaction and gave the quality of care provided at their hospitals higher ratings than did nurses at the AAN magnet hospitals. Our findings validate the ability of the Magnet Nursing Services Recognition Program to successfully identify hospitals that provide high-quality nursing care.
In the s, the American Academy of Nursing reported on hospitals that were able to recruit and retain highly qualified nurses in a competitive market. This study compares the original magnet hospitals with ones that met criteria for accreditation as magnet hospitals by the American Nurses Credentialing Center. It provides the evidence nurses need to convince their hospitals to seek this accreditation. The public is inundated with media coverage of changes in health care that could adversely affect their access to and the quality of health care services.
For close to two decades, nursing has had a potential vehicle for informing consumers about the quality of hospital nursing care. Two aims of the AAN initiative were to identify hospitals that were successful in attracting and retaining nurses and to determine the organizational features those hospitals had in common that might account for their success. The organizational attributes that attract nurses to magnet hospitals have also been found to be consistently and significantly associated with better patient outcomes than those of matched nonmagnet hospitals.
Several recently published research synthesis papers reinforce the empirical evidence suggesting that magnet hospitals achieve better outcomes than comparable hospitals. In the first study, we examined Medicare mortality rates using data for 39 of the 41 original magnet hospitals one hospital had closed and one was a Veterans Administration hospital not included in the Medicare data by using a multivariate matched sampling procedure that controlled for hospital characteristics that previous research had shown to be associated with mortality such as ownership, teaching status, size, location, financial status, physician qualifications, technology index, and emergency admissions.
The 39 magnet hospitals were matched with comparison hospitals five per magnet hospital selected from all nonmagnet U. Medicare mortality rates in magnet and comparison hospitals were compared using variance components models, which pool information from each group of five matched hospitals and adjust for differences in patient composition, as measured by predicted mortality.
After adjustment for differences in predicted mortality for Medicare patients, the magnet hospitals had a 4. The second study of the magnet hospitals involved data from 1, consecutively admitted patients with AIDS and from nurses on 40 units in a subset of 20 magnet hospitals. While magnet hospitals were found to have higher nurse-to-patient ratios than other hospitals, the cost of more nurses was more than offset by significantly shorter lengths of stay and lower utilization of ICU days.
Overall, multiple studies point to significantly better outcomes in magnet hospitals, as compared with nonmagnet hospitals.
In the early s, the ANA, through the ANCC—the organization that certifies registered nurses in clinical specialties—established a formal magnet hospital program to recognize excellence in nursing services.
The ANCC magnet hospital recognition program is similar in objectives and design to the original AAN magnet hospital program, except that the ANCC program involves a voluntary application process and requires hospital recertification every four years. The purpose of this study was to examine whether ANCC-recognized magnet hospitals had the same organizational attributes responsible for excellent nursing care as the original magnet hospitals did and whether they had high rates of nurse satisfaction and the same quality of care as assessed by nurses and thus offered evidence that the good outcomes shown to exist in the original magnet hospitals can be expected to exist in those selected through the newer ANCC Magnet Nursing Services Recognition Program.
In the present study, seven ANCC magnet hospitals were compared with 13 original magnet hospitals see More on Methods and Statistics , page We do not contend that the two groups are matched groups of hospitals as in our previous studies ; they are simply two groups of magnet hospitals selected through different processes a decade apart. In fact, there are several differences between the two groups of hospitals.
The ANCC magnet hospitals are larger, with an average of beds, compared with beds in the original magnet hospitals. This study used a comparative multisite observational design incorporating two subsamples of hospitals. Our objective was to compare contemporary ANCC-recognized magnet hospitals with the original magnet hospitals.
The original magnet hospital subsample was selected through use of a sampling frame developed by Marlene Kramer for her study of the original magnet hospitals. We attempted to recruit all 15 hospitals to our study, but three nurse executives declined to participate, leaving us with 12 hospitals and without an original magnet hospital in the West Coast region. We therefore recruited the remaining original magnet hospital located in that region for our study a hospital not studied by Kramer , for a total of 13 original magnet hospitals.
The three nurse executives who declined to participate noted that their hospitals no longer had the elements of professional nurse practice that had won them AAN magnet hospital designation in Thus, to the extent that the refusals bias the sample of original magnet hospitals, the bias would be toward having a stronger group of original magnet hospitals, since the weaker ones declined to participate and would thereby provide a stronger test of how the ANCC-recognized magnet hospitals measure up than might be the case if all the original magnet hospitals had been included.
The nurse survey component of the study included a census of all registered nurses on staff who worked at least 16 hours per week on any medical or surgical nursing unit in study hospitals, yielding roughly 3, eligible nurses. Study participation was voluntary and all participating nurses provided informed consent. A research nurse was appointed at each hospital to carry out the protocol, which involved distributing the questionnaire packets and sending reminder postcards at two weeks, follow-up questionnaires at four weeks, and final reminder postcards at six weeks.
