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Tme magnetic matrix: Building blocks of Magnet™ hospitals

Even during a nursing shortage, building magnetism into a healthcare environment promotes better patient outcomes, lower mortality rates, and higher patient satisfaction. Although Magnet™ hospitals don’t escape the effects of national healthcare trends, such as cost-cutting and other pressures, certain characteristics allow them to respond differently.

 In the April issue, we explored nurse staffing, autonomy, and control over practice as three characteristics of Magnet hospitals identified by the original (1983) Magnet hospital study. This month, we investigate three additional characteristics that promote magnetism—positive nurse-physician relationships, educational support and professional development, and strong organizational and administrative support.
Positive nurse-physician relationships
Strong nurse-physician relationships are a major environmental factor affecting both nurse and patient satisfaction. The relationship must be an authentic partnership with equal power for both parties within their respective practice areas. Nurses and physicians must respect each other’s knowledge and expertise while focusing on their common concern—the patient and the quality of care.
Since the early 1980s, staff nurses have identified positive, collaborative, collegial nurse-physician relationships as a trait of Magnet hospitals. Such relationships help Magnet hospitals retain staff nurses. Also, studies of intensive care units in both Magnet and non-Magnet facilities found that increased communication among nurses and physicians reduced patient mortality and length of stay. A 2001 survey found that positive nurse-physician relationships ranked second among 279 Magnet-hospital nurses as a characteristic essential to providing high-quality care.
Educational support and professional development
Magnet hospitals provide educational support for nurses and nurture their professional development through orientation, continuing education, formal educational support, and career development activities. Educational support encompasses formal support for further degrees and clinical certification as well as hospital-based programs involving both new graduates and experienced nurses.
Educational support and nursing preparation are basic to the staff nurse’s ability to gain and maintain competence. Clinical competence is linked to other essential Magnet characteristics, including autonomy, control over nursing practice, and strong nurse-physician relationships. Consistently, nursing leaders and staff nurses at Magnet hospitals are educated at a higher level than at non-Magnet hospitals. Also, support for formal and informal education and professional development of nurses is linked to increased nurse satisfaction and retention in Magnet hospitals. (See Supporting nurses’ educational and professional development.)
Organizational and administrative support
The original Magnet study found that high-quality leaders provided the kind of organizational and administrative support that most attracted and retained professional nurses. Today, Magnet hospitals exhibit strong, consistent administrative support. Such support manifests as a decentralized structure, with clinical decision making and control over practice devolved to frontline nurses and a participative management style by visible, influential nursing leaders at both the executive and unit levels.
In Magnet hospitals, nursing chief executives provide vision and direction for high-quality, patient-
centered care and convey the importance of nursing’s contribution to such care. Nurse managers and staff nurses operationalize this vision at the unit level. (See Developing organizational and administrative support.)
All studies of Magnet hospitals show that a strong, competent, executive-level nurse leader is a requirement for excellence. In Magnet hospitals, the chief nursing officer functions at the executive level, engaging in management of the entire organization and assisting in achieving the facility’s goals.
Magnet hospitals have a culture of excellence not just in nursing but in all departments and at all organizational levels. Cultural excellence starts with an enlightened board of directors and, most importantly, an enlightened chief executive officer. Without such excellence, even the best nursing leader would fail. In Magnet hospitals, excellence at the highest levels nourishes excellence at lower levels. Administrative and management excellence nurtures and inspires excellence in all staff members.
In the original Magnet hospital study, a participative management style provided administrative and organizational support for professional practice models. With the restructuring of the 1990s, the primary nursing delivery model faded, and care and service team models became more popular. Care and service team models provided an empowered staff, multidisciplinary collaboration, multiskilled workers, and a case-management approach to nursing care. Although these models gave nurses less direct patient care, they allowed nurses to retain control over nursing care through delegation and by working with unlicensed personnel. In many facilities today, the care delivery model combines primary nursing’s continuity-of-care concept with the service team concept of multiple professionals and assistive personnel leveraging each other’s expertise and skills.
Magnet hospitals in the vanguard
Restructuring of the 1990s diminished some of the Magnet characteristics identified in the original study. Yet these characteristics still help attract and retain nurses. As we entered the 21st century, it became clear that truly successful hospitals would need to rebuild their original Magnet elements to stay at the forefront. Recent studies show that today, Magnet hospitals provide a strong model for the type of healthcare system the United States needs—a system in which patients and their families are the central focus and healthcare professionals work together to achieve optimal patient outcomes and safety.
Selected references
Aiken L, Havens D, Sloane D. The magnet nursing services recognition program: a comparison of two groups of magnet hospitals. Am J Nurs. 2000;100(3):26-36.
Havens D, Aiken L. Shaping systems to promote desired outcomes. The Magnet hospital model. JONA. 1999;29(2):14-20.
McClure M, Poulin M, Sovie M, Wandelt M. Magnet Hospitals: Attraction and Retention of Professional Nurses. Washington, DC: American Nurses Association; 1983.
Ritter-Teitel J. The impact of restructuring on professional nursing practice. JONA. 2002;32(1):31-41.
Sovie M, Jawad A. Hospital restructuring and its impact on outcomes. JONA. 2001;31(12):588-600.
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