A Magnet4Europe twinning journey
- A U.S. and UK hospital participated in the Magnet4Europe study, which included 63 European hospitals.
- The UK hospital conducted a self-assessment and received mentoring from the U.S. Magnet-designated organization.
- Both hospitals participated in surveys to evaluate and compare clinician well-being.
In 2020, Magnet4Europe (M4E) began as a European Union (EU)-funded project to improve the mental health and well-being of health professionals in six European countries. The intervention intends to gain insight into the care provided in EU hospitals and the demands placed on clinical staff and then implement interventions based on the American Nurses Credentialing Center’s Magnet® model. Ultimately, M4E aims to improve mental health and well-being among health professionals and provide better patient outcomes.
About M4E
The M4E intervention included five key components to improve work environments and patient outcomes for 63 European hospitals: access to Magnet resources, twinning partnerships, international learning collaboratives, international networking, and staff surveys at designated times. The project provided European sites with access to Magnet resources, including the current Magnet application manual, a Magnet self-assessment tool, and international guidance and clarifications from the Magnet Program Office.
Participation required the EU organization to conduct a self-assessment while receiving mentoring from a selected Magnet-designated organization in the United States (twinning). In-person and virtual international learning collaboratives, facilitated by the M4E principal investigators, enhanced the M4E activities via discussion of project progress, expectations, and best practices. The learning collaboratives, the annual Magnet conference, and the twinning partnership aided the international networking component of the project.
Upon joining M4E, the EU organizations and U.S. partners participated in a survey to evaluate clinician well-being. Hackensack Meridian Hackensack University Medical Center (HM-HUMC) and Lancashire Teaching Hospitals (LTHTr), a National Health Services (NHS) Foundation Trust, embarked on a twinning partnership that made a work environment impact.
Organization profiles
HM-HUMC, an 803-bed nonprofit teaching and research hospital located in Hackensack, New Jersey, represents the academic flagship of the Hackensack Meridian Health network. It has a five-star rating from the Centers for Medicare & Medicaid Services and serves as the largest provider of inpatient and outpatient services in New Jersey. In 1995, HM-HUMC became the first organization in New Jersey—and the second in the nation—to receive Magnet recognition. In 2024, the organization celebrated its seventh Magnet designation and remained ranked as #1 in New Jersey by U.S. News & World Report for adult and children’s hospitals.
LTHTr, one of 14 NHS Trusts in England, participated in M4E alongside 60 hospitals across Europe. The 996-bed hospital delivers district general and emergency services to Central Lancashire and serves as a regional specialist center to provide major trauma, neurosurgery and neurology, renal, vascular, neonatal intensive, maternal and fetal medicine, cancer, adult allergy and clinical immunology, and disablement services.
Clinician well-being study
In 2021, HM-HUMC and LTHTr began their partnership and participation in the second cohort of M4E research. Both organizations participated in surveys to evaluate and compare clinician well-being within their geographical area.
In the United States, 60 Magnet designated hospitals participated in the U.S. Clinician Well-Being survey, a large, multisite collaborative investigation of health and well-being of clinicians, including physicians and nurses. At HM-HUMC, 28% of eligible nurses, advanced practice providers, and physicians participated. The results provided nurse leaders with insight into clinician well-being and participants’ top-ranked interventions. Results indicated that 37% of participants were experiencing high burnout, 33% intended to leave, and 19% felt dissatisfied with their current role. They ranked the following well-being interventions as their top five: nurse staffing levels, support for uninterrupted break time, team communication, more time in direct care, and less time spent on documentation.
In the EU, 69 hospitals across six countries participated in the survey, which measured indicators of mental health, clinician well-being, quality of patient care, culture of safety, and work environment. LTHTr ranked as the top-scoring United Kingdom (UK) hospital in safety and the second highest in quality. The M4E study team presented and disseminated the full study details at learning collaboratives and via publication.
Twinning partnership
The HM-HUMC and LTHTr twinning partnership began with monthly virtual meetings (coordinated to accommodate the 5-hour time difference), which included the LTHTr chief nursing officer, business manager, deputy associate director of risk and assurance, and deputy associate director of safety and learning. In the initial meetings, HM-HUMC provided LTHTr with an overview of the Magnet principles, described the key foundational practices that sustain nursing excellence, and assisted the LTHTr team with interpreting the Magnet self-assessment components gap analysis.
On November 30, 2021, LTHTr received the M4E Milestone Achievement Award recognizing the completion of the M4E gap analysis. The gap analysis and ongoing discussion identified LTHTr commitment to quality, safety, and research as an organization strength in alignment with the Magnet components. The team prioritized shared decision-making, nursing recognition, and empirical outcomes as opportunities to enhance nursing excellence.
HM-HUMC described their shared decision-making framework and structure, and LTHTr nursing leaders virtually observed HM-HUMC’s daily interprofessional high-reliability huddle (Safety First) and selected shared governance councils facilitated by clinical nurses. HM-HUMC provided LTHTr leaders with guidance in optimizing current workflows to engage, mentor, and support front line clinicians to drive change and improve outcomes.