Although the results we report are bivariate and largely descriptive, we used significance tests chi-square statistics with categorical variables and t-statistics with continuous ones, such as the years-of-experience and practice-environment subscales to ensure that the differences we observed between the nurses in the two groups of hospitals were not the result of sampling fluctuations or chance.
Nurses on medical-surgical units at all institutions were invited to complete a page self-administered survey that took approximately 30 minutes to complete. It included the following sections:. The results presented below are from analyses of the nurse survey data alone and reflect our belief that by querying nurses much can be learned about hospitals—how they are organized and how their organization affects nurses and, ultimately, patients.
Generally, both groups of magnet hospitals had a registered nurse workforce with significantly higher educational preparation than nonmagnet hospitals had. However, nurses practicing in ANCC magnet hospitals had significantly less nursing experience, fewer years of employment at their current institutions, and fewer years assigned in their current units than did nurses in the original magnet hospitals see Years of Nursing Experience in the Two Groups of Hospitals , above.
On average, nurses in ANCC magnet hospitals had worked in nursing and at their current hospitals for about one and a half years less than had nurses in the original magnet hospitals. Similarly, nurses in ANCC hospitals had worked on their current units for about one year less than had nurses in the original magnet hospitals.
The chi-square value testing the independence of education across the two hospital settings is T-test statistics for mean differences were 3. Standard errors associated with estimated means are between 0. Two independent data sources show that the ANCC magnet hospitals had a significantly higher ratio of registered nurses to patients than did the original magnet hospitals.
Data from the Annual Hospital Survey of the American Hospital Association AHA were analyzed and show that ANCC magnet hospitals employed full-time equivalent registered nurses per patients average daily census , compared with nurses per patients in the original magnet hospitals. Analysis of the AHA data also reveal that the average nurse-to-patient ratio for community hospitals overall was lower still, at registered nurses per patients. In addition to differences in nurse staffing, nurses at ANCC and original magnet hospitals differed in their appraisals of other aspects of their practice environment.
By control over the practice setting, we mean that nurses had sufficient intraorganizational status to influence others and to deploy resources when necessary for good patient care. T-tests for mean differences were 6.
Standard errors associated with the estimated means are approximately 0. Nurses in ANCC magnet hospitals were substantially and significantly more likely than nurses in the original magnet hospitals to report that their units have adequate support services and enough RNs to provide high-quality care. They also reported having adequate time to discuss patient problems with other nurses. These findings are consistent with the higher reported nurse-to-patient ratios in ANCC magnet hospitals.
Nurses in ANCC magnet hospitals also reported in greater relative numbers that they control their own practice, participate in policy decisions, have a powerful chief nursing executive, and that the contributions they make are greatly appreciated.
In responding to these survey items and a majority of the full set of items on the NWI-R, the nurses in ANCC magnet hospitals rated their practice environments more highly than did nurses in the original magnet hospitals. Here again, we note that our previous research documented that nurses in the original magnet hospitals rated their practice environments significantly more favorably than did nurses in nonmagnet hospitals.
Chi-square values with one degree of freedom associated with the tests of independence of the seven variables across the two hospital settings are All have p values of less than 0. Differences in staffing and practice environments were associated with differences in nurse outcomes in the two groups. Nurses in ANCC magnet hospitals were significantly less likely than nurses in the original magnet hospitals to report feeling burned out, emotionally drained, or frustrated by their work see Nurse Burnout in the Two Groups of Hospitals , page Moreover, when nurses were asked how satisfied they were with their present job, those in ANCC magnet hospitals answered decidedly differently from those in the original magnet hospitals.
The chi-square value testing the independence of job satisfaction across the two hospital settings is A wide range of insightful information will be presented. Attendees will find topics of interest no matter where their organizations are along the Magnet journey.
We also remain busy with other projects and initiatives to assist and support you in your Magnet journey. This website is a great place to connect with peers, find valuable resources, and access the latest information via webinars and other educational offerings. A significant amount of time has been put into developing a product that will be useful to Magnet organizations and the Magnet office. Piloting of the DIF, which now functions more like a database, has been completed.
Stay tuned for future announcements, which will detail educational offerings and official dates related to utilization of the new DIF. Before initiating a review of the manual, ANCC began an in-depth review of the original Magnet research in early , combined with a review of related subsequent research.
During the manual revision, a priority was that the foundation of the Magnet Program continue to be based on research, promoting evidence-based nursing practice. During revision, many individuals assisted in evaluating every aspect of the manual, providing valuable feedback. I greatly appreciate the time and effort of Magnet Senior Analysts, members of the Commission on Magnet, and individuals who participated in providing public feedback on recommended changes.
The Magnet Recognition Program encourages nurses to be innovative, while involving and inspiring others from all disciplines to improve the patient experience throughout the continuum of care. The revised Application Manual remains focused on improving the environment and practice of nursing through effective deployment of structures and processes that support delivery of outstanding outcomes. I hope to see many of you at the Magnet Recognition Conference. Whether or not you attend, please read the articles in this Magnet Profiles section.
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