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Dispelling common myths about ANCC’s Pathway to Excellence®

By: Christine Pabico, PhD, RN, NE-BC

Is this program the right fit for your organization?


  • Pathway to Excellence frequently asked questions are answered.
  • Common myths are dispelled.
  • The framework to benefit all healthcare organizations (regardless of size, type, or setting) is discussed.

The American Nurses Credentialing Center’s (ANCC) Pathway to Excellence Program® is a premier international designation for positive practice environments. Achieving the designation recognizes a healthcare organization’s commitment to creating an engaging and supportive workplace. The National Academy of Medicine’s (NAM’s; formerly known as the Institute of Medicine) 2004 report Keeping Patients Safe: Transforming the Work Environments of Nurses recommends improving the working conditions of nurses to enhance patient safety. Positive practice environments increase clinician satisfaction, improve the patient experience, and reduce turnover.

The Pathway to Excellence® framework addresses many practice environment characteristics that studies have found to correlate with nurse and patient outcomes. However, some healthcare organizations are hesitant to use the framework because of misconceptions about it. Let’s dispel those myths and reveal how nurses, patients, and organizations benefit when they leverage the Pathway to Excellence framework.

MYTH #1: Pathway to Excellence is only for small hospitals.

FACT: The Pathway to Excellence framework is relevant to and attainable by healthcare organizations of all sizes and settings and has been used to successfully build a solid foundation (a positive practice environment) that supports nurse excellence.

Pathway to Excellence began as the Texas Nurse-Friendly program, designed to enhance quality care and professional satisfaction among nurses working in small, rural hospitals in Texas. When ANCC acquired the program in 2007 and relaunched it nationwide (and expanded it to international applicants in 2010), Pathway to Excellence was transformed into a credential for all types of healthcare organizations. The Commission on Pathway to Excellence and the Pathway Program Office have gone to great lengths to ensure that all elements of performance (criteria applicants must meet) are relevant and attainable in all settings, regardless of size or specialty, across the globe where nurses work. (See Size doesn’t matter.)

Size doesn't matter

Did you know?

  • The smallest hospital to achieve Pathway to Excellence® designation has fewer than 20 beds; the largest has 1,000 beds.
  • Pathway organizations include acute-care hospitals as well as long-term care, home health, ambulatory centers, hospice, and a national retail clinic.
  • Veterans Administration medical centers and military hospitals have successfully used the Pathway framework to transform their practice environments and work cultures.
  • The 184 (as of February 2020) currently designated Pathway to Excellence organizations include nine international hospitals representing seven different countries, which underscores how well the Pathway framework translates to diverse cultures.

MYTH #2: Pathway to Excellence benefits only nurses.

FACT: Embarking on the Pathway to Excellence journey results in a cultural transformation that benefits patients, nurses, and other employees of the organization.

One of the major changes introduced in the 2016 Pathway to Excellence Application Manual was to thread interprofessional requirements throughout the six Pathway standards, making collaboration critical to success. And the 2020 application manual now includes non-RN midwives in the Pathway designation process and survey validation phase.

These changes to the program are aligned with the NAM’s recommendations to capitalize on staff members’ unique skills to meet patients’ diverse needs. When an organization embarks on the Pathway to Excellence journey, everyone wins because the benefits of a more positive practice environment are experienced across the organization. Living the Pathway standards also ensures that improvements last well beyond achieving the designation.

MYTH #3: Pathway to Excellence is a stepping-stone to ANCC’s Magnet Recognition Program®.

FACT: Some organizations pursue Pathway designation as a first step toward seeking Magnet recognition, some pursue Pathway alone, and some pursue both.

Some organizations apply for Pathway to Excellence designation before pursuing Magnet recognition to ensure they have the infrastructure for creating a culture of sustained excellence. Pathway focuses on establishing the essential elements of a positive practice environment, improving nurse engagement, and safeguarding clinician well-being. Pathway to Excellence program highlights that an organization’s “frontline is its bottom line” because the nurses who work on the frontline are closest to the patients and have the greatest potential to make an impact on patients’ safety and hospital experience. Many healthcare administrators agree and see the benefit of creating an environment that values frontline nurses’ contributions in decisions that impact their practice. An engaged workforce is pivotal to achieving and sustaining outcomes, a big component for attaining Magnet recognition.

