Aiken Study Finds Superior Work Environment in Magnet Hospitals

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By Debra Wood, RN, contributor 

November 10, 2011 - A new study from internationally recognized nurse investigator Linda H. Aiken, Ph.D., RN, FAAN, FRCN, and colleagues at the University of Pennsylvania School of Nursing shows that Magnet® hospitals have better work environments, a more highly educated nursing workforce, superior nurse-to-patient staffing ratios, and higher nurse satisfaction than non-Magnet facilities.

Work Environment in Magnet Hospitals
Linda H. Aiken, Ph.D., RN, FAAN, FRCN, called Magnet hospitals a “best practice.”

“Linda’s research methodology is so strong, and this is confirmatory evidence of two decades of research that links positive work environments to the work of Magnet,” said Karen Drenkard, Ph.D., RN, NEA-BC, FAAN, director of the Magnet Recognition Program® at the American Nurses Credentialing Center (ANCC).

The Penn team surveyed more than 26,250 registered nurses at 567 hospitals in California, Florida, New Jersey and Pennsylvania, 46 of which had achieved Magnet recognition. Those hospitals account for nearly one-quarter of the patients hospitalized in the United States during the study period.

“This study design is statistically powerful and a huge sample size, really reliable, good hard science,” Drenkard said.

The researchers reported in the Journal of Nursing Administration finding a larger number of specialty-certified nurses, and a greater proportion of nurses with a BSN degree or higher education in the Magnet facilities.

“We found the practice environment, staffing levels, etc. were by and large better in Magnet hospitals, particularly those things we consider core to defining what it is to be a Magnet hospital,” said Matt McHugh, Ph.D., JD, MPH, RN, CRNP, assistant professor at the Penn School of Nursing.

Work Environment in Magnet Hospitals
Matt McHugh, Ph.D., JD, MPH, RN, CRNP, said the UPenn team found the practice environment better in Magnet hospitals.

Nurses in Magnet hospitals were 18 percent less likely to be dissatisfied, 13 percent less likely to have high levels of burnout, and much less likely to report intent to leave their current position.

The Penn researchers did not find a statistically significant difference in staffing between Magnet and non-Magnet hospitals when data from seven hospitals in California was included, something they explain as related to the outside influence of that state’s nurse-to-patient staffing ratios. However, without the California hospitals, the average number of patients per nurse in the other states was five in Magnet facilities and 5.54 in non-Magnet hospitals.

“When we took California out, the difference between staffing became more pronounced,” McHugh said. “In those states without such a [ratios] policy, their staffing levels are benefiting from Magnet certification.”

McHugh said the team undertook the research following a study from the University of Maryland released last year that found no real differences in schedules and working conditions in hospitals that have obtained Magnet status and those that had not. The Penn team hypothesized that study may have been underpowered to detect differences with only 14 Magnet hospitals out of 171 studied.

Work Environment in Magnet Hospitals
Alison Trinkoff, ScD, RN, FAAN, said her study of Magnet environments had a different emphasis—work schedules.

Alison Trinkoff, ScD, RN, FAAN, lead author of the University of Maryland study, however, explained that her research had a different focus--concern for work schedules, including long work hours and job demand, which have been shown to adversely affect nurse health and patient outcomes. The Penn study did not address these variables.

“I see these studies as having different streams of research, exploring different questions,” Trinkoff said. “Fully capturing the multiple dimensions of the job is challenging and further work is needed.”

About the ANCC Magnet Program:

Developed by the American Nurses Credentialing Center (ANCC), the Magnet Recognition Program® recognizes healthcare organizations for quality patient care, nursing excellence and innovations in professional nursing practice. Magnet designation is the leading indicator of successful nursing practices and strategies worldwide. Approximately 6.61% of all registered hospitals achieved ANCC Magnet Recognition, according to American Hospital Association Fast Facts on US Hospitals, 2011.


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