In collaboration with LTHTr, HM-HUMC displayed a poster titled “Shared Governance and Recognition” at an international M4E session at the 2022 Magnet Conference in Philadelphia. The poster captured the teams’ recognized similarities, strengths, and opportunities.
On-site tour and meeting
In March 2024, the HM-HUMC Magnet Program Director and Co-Magnet Program Director traveled to the UK for a tour and meeting with LTHTr nursing leadership and team members. They aimed to gain a real-time view of LTHTr services and observe any shared learning based on Magnet principles. The welcoming staff at LTHTr displayed enthusiasm, optimism, and openness during the site visit.
To gather a holistic view of the organization, the HM-HUMC team met a range of clinical staff team members—including clinical nurses, nurse leaders, advanced practice nurses, and clinical partners—from across all LTHTr sites and shifts. During rounding, the team focused on key questions to capture the frontline team members’ impact on their own clinical practice and perceptions of the work environment.
Rounds gained insight into the LTHTr team’s strengths and opportunities for alignment with nursing excellence. Strengths included team collaboration and support, a welcoming environment, a family culture, passion for care delivery, and a commitment to quality clinical care. In addition, the LTHTr advanced care practitioner role is similar to the U.S. role, the organization has achieved STAR quality assurance (bronze, silver and gold ranking which evaluates safety and sustained improvements), and they maintain a safety-first culture.
Opportunities for alignment include estate issues (physical location limitations due to age and space), capacity and workload, staffing (skill mix, recruitment, percentage out of work), competing demands, and coaching and leader development. Other areas for alignment include increased networking within the organization and with the NHS trust and similar organizations; sharing best practices; and internal and external benchmarking. The HM-HUMC team presented feedback at the wider nursing forum within LTHTr to provide all nursing staff with the opportunity to learn from the visit and observations.
During rounds and in the presentations, the HM-HUMC team observed the LTHTr team’s work, recognizing and highlighting areas where clinical nurses already engaged in shared-decision making activities. The team noted that most clinical settings monitored at least one nurse-sensitive indicator; however, due to constraints of vendor availability and the NHS payment structure, external benchmarking remained limited.
In addition, the HM-HUMC team discussed the presence of nursing engagement with empirical outcomes and potential opportunities to use specialty or industry performance benchmarks or internal data to improve nursing analysis of excellence and enhance the delivery of patient care. LTHTr team members shared a need to better understand what excellence looks like within their organization.
“The experience of participating in the M4E research program and benefitting from the site visit by HUMC colleagues has been genuinely positive for everybody involved,” said LTHTr Chief Nursing Officer Sarah Cullen, RN, MSc. “The HUMC team are so passionate about the benefits of Magnet and did a fantastic job of communicating this and translating how this would fit into UK health systems. The visit further emphasized the importance of listening and investing in our nursing workforce and the difference this can make to the outcomes of patients and teams.”
The M4E research program officially ended on June 24, 2024; however, both organizations remain committed to extending the twinning relationship to continue learning from one another. Future plans include an LTHTr team visit to HM-HUMC.
Universal and global
Using the Magnet program’s components and key elements for nursing excellence as a guide, the twinning partnership provided LTHTr and HM-HUMC with the opportunity to reflect, capture, and celebrate the uniqueness of nursing. Through their participation in M4E, both organizations came to appreciate that, regardless of geographical differences, nursing professionals universally confront similar challenges, which underscores the need for collaboration to seek solutions that enhance patient care and advance nursing practice globally.
Judy Miranda Rankin is the administrative director in the Inpatient, Oncology & HTP 7 South Unit and Magnet Program Director at Hackensack University Medical Center in Hackensack, New Jersey. Bridget Wertz is the Magnet Program Director at Hackensack Meridian Hackensack University Medical Center. Sarah Cullen is chief nursing officer at Lancashire Teaching Hospitals NHS Foundation Trust in Preston, Lancashire. Katie Marshall is the business manager to the chief nursing officer and Magnet4Europe programme manager at Lancashire Teaching Hospitals. Hajara Ugradar is deputy associate director of risk and assurance at Lancashire Teaching Hospital. Michelle Durkin is deputy associate director of safety and learning at Lancashire Teaching Hospital.
References
Aiken LH, Lasater KB, Sloane DM, et al. Physician and nurse well-being and preferred interventions to address burnout in hospital practice: Factors associated with turnover, outcomes, and patient safety. JAMA Health Forum. 2023;4(7):e231809. doi:10.1001/jamahealthforum.2023.1809
Aiken LH, Sermeus W, McKee M, et al. Physician and nurse well-being, patient safety and recommendations for interventions: Cross-sectional survey in hospitals in six European countries. BMJ Open. 2024;14(2):e079931. doi:10.1136/bmjopen-2023-079931
American Nurses Credentialing Center. 2019 Magnet® Application Manual. Silver Spring, MD: ANA Enterprise; 2017.
Magnet4Europe. magnet4europe.eu
American Nurse Journal. 2025; 20(6). Doi: 10.51256/ANJ062532
Key words: mentoring, Magnet4Europe, international collaboration