Many organizations that pursue Pathway designation believe that it supports their strategic objectives. They use the Pathway framework to establish structures and processes to improve the practice environment, strengthen the work culture, safeguard staff well-being to decrease burnout, increase engagement, and improve nurse recruitment and retention. Most organizations that have achieved Pathway designation choose to maintain the credential; some have been designated as many as five times. These organizations recognize the value of using the framework to regularly assess the practice environment as it adapts to changes in healthcare and to demonstrate the executive leadership team’s ongoing commitment and investment in its workforce. Taking on the designation process every 4 years ensures that an organization is addressing current challenges and that employees continue to live the Pathway Standards. (See A symbiotic connection.)

A symbiotic connection

Did you know?

  • A few organizations have recognized the unique value of Magnet® and Pathway to Excellence® by achieving both recognitions.
  • Some hospitals that have received Magnet recognition are inquiring about applying for Pathway to Excellence because they recognize that the Pathway framework has been used by others as a blueprint for creating a culture of sustained excellence, which is essential for achieving and maintaining regulatory and voluntary organizational credentials.
  • In 2018, the Commission on Magnet and the Commission on Pathway to Excellence completed an evaluation of each program’s current standards to determine if relationships exist between the required elements. Several elements were determined to be highly correlated. As a result, organizations pursuing a dual designation or a single designation in one program and transitioning to the other are exempt from having to submit evidence on those elements.

MYTH #4: Pathway to Excellence is easy to attain.

FACT: To attain the Pathway to Excellence designation, an organization must successfully pass two phases. First, it must address 64 required elements in the Pathway Standards written document. Then, in the validation phase, nurses at all levels in the organization are invited to share their perceptions of the practice environment in a confidential online survey.

All nurses under the chief nursing officer’s (CNO’s) purview—regardless of their role, employment status, shift, or reporting structure—are invited to take the survey. Passing this phase requires meeting three thresholds:

  • At least 60% of the RNs in the organization must participate in the survey.
  • At least 75% of the responding nurses must score three-quarters (21 of the 28) of the survey items favorably.
  • At least 50% of the participants must score all survey items favorably.

This makes the Pathway designation not only a validation by an external third party (ANCC) but also by the organization’s nursing workforce. CNOs attest that the validation phase can be anxiety provoking; however, achieving all three nurse survey thresholds is one of the most fulfilling accomplishments of the application process. Successfully passing the survey corroborates that what organizations are doing to support nurses is recognized by nurses.

MYTH #5: Pathway to Excellence–designated hospitals don’t conduct research.

FACT: Conducting research is not a requirement to achieve the Pathway to Excellence designation.

However, most Pathway organizations conduct research and many have published results of their studies.

Another important fact

Pathway to Excellence is the only credentialing program with a dedicated standard focused on safeguarding clinician well-being. Pathway to Excellence was the first and remains the only organizational credentialing program to have a dedicated standard on clinician well-being. Pathway Standard 5: Well-being requires applicants to proactively reduce burnout and compassion fatigue by implementing support pro­cesses that foster work-life balance and resilience and align with healthcare’s most relevant initiatives, including the Institute for Healthcare Improvement’s Qua­druple Aim, NAM’s Action Collaborative on Clinician Well-Being and Resilience, and the American Nurses Association’s zero tolerance policy on workplace violence, incivility, and bullying.

Long-term transformation

To realize their full potential, nurses must practice in an environment that’s safe, empowering, and satisfying. A positive practice environment generates engagement and cultivates joy among workers, which leads to improved care, excellent patient experiences, and increased nurse recruitment and retention. Pathway to Excellence is a powerful way to achieve these goals and transform your organization for years to come.

Learn more about ANCC’s Pathway to Excellence Program at

Christine Pabico is the director of Pathway to Excellence at the American Nurses Credentialing Center in Silver Spring, Maryland. This article underwent peer review.


Aiken LH, Sermeus W, Van den Heede K, et al. Patient safety, satisfaction, and quality of hospital care: Cross sectional surveys of nurses and patients in 12 countries in Europe and the United States. BMJ. 2012;344:e1717.

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Institute of Medicine. Health Professions Education: A Bridge to Quality. Washington, DC: National Academies Press; 2003.

Institute of Medicine. Keeping Patients Safe: Transforming the Work Environment of Nurses. Washington, DC: National Academies Press; 2004.

Kutney-Lee A, Wu ES, Sloane DM, Aiken LH. Changes in hospital nurse work environments and nurse job outcomes: An analysis of panel data. Int J Nurs Stud. 2013;50(2):195-201.

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