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Recognizing excellence in nursing services
Regardless of the health care organization's size, setting, or location, achieving Magnet designation serves to attract and retain quality employees. Magnet designation helps consumers locate health care organizations that have a proven level of excellence in nursing care. "In an environment rife with controversy about patient safety in hospitals, medical error rates, and nursing shortages, consumers need to know how good the care is at their local hospitals. [Magnet is] a seal of approval for quality nursing care." (From: The Magnet Nursing Services Recognition Program: A Comparison of Two Groups of Magnet Hospitals.)
Why was the Magnet Recognition Program™ developed?
The Magnet Recognition Program was developed by the American Nurses Credentialing Center, the credentialing arm of the American Nurses Association, to recognize health care organizations that provide the very best in nursing care and uphold the tradition within nursing of professional nursing practice. The program also provides a vehicle for disseminating successful practices and strategies among nursing systems.
The Magnet Recognition Program™ is based on quality indicators and standards of nursing practice as defined in the American Nurses Association's Scope and Standards for Nurse Administrators (1996). The Magnet designation process includes the appraisal of both qualitative, e.g., leadership roles and shared decision-making, and quantitative, e.g., nurse/patient ratios, factors in nursing.
Recognizing quality patient care and nursing excellence, the Magnet Recognition Program™ provides consumers with the ultimate benchmark to measure the quality of care that they can expect to receive. As a natural outcome of this, the program improves the positive work environment and elevates the standards of the nursing profession.
Objectives of the Magnet Recognition Program™
 Recognize nursing services that use the Scope and Standards for Nurse Administrators (ANA, 1996) to build programs of nursing excellence for the delivery of nursing care to patients
 Promote quality in a milieu that supports professional nursing practice
 Provide a vehicle for the dissemination of successful nursing practices and strategies among health care organizations using the services of registered professional nurses
 Promote positive patient outcomes
The Benefits of Becoming a Magnet Designated Facility
Magnet Designation is an important Recognition of Nurses' Worth
Designation recognizes the quality of a nursing program and demonstrates its importance, and the importance of nurses to the success of the entire organization. "This is one of the highest achievements a hospital can attain in the nursing world. Magnet status recognizes the caliber of the nursing staff, and what that professionalism translates into in terms of patient care and health care services. I am extremely proud of our nurses and our growing reputation as a first-rate hospital." Colleen Goode, RN, PhD, vice president for patient services, University of Colorado Hospital, Denver, CO (Magnet designated January 2002)
Magnet Designation is a Major Factor in Nursing Recruitment and Retention
Dr. Linda Aiken's independent research shows that Magnet designated facilities consistently out perform their peers in recruiting and retaining nurses. "The label 'Magnet hospitals' originally was given to a group of U.S. hospitals that were able to successfully recruit and retain professional nurses during a national nursing shortage in the early 1980s. Studies of Magnet hospitals highlight the leadership characteristics and professional practice attributes of nurses within these organizations... Hospitals selected met the following criteria: 1) nurses within the hospitals considered them good places to practice nursing, 2) the hospitals had low turnover and vacancy rates, and 3) the hospitals were located in areas where there was significant regional competition for nursing services." (JONA, January 1999) These "nurse friendly" organizations benefit from reduced costs due to low turnover, which results in greater institutional stability.
Magnet designated health care organizations consistently outperform their peers in recruiting and retaining nurses, resulting in increased stability in patient care systems across the organization.
