We read with interest the study reported in the July/August article, "A Comparison of Working Conditions in Magnet(R) and Non-Magnet(R) Hospitals,"1 by Trinkoff et al that showcased some of the significant benefits that Magnet status confers on hospitals and the nurses who work in them. However, the multiple limitations identified in the study complicate interpretation of data related to practical significance, and relationships between the variables can be interpreted in many different ways.
The purpose of the study was to compare working conditions, including schedule, job demands, and practice environment, among nurses working in Magnet and non-Magnet hospitals. The study's key finding is something on which we all agree-nurses have demanding jobs-and it highlights factors that support a Magnet(R) environment:
* Physical demands were lower among nurses in Magnet hospitals compared with those working in non-Magnet hospitals.
* Magnet hospitals were less likely to have mandatory overtime and on-call work requirements.
* Job satisfaction was higher.
However, in the discussion section of the article, the authors set aside these positive findings and focus on factors such as specific numbers of hours worked and psychological demands. The study also used a convenience sample and compared nurses in 14 Magnet hospitals (162 nurses) with those in 157 non-Magnet facilities (675 nurses) in 2 states. The authors' study conducted a secondary analysis of data that is now 5 years old from hospitals that were credentialed under the old Magnet model in 2005. The Magnet model changed in 2008 to include outcomes requirements.
Although Magnet hospitals explicitly demonstrate, through the application process, the characteristics and attributes described in the Magnet model, one cannot assume that organizations that are not Magnet recognized do not exhibit Magnet characteristics. Magnet is a voluntary credential, and there are many excellent healthcare facilities that are not Magnet designated.
Finding no difference in some working condition factors selected for this study does not mean that Magnet hospitals do not have positive working conditions. In fact, the results in Table 3 show factors for which there are differences including increased job satisfaction, less mandatory overtime, and less required on-call in the selected Magnet hospitals.1(p313) The authors also suggest that changes to the nursing practice environment (such as adequate staffing and organizational support) that have been driven by the Magnet program have benefited all hospitals-both Magnet and non-Magnet. We applaud this conclusion, and we encourage more research to demonstrate that this is evidence for the improvement that Magnet requirements generate in all healthcare organizations.
The commission on the commitment of Magnet to have an evidence-based approach to the Magnet standards will continue to guide the commission with studies of this kind helping us all improve our ability to provide positive practice environments that ultimately impact excellence in patient- and family-centered care.
REFERENCE
1. Trinkoff A, Johantgen M, Storr C, et al. A comparison of working conditions among nurses in Magnet(R) and non-Magnet(R) hospitals. J Nurs Adm. 2010;40(7/8):309-315.
Patricia Reid Ponte, DNSc, RN, FAAN
Chair-Elect, Commission on
Magnet Recognition(R)
Gail A. Wolf, DNSc, RN, FAAN
Chair, Commission on
Magnet Recognition(R)
The Authors' Reply
Thank you for your interest in our article and the opportunity to dialogue about the nursing working conditions. We believe it is very important for all hospital leaders to examine their scheduling policies and practices and work to improve the healthfulness of schedules for nurses. This is not only to protect nurses' health and performance, but also for the safety of patients. We look forward to continuing our research in this area and hope that nursing stakeholders will give it increasing attention.
Alison M. Trinkoff, ScD, RN, FAAN
on behalf of the coauthors
Professor, School of Nursing
University of Maryland, Baltimore