By Kristin Rothwell, NurseZone feature writer
"There are only  magnet hospitals," said Mary E. Foley, RN, MS,
president of the American Nurses Association, which supports the American Nurses Credentialing Center Magnet program, while speaking to members of the Florida Nursing Association District 5 in October. "We [ANA] think there are about 5,000
hospitals in the country. So what about the rest of them?"
As nursing shortages, mandatory overtime and burnout among nurses continue to
worsen, several health care organizations across the United States are stepping
up to the challenge to support, maintain and encourage nurse-friendly,
patient-friendly environments by applying for and receiving Magnet award status
through the American Nurses Association (ANA) American Nurses Credentialing
"What we’ve seen is that patient satisfaction at Magnet facilities is
much higher, as well as nurse satisfaction," said Kammie Monarch, director
of the accreditation and magnet recognition program for the American Nurses Credentialing Center .
Established in 1994, the Magnet Hospital Recognition Program, which has since
been renamed the Magnet Nursing Services Recognition Program for Excellence in
Nursing Services, was created following a study of 41 hospitals by the American
Academy of Nursing (AAN) in 1982. Results from the study identified
characteristics of health care environments that attracted and retained
well-qualified nurses, as well as provided quality patient care with first-rate
By 1990, the ANA approved a Magnet program and in 1993, once the
infrastructure was in place, the ANCC invited several hospitals to apply. The
first and only health care facility to receive Magnet designation in the program’s
first year was given to the University of Washington Medical Center in 1994.
"We are in a unique position because we had been identified and
recognized for what we were," said Catherine Broom, ARNP, clinical
specialist and Magnet project coordinator at the University of
Washington Medical Center. "However, we cannot rest on our laurels.
We need to focus on how to sustain our Magnet environment. That means
looking for ways to continue to support and promote high quality nursing
practice and patient care in the context of cutbacks in reimbursement,
changes in organizational structure and leadership, and changes in
regulations that affect healthcare. We strive for an environment
where nurses feel supported and are proud of the patient care they
The University of Washington Medical Center was re-designated Magnet status
in 1998. Broom, with the assistance of a steering committee, is currently
completing the facility’s third application for Magnet re-designation, due at
the end of this month.
Health care facilities interested in applying for ANCC Magnet status can
expect a lengthy process. To help facilities discern whether they have the
qualities necessary for magnet accreditation, the ANCC provides them with a
short questionnaire, which asks various questions about the facility.
"If the facility answers ‘yes’, then maybe the facility is ready to
apply for Magnet status," Monarch said. "If ‘no’, then maybe there’s
some room for work prior to applying."
Avera McKennan Hospital and University Health Center in Sioux Falls, South
Dakota, answered ‘yes.’ Soon after several nursing leaders at Avera McKennan
attended a Magnet conference in Atlanta, Georgia, Carla Borchardt, RNC, Magnet
project director and director of professional practice at Avera McKennan
explained that a core group, composed of staff in different leadership levels
throughout the organization, was developed to identify what components needed to
be included in the Magnet application.
The core members submitted a report, proving that Avera McKennan could meet
ANCC’s 14 standards. They highlighted nursing philosophy and structure,
expertise and role of nursing administration, use of the nursing practice, and
use of nursing research and recognition of a diverse client population.
A review follows the application submission.
"There's a site visit by ANCC representatives to verify that what has
been written matches what is actually occurring at the facility,"
Broom said. "ANCC appraisers will meet with representatives from
leadership, other disciplines, and nurses at all levels of the
Monarch further explained that, "Oftentimes there are gaps or particular
pieces of information that needs to be gathered on-site that wasn’t available
in the written documentation. The appraisers look for those things and try to
ensure that the actual environment, the day-in and day-out practice at the
environment, is consistent with the evidence that was submitted in
She added, "It’s a way to verify that an organization is doing what it
is they say they do."
The process to receive magnet accreditation not only requires time but also
financing and support from hospital administrators and nursing leaders.
"What might hold hospitals back [from earning Magnet status] might be
the cost because it certainly is not inexpensive between the fees to apply and
the financial and human resources, such as time, that it takes to pull
everything together for the application," said Darcy Sherman-Justice, RN,
MS, who helped work on the magnet application at Avera McKennen.
"I think there are a certain number of organizations that don’t have
the organizational culture that supports the principals of what a Magnet
facility is," said Sherman-Justice. "It’s very important to have the
support of your CEO and whoever your chief nurse leader is and the belief that
nursing is a very important, integral part of what your organization does."
Avera McKennan earned magnet status for the first time in June 2001.
The Future of the ANCC Magnet Program
Currently 19 states have at least one Magnet facility, which have been
labeled by the ANCC as "magnet states."
"We haven’t tapped into all of the states in the United States yet,
but we are working on that," said Monarch.
So far New Jersey is in the lead with nine Magnet facilities. Wisconsin and
Florida are a close second, each have five Magnet facilities.
While the ANCC has tried to keep the cost of the program reasonable so that
more organizations can apply, Monarch said the government affairs department of
the ANA has been working with Congress to pass a bill that would make it an
incentive for hospitals to attain Magnet status. Democratic Sen. Hillary
Rodham-Clinton of New York, one of the co-sponsors of the bill, introduced the
Nurse Retention and Quality Care Act of 2001, which would provide grants to
hospitals to improve nurse retention and implement successful nursing care
The ANCC’s Magnet program has also received international attention among
nurses and nursing organizations from around the world who have heard and seen
how the magnet program has made a difference for nurses and patients in the
Significant interest in the magnet program has been shown in places such as
Australia, Canada, Korea, Hong Kong, Central and South America and Central and
"We’re finding that there is a high-degree of transferability between
the programs as it’s implemented in the United States and as it will be
implemented internationally," said Monarch.
Already, the ANCC has established a pilot project in the United Kingdom at
the Rochdale National Health Trust. Next month, ANCC appraisers will make a
site visit to the facility. If it passes all of the requirements for ANCC
accreditation, it will be the first international organization to receive Magnet
"That will be exciting," said Monarch. "It’s a really nice
position for us to be in."
She added, "We believe these [Magnet organizations] are ones that really
use excellence as their benchmark for a day-in and day-out basis rather than the
status quo or rather than what would be normal or predictable. They really look
at how and what would be the excellent way to approach a situation or an
excellent way to provide patient care services."
For more information about the ANCC magnet accreditation program, visit
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