National Nurses United

addressing staffing. Back in the 1980s, nurse researchers connected to the American Nurses Association (ANA) studied a handful of hospitals (mostly academic, teaching facilities) that were renowned for their nurs- ing care to better understand what made them special. The answers were common sense: excellent ratios of RNs to patients; respect and value for RN judgment, autonomy, practice; investment in RN staff, and more. But instead of advocating for their findings to be adopted by the hospital industry, the ANA's response was to turn its research into a pro- duct by creating the Magnet Recognition Program, which is run by the American Nurses Credentialing Center (ANCC), a subsidiary of the ANA. Today, this certification system continues to be a big deal for hos- pital executives, as it's supposed to be an apparent marker of a facility's commitment to its nursing staff and high-quality medical care. Think of it like a Good Housekeeping Seal of Approval for hospitals. And the program is even spreading internationally, as the ANCC continues to look for new customers abroad. Hospitals in the United Kingdom and Europe, Asia, and elsewhere are starting to seek Mag- net accreditation. But NNU nurses at Magnet facilities say the program is not all it's cracked up to be. Instead of being a reliable sign that a facility treats nurses well, Magnet has become a "farce" that co-opts nurses' existing organizing, gives them little input on the process, costs mil- lions of dollars to maintain, is primarily a marketing tool for management, and has created cottage industries of "Magnet coordi- nator" nursing executives and Magnet-obsessed nursing schools eager to milk students for every penny. A 2010 University of Mary- land School of Nursing study found that nurses at Magnet hospitals did not have better working conditions than nurses at non-Magnet hospitals, and a 2015 systematic review of the Magnet literature found that it was not possible from the available research to con- clude whether Magnet accreditation had an effect on nurse and patient outcomes. Moreover, the nurses National Nurse spoke to said that every good thing that Magnet promises nurses can actually be delivered— with transparency and accountability—by unionizing. "I think that people don't understand [Magnet's] really not about nurses and patients," said Lindsay Spinney, an RN at the newly unionized Ascension Seton Medical Center Austin in Texas, a Mag- net-recognized facility. "It's really about executives, and it's really about the employer. It's a marketing tool, and there's a massive lack of transparency in what it is. I think when there's a lack of transpar- ency, it tends to mean there's some issues behind the curtain." * * * * * F or this great honor of calling itself a Magnet facility, hospitals are willing to spend incredible sums of money—often mil- lions of dollars. According to the ANCC's website, for 2022, application fees and annual payments can range from roughly $60,000 to more than $120,000, depending on the size of the facility. And that's only for a single three-year period of Magnet accreditation. In the fourth year of each cycle, facilities must reapply and spend more on the next application and appraisal. On top of that, there are additional pre- miums for multi-facility systems. Meanwhile, as the ANCC website notes, fees are "subject to change" and applicants are advised to check prices at the time of their application for the current costs. But don't worry—for just $335, you can get the official 2023 ANCC Magnet® Application Manual. Beyond that, hospitals may also pay for Magnet appraisers' travel, lodging, and per diem expenses as they appraise a facility, let alone the other things that management might spend on to bolster their case for Magnet or celebrate a win. Research conducted by the Robert Wood Johnson Foundation has put the total cost of the "Magnet journey" for a hospital at up to $2 million. So why would hospital systems shell out for Magnet? As you probably guessed, the answer is money, but not in the traditional way that you might think. Some people think Magnet status helps attract more patients as customers, and it might on some level. But Magnet's real money value lies in providing hospitals cover as a form of "faux staffing regulation" that they can claim they are following instead of being subject to real, enforceable safe staffing standards imposed by law through the government. Hospitals use Magnet des- ignation as an excuse to oppose safe staffing ratios by asserting that they are already engaged in a form of "self-regulation," an argument echoed by the ANA and its spin-off nursing groups—all of which are opposed to staffing ratio laws. "Nurses should be wary of anything that a corporate hospital is trying so hard to achieve because it's not for the nurses. The bottom line is it will make them more money, one way or another," said Strum, the Maine Med RN. "It has nothing to do with nurses or A P R I L | M AY | J U N E 2 0 2 3 W W W . N A T I O N A L N U R S E S U N I T E D . O R G N A T I O N A L N U R S E 15 Amy Strum, RN

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