Magnet Designation Means a Competitive Advantage
A national survey conducted in March 1999 by Wirthlin Worldwide, dramatically illustrates the competitive edge enjoyed by Magnet-designated facilities. The survey found that 93% of the public would have more confidence in the overall quality of a hospital if that hospital had passed the nursing standards required to be a Magnet Program. The same survey found that 85% of the public would have more confidence in a long-term care facility that had passed similar nursing standards. Thus, in addition to the quality of nursing care, the Magnet Designation speaks to a facility's overall quality. Magnet facilities use this benefit to their advantage in the market place. For example, Hackensack University Medical Center, a Magnet-designated facility, routinely highlights the designation in their hospital-wide promotional campaigns. "The Magnet process is incredibly valuable because it helps to validate the programs that you have in place." Elaine Graf, magnet coordinator, Children's Memorial Hospital, Chicago, IL (Magnet designated December 2001). "We asked a visitor from Mayo (Mayo-Rochester Hospitals) how he was able to attract nurses in the middle of Minnesota. He said, 'we have Magnet status, that is the important thing.' I then had the great pleasure of showing him our award for Magnet status." Dr. Stephen Hall, medical director, North Shore University Hospital, Manhasset, NY (Magnet designated, December 2001).
NOTE: Mayo recruits 5-8 of the nurses from each of Purdue’s baccalaureate nursing graduating classes of 100. Their magnet status is one of the criteria that the graduates use for choosing their place of employment from among 5-10 offers per graduate.
Magnet Designation Attracts High Quality Physicians and Specialists
Research documents that high quality nurses is one of the most important attributes in attracting high quality physicians. Therefore, achieving this status creates a positive "halo" effect beyond the nursing services department that permeates the entire health care team.
Magnet Designation Reinforces Positive Collaborative Relationships
A basic premise of the Magnet Designation is a climate that reinforces collaborative working relationships. As Dr. Aiken and Donna Sullivan Havens reported, "They foster respect and caring for the individual (patients and staff), and actively bring out the best in people." (JONA, February 1999, pg. 16) "Our team work and hard work really paid off. It was very rewarding." Debbie Bothe, RN, staff nurse, North Shore University Hospital, Manhassett, NY (Magnet designated December, 2001)
The Magnet Designation Process Creates a "Magnet Culture"
The "Magnet Culture" is holistic in creating a dynamic and positive milieu for professional nurses. Core values such as empowerment, pride, mentoring, nurturing, respect, integrity, and teamwork are demonstrated in Magnet facilities. "Thus, these hospitals have been cited as cultures of excellence, the measure of goodness, and the 'gold standard' in nursing." (JONA, February 1999, pg. 14)
"[Magnet hospitals] are infused with values of quality care, nurse autonomy, informal, non-rigid verbal communication, innovation, bringing out the best in each individual, and striving for excellence." (Kramer, M., Schmalenberg. C. Magnet Hospitals: Part II: Institutions of excellence. Journal of Nursing Administration, 1988, 18(2): 17.)
Magnet Designation Improves Patient Quality Outcomes
"The Magnet process facilitated an intense look at the way we organized and delivered nursing care. It encouraged each of us to take responsibility for improving our service" Tracey Williamson, research nurse, Pennine Acute Services NHS Trust: Rochdale Infirmary & Birch Hill Hospital, Rochdale, Lancashire, United Kingdom (Magnet designated March, 2002). "We created nursing consuls that establish policy, and established every nursing unit as a nursing department so that each department didn't have layers of bureaucracy." Harvey Yorke, chief executive officer, Southwestern Vermont Medical Center, Bennington, VT (Magnet designated March 2002).
The Magnet Recognition Program establishes standards of excellence, which health care organizations must attain. According to a study conducted at the Center for Health Outcomes and Policy Research at the University of Pennsylvania School of Nursing, Philadelphia, "Magnet hospitals ... consistently provide the highest quality of care." (Bensing, K. Magnet hospitals provide havens for quality care and happy nurses. ADVANCE for Nurses (DC/Baltimore): April 10, 2000: 27)
When marketed effectively, Magnet designation increases use of the health care organization by consumers and health care plans.
Of respondents in a recent survey, 93% indicated that knowing that a hospital has passed rigorous standards regarding quality of hospital nursing care would increase their confidence in the overall care provided by the hospital. Through recognition of an organization as being among the best in the nation for nursing care, consumers can be sure they have chosen the best provider, and health plans can be assured of the organization's commitment to high-quality patient care.
