In 1983, in the wake of a severe national nursing shortage, a group of innovative nurse researchers from the American Academy of Nursing (AAN) undertook an in-depth study of hospitals that successfully recruited and retained nurses.1 The group uncovered 14 characteristics shared by organizations with high nurse retention. Originally known as the "Forces 1983 of Magnetism," these traits included quality leadership, practice autonomy, clinical authority, shared governance, the imperative to improve care, and more. Institutions exhibiting these qualities were dubbed "Magnet hospitals" recognizing their ability to attract and retain well-qualified nurses, and the ANCC Magnet Recognition Program(R) was born.
Addressing Emerging Challenges
In 2007, the Commission on Magnet developed the Magnet Model,2 which consolidated the 14 Forces of Magnetism into 5 components that interact to create an environment of nursing practice excellence. At the time, the model reflected current research on organizational behavior and transitioned the Magnet framework to focus on the Donabedian model of structure, process, and outcomes.3
Over the years, the original Forces of Magnetism have demonstrated considerable staying power. Although some terminology has changed, the concepts remain the same, and their value and relevance continue to impact the environment of care. With each new iteration of the Magnet manual, most recently the 2023 edition,1 the Commission on Magnet raises the bar and builds on the attributes rooted in the original study. At the same time, those concepts are tailored to address emerging challenges and changes that healthcare organizations face today.
An Enduring Framework
The Magnet framework is designed to move beyond quick fixes and implement long-term, sustainable structures that help organizations ride the waves and manage the tumult. In that way, it provides the basis to address many of the challenges inherent in the evolving environment. Long-range benefits, including cost savings, result from the culture of excellence.
Foundational elements include the following:
* Leadership excellence. As the AAN researchers found, success begins with dynamic, transparent leadership. Leaders who are present, and convey a strong sense of advocacy and support for staff and patients, inspire confidence and loyalty. Transformational leaders foster a culture of accountability, which contributes to improved nurse satisfaction and autonomy.
* Shared decision making. A robust shared governance structure ensures nurses at all levels are involved in decision making, which promotes trust. An environment of trust breeds cohesion and high morale. Team members feel comfortable speaking up and sharing ideas.
* Practice autonomy and clinical authority support effective and efficient care services, interprofessional collaboration, and the delivery of safe, evidence-based care. Nurses know they have a voice and the self-sufficiency and independence to determine what is right for their patients.
When the COVID-19 pandemic was at its most intense, we heard the same thing, over and over, from nurses working in Magnet organizations: an environment steeped in transformational leadership, strong interprofessional teams, shared governance, empowered staff, and high levels of transparency and trust helped make health systems, and the nurses who work for them, resilient in times of change.
From its origins in the 1980s, Magnet's purpose was to support nursing practice through a constant commitment to excellence. The American Nurses Credentialing Center and the Commission on Magnet seek to ensure that the program continues to reflect that commitment and promote nurses at the forefront of healthcare, even more now in consideration of the challenges they face.
References