National Nurses United

CE:Final 5/27/08 11:58 AM Page 18 CE Home Study Course TheTrueForcesBehindMagnetism CNA/NNOC's position statement on hospital magnet status Submitted by the Joint Nursing Practice Commission and Hedy Dumpel, RN, JD BACKGROUND n 1990 the American Nurses Association (ANA) approved a proposal that recognized excellence in nursing services. This was based on earlier research done by the American Academy of Nursing on practice in U.S. hospitals. The variables used in the study were called "forces of magnetism" and the facilities were called "magnets" because they allegedly attracted and retained registered nurses. The Magnet Recognition Program was developed by the American Nurses credentialing Center (ANCC), an ANA subsidiary, to recognize "healthcare organizations that provide nursing excellence." The program also provides a vehicle for "successful" nursing practices and strategies. The Magnet program is based on quality indicators and standards as defined in the ANA Scope and Standards for Nurse Administrators (2004). The Magnet designation process includes fourteen (14) qualitative factors in nursing also known as the 14 "forces of magnetism" which was first identified through the research done in 1983 (See Appendix A). The stated intent is also to provide "consumers with the ultimate benchmark to measure the quality of care that they can expect to receive." I HISTORY OF MAGNET HOSPITAL RECOGNITION The Beginning – "Forces of Magnetism" Aligned with Patient Interests The Magnet hospital program began in the early 1980s when healthcare provider services were funded by fee-for-service and indemnity insurance methods of paying and guaranteeing payment for healthcare services. Hospital and medical group revenue and profit were generated by providing services to meet patient needs as determined necessary by physicians and other professional caregivers including direct-care registered nurses. Fee-for-service financing of hospital care delivery generally aligned the interests of physician and hospital providers with patients in ways that promoted trust, continuity, and financial incentives to provide necessary care for patients. In this economic scheme, the original magnet hospitals were recognized on the basis of superior RN staffing ratios and significant administrative support for direct-care RNs. The staffing ratios and administrative support provided the necessary foundation for effective, RN-friendly scheduling policies and a direct-care RN-patient relationship which allowed competent practice under professional standards of care. As described by the American Academy of Nursing in 1983: In magnet hospitals there is a low patient-to-registered nurse ratio, with adequate staff to provide total nursing care to all patients. Fur- 18 REGISTERED NURSE thermore, the quality and complexity of patient care needs are taken into consideration when the staffing is planned; this is important in minimizing stress. The nurse does not feel overworked and has an opportunity to meet all of the patient's needs — psychological, interpersonal, and physical. There is also time for interaction among nurses so that continuity of care is insured and nurse-to-nurse consultation is encouraged. The nurses express great satisfaction in their opportunity to provide good care and in administration's support for it. The 1983 study by the AAN interviewed nurses working for hospitals that were part of the original selection process for identifying magnet hospitals who summarized their experiences by identifying "the most important" factors "in promoting recruitment and retention of staff." The key factor and driving force for all factors was "a nursepatient ratio which assures quality patient care," followed by "flexible staffing to support patient care needs," "flexible scheduling," and the practice of "primary nursing." Staffing ratios was the absolute and mandatory condition of magnet hospital nursing service that enabled nurses to care for their patients in a manner consistent with their professional practice obligations, ethical norms, and personal career mission as registered nurses. The AAN summarized the essential finding of its study in unequivocal terms: "The nurses speak of being able to deliver safe, adequate care as a result of these staffing patterns." Sharing similar operational interests driven by fee-for-service economic incentives, nursing and hospital management at the original magnet hospitals broadly agreed with nurses regarding the central factors that had an impact on recruitment and retention, citing: "adequate staffing and flexible scheduling," "good salaries and benefits," "participative management with active involvement of staff in planning and decision making," "primary nursing," and "a predominantly RN staff that is fully supported by nursing administration." Nursing executives emphasized the importance of RNs being able to carry out skilled nursing tasks themselves, without delegation to less trained individuals. And the original magnet hospitals were founded on a commitment to maintaining a sufficient complement of directcare RN staff to meet patient needs at all times, with virtually no use of agency personnel. This was the meaning and workplace reality of the "forces of magnetism" identified by the American Academy of Nursing 25 years ago, a time when institutional providers and physician groups were generally thriving in a dominant "fee-for-service" market characterized by a close alignment of provider, direct-care nurse and patient interests, and institutional economic incentives to ensure safe, competent, and therapeutic nursing care. W W W. C A L N U R S E S . O R G M AY 2 0 0 8

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