The Magnet Application and Appraisal Process
The Magnet Recognition Program™ application and appraisal process is recognition of a health care organization's attainment of excellence. It is also a rewarding and valuable educational experience for an organization seeking focus and direction for growth and development. The process is thorough and lengthy, demanding widespread participation within the applicant nursing service. Health care organizations find this to be a revealing self-assessment, creating opportunities for organizational advancement, team building, and enhancement of individuals' professional self-esteem.
Eligibility Requirements (ANCC Web site)
To apply, a health care organization must meet the following eligibility criteria:
1. The applicant nursing service system exists within a health care organization.
2. The applicant organizations' nursing service must include one or more nursing settings with a single governing authority and one individual serving as the Chief Nursing Officer (CNO). The CNO must be ultimately responsible for all areas in which nursing is practiced. The CNO must participate on the applicant organization's highest governing decision-making and strategic planning body. Each applicant applying as a system will have at each facility and setting a designated on-site RN leader who is prepared in nursing at a baccalaureate or higher level, responsible for nursing services at that facility.
NOTE: The Veteran’s Health Administration’s support for the BSN in nursing for positions beyond entry level is consistent with other progressive health care facilities and Magnet designation that place a high value on learning. Aiken, et al. Published in JAMA, September 24, 2003-Vol 290, No.12 concluded that in hospitals with higher proportions of nurses educated at the baccalaureate level or higher, surgical patients (232,342) experienced lower mortality and failure-to-rescue rates.
3. The CNO must possess a master's degree. The CNO's baccalaureate or master's degree must be in nursing. Except in the receipt of military orders, the CNO must have been in that position for at least one year at the time of the submission of the organization's written documentation for initial designation and must remain in that position throughout the appraisal process.
4. Scope and Standards for Nurse Administrators (ANA Publishing) must be currently implemented by the nursing system.
5. In the five (5) years preceding application, the applicant nursing service must not have committed an unfair labor practice as determined in a fully and finally adjudicated arbitration proceeding or before the National Labor Relations Board (NLRB) or state or international regulatory agency within jurisdiction over labor relations and/or a reviewing federal, state or international court. If an unfair labor charge or grievance related to nursing or patient/resident/client care is pending before an arbitrator, the NLRB or other appropriate governing body at the time an application is being processed, no action will be taken on the written documentation until arbitration, the NLRB or appropriate governing/regulatory body finally resolves the dispute.
6. Applicants for Magnet recognition are required to participate in a national database that benchmarks nurse-sensitive quality indicator at the unit level.
Criteria Used for the Magnet Application Process
The Magnet Recognition Program™ is based on the American Nurses Association's Scope and Standards for Nurse Administrators (ANA Publishing) and upon the Forces of Magnetism as described in the publication Magnet Hospitals Revisited: Attraction and Retention of Professional Nurses. The applicant facility provides documentation and evidence that support and verify that they are implementing the standards throughout the nursing service.
An applicant must purchase The Magnet Recognition Program For Excellence in Nursing Service, Health Care Organization, Instructions and Application Process (ANCC, 2003, Pub#MAGMAN03). It outlines the entire application process and contains the application form and all necessary directions for preparing the written documentation. This manual costs $100 plus shipping and handling.
All of these publications are available through American Nurses Publishing (toll free 1-800/637-0323). In addition, the application manual can be ordered online at Magnet's E-Store.
The Application Process
The application process consists of four phases:
In the First Phase (The Application Phase) the applicant completes the one-page (double-sided) application form indicating the anticipated date for submission of the appraisal documents. This submission date must be a minimum of three months AFTER submitting the application to enable Magnet Program Office time to select and schedule appropriate appraisers. A nonrefundable payment of $2,500 for the application fee must accompany the application. The active application period, within which the written appraisal documentation must be submitted, is two years from the date the application is submitted to the Magnet Program Office.
To obtain a Microsoft Word version of the two-page Magnet Recognition Program Application via e-mail, send request to Twelch@ana.org. Save and fill in the form, then submit the completed application to via return e-mail.
