The Pull of Magnetism: The What, Why, and Where of Achieving and Sustaining Magnet Status
What is this magnetism in practice settings that attracts and retains nurses? Is it a prize to be won? Is it an accolade to be awarded for recruitment and retention of nurses? Can any practice setting achieve this much sought after recognition? How did this Magnet hospital designation start? The American Nurses Association and the American Academy of Nursing Task Force on Nursing Practice published the original Magnet Hospitals study in 1983. This was a time of a national nursing shortage, and it was decided to capture what practice settings succeeded in attracting and retaining nurses, as identified by peer reference community of nurses, where successful strategies and programs sustained and expanded magnetism for hospital nurses. A total of 165 institutions were nominated by Fellows in the academy as potential Magnet hospitals, meeting the following criteria: (1) Nurses consider the hospital a good place to practice nursing and a good place to work. (2) The hospital has the ability to recruit and retain professional nurses, as evidenced by a relatively low turnover rate. (3) The hospital is located in a geographic area where it has competition for staff from other institutions and agencies.
The directors of nursing and staff nurses were interviewed by academy Fellows with the following questions: (1) What makes your hospital a good place for nurses to work? (2) Can you describe particular programs in your situation that you are leading to professional/personal satisfaction? (3) How is nursing viewed in your hospital and why? (Image of nursing) (4) Can you describe nurse involvement in various ongoing programs/projects whose goals are quality of patient care? (5) Can you identify activities and programs calculated to enhance, both directly and indirectly, recruitment/retention of professional nurses in your hospital? (6) Could you tell us about nurse/physician relationships in your hospital? (7) Please describe staff nurse/supervisor (various levels) relationships in your hospital. (8) Are some areas in your hospital more successful than others in recruitment/retention? Why? (9) What single piece of advice would you give to a director of nursing who wishes to do something about registered nurse vacancy and turnover rates in her hospital?
Of the 41 hospitals in the final report, I had the privilege to be the nursing leader in two of the original study hospitals: Family Hospital, Milwaukee, Wis, and Virginia Mason, Seattle, Wash. What is so important in today's search for magnetism is that not all settings need to have this designation to have positive professional practice environments nor did we set out to be designated as such. Family Hospital took 5 years of turnaround strategies and Virginia Mason took at least 3 years, but in each, it took a strong nursing voice, and team building in planning and policy making and gaining control of nursing practice with setting limits on what nurses would do and not do. The most significant factor is for the nurse leader to be a strong nurse advocate, representing the needs of nursing in an articulate fashion with a patient- and family centered caring philosophy that pervades the practice environment. Nurses need and have to be empowered to direct their practice and create their practice environments to give quality patient care.
Nursing Administration Quarterly is most fortunate to have two such strong leaders who are the guest editors for this issue addressing the pull of magnetism for practice environments. Elaine Cohen, EdD, RN, FAAN, is Director for Case Management, Utilization Management, Quality/ Outcomes at the University of Colorado Hospital and also holds a joint appointment as Associate Professor at the University of Colorado School of Nursing. As a nursing and healthcare author and through extensive writing and frequent presentations, she informs and influences the greater healthcare community about nursing case management. She holds two AJN Book of the Year Awards: 1997, 1999. Dr Cohen was sought out by both the Colorado Hospital Association and JCAHO for her expertise in case management and as a "Best Practice" resource. She inspires students and colleagues alike to realize the impact of professional nursing practice in an interdisciplinary, managed care environment. She serves on the Board of Directors for the American Organization of Nurse Executives, and Chair of the American Organization of Nurse Executives Diversity Council.
Colleen Hallberg, MSN, RN, is CEO, Banner Thunderbird Medical Center, a 395-bed, nonprofit medical center in Glendale, Ariz. Prior to being selected as CEO, she was Senior Administrator and Chief Nursing Officer and was integral in the development of a service excellence program that has received national recognition including JCAHO Best Practice, 1999 Press/Ganey Compass Award, and 2000 Voluntary Hospitals of America (AHA) Award for Operational Performance and Service. Hallberg is recognized as a leader with excellent colleague, staff, community, and medical staff relationships. She has served as President of the Arizona Organization of Nurse Executives and has served as an Appraiser in the Magnet Recognition Program for the American Nurses Credentialing Center.
Strong nursing leadership and advocacy for nurses and patient care is clearly a value throughout the world. This is evidenced by the recent most prestigious international award, the Christiane Reimann Prize, presented to Dr Margretta Madden Styles, a nurse scholar renowned globally as an international leader in nursing education, regulation, and credentialing. "Gretta" Styles has demonstrated a lifelong commitment to leadership in nursing. She was the architect of the first comprehensive study of nursing credentialing in the 1970s, and an innovator and pioneer in defining this critical work that recognizes and differentiates quality in all aspects of nursing practice. The Christiane Reimann Prize was awarded officially to Dr Styles in May 2005 during the opening ceremony of the ICN 23rd Quadrennial Congress in Taiwan.
Being credentialed as a Magnet work setting is truly a dedicated team effort of strong nursing leadership in whatever practice setting that achieves and sustains this very significant recognition as a superb professional nursing practice environment.
Barbara J. Brown, EdD, RN, CNAA, FAAN, FNAP
Editor-in-chief, Nursing Administration Quarterly