In the Second Phase (Submission of Written Documentation and Evaluation Phase) the nursing service applicant completes appraisal documentation as outlined in the program instruction and application manual. This written documentation must reflect the innovative, dynamic, excellence-focused features of the organization. It also must demonstrate how the health care organization implements the Scope and Standards for Nurse Administrators within the organizations' structure, leadership, and management philosophy, as well as how the standards are incorporated within the nursing service. The instruction manual provides guidance in selecting evidence that supports the requirements of the written documentation. Once completed, the written documentation is then submitted to the Magnet Program Office with the required appraisal fee, which is based on the licensed bed size, and/or patient encounters of the applicant health care organization.
The Third Phase (Site Visit) occurs if the documents of the Organizational Overview are present and adequate, and the scores for the measurement criteria fall within a range of excellence. The purpose of the site visit is to verify, clarify, and amplify the content of the written documentation and evaluate the organizational milieu in which nursing is practice. The site visit process also involves a process of community participation and public comment in which the written documentation is open for public review and comment, and the applicant submits the names of reference. The site visit expenses are the responsibility of the applicant and include travel and lodging expenses for a minimum of two appraisers plus an honorarium of $1,500 per day per appraiser. Most site visits are at least two days in duration.
Professional registered nurses conduct both the review of the written documentation and the site appraisal with experience in quality indicators, nursing services administration, and nursing care.
The Fourth Phase (Internal Operations at the Magnet Program Office) involves appraisers submitting a final report and recommendations, the Commission on Magnet Recognition reviewing the findings, and determining if Magnet Recognition status will be awarded. The Commission on Magnet Recognition meets quarterly to determine if Magnet status will be awarded.
Once Magnet Designation is awarded
The health care organization is notified immediately if the Commission on Magnet Recognition votes to extend Magnet designation. A nationwide press release is issued by ANCC. Organizations use this opportunity to advertise their designation and recognize their nursing staff in any variety of ways. Designation is an overall boost not only for the nursing staff but also for the staff of the entire organization. As stated by Rob Muilenberg, Executive Director, University of Washington Medical Center, Seattle, WA, "A real cause for celebration. Instilled a sense of pride and accomplishment in the nursing service and to the institution as a whole. ...Built a sense of team and commitment to mission, vision, and values– patient focused care."
Public Notice of Magnet Applicant Evaluations by ANCC Magnet Recognition Program Appraisers
Input from the patients, families, clients, staff, and public with who health care organizations interact is sought to assist Magnet program appraisers in the evaluation of nursing services that have applied for Magnet designation.
ANCC evaluates the environment in which nursing is practiced as well as the nursing service's compliance with standards promulgated by the American Nurses Association. The written documentation is available for public review at the health care organization. Its exact location is indicated in the public notice posted at entrances throughout the organization's facility.
Anyone who would like to participate in this evaluation process is encouraged to do so. Comments are confidential and may be made anonymously. Comments should be forwarded to ANCC before the comment deadline date indicated below. All comments must be in writing, and forwarded to ANCC via e-mail, fax, or direct mail to the addresses and/or numbers listed below. Comments may include request to meet with or talk to the appraiser should the evaluation of the written documentation progress to an on-site review.
American Nurses Credentialing Center (ANCC)
Magnet Recognition Program Office
600 Maryland Avenue, SW, Suite 100W
Washington, DC 20024-2571
Fax: 202/651-7004
E-Mail: magnet@ana.org (Please indicate "Public Notice Comment" in the subject line.)
As the Head of the Purdue University School of Nursing in West Lafayette, Indiana and Associate Dean of the Schools of Pharmacy, Nursing and health Sciences, I know that our undergraduate and graduate nursing students select from among five to ten employment opportunities each year. If they are not geographically bound to the greater Lafayette area, they begin their search with an examination of the ANA web site list of Magnet-designated hospitals. The hospitals with whom we partner are applying for Magnet designation and those are the institutions with which we are expanding our partnerships in learning, engagement, and discovery.