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Magnet status: What it is, what it is not, and what it could be

Magnet status is an award given by the American Nurses' Credentialing Center(ANCC), an affiliate of the American Nurses Association, to hospitals that satisfy a set of criteria designed to measure the strength and quality of their nursing. A Magnet hospital is stated to be one where nursing delivers excellent patient outcomes, where nurses have a high level of job satisfaction, and where there is a low staff nurse turnover rate and appropriate grievance resolution. Magnet status is also said to indicate nursing involvement in data collection and decision-making in patient care delivery. The idea is that Magnet nursing leaders value staff nurses, involve them in shaping research-based nursing practice, and encourage and reward them for advancing in nursing practice. Magnet hospitals are supposed to have open communication between nurses and other members of the health care team, and an appropriate personnel mix to attain the best patient outcomes and staff work environment. We encourage all nurses tolearn moreabout the principles of Magnet certification, and to consider appropriate nursing certification programs for their hospitals. Learn more about Magnet status:eligibilityfor it, thebenefitsof it,hospitalsthat have achieved it, and hospitals that are seeking it on which the ANCC is seeking public comment. We understand that some nurses are enthusiastic about the program and feel that it promotes the important practices outlined above. However, it is important to be aware that others, notably nursing unions, have been highly critical of the way the Magnet program has been implemented. Some critics, including the California Nurses Association and the Massachusetts Nurses Association, have argued that the Magnet program is primarily a hospital promotion tool that resembles the Joint Commission on Accreditation of Healthcare Organizations in its seemingly incestuous relations with hospital management. Such critics have also asserted that there is little evidence that nurses at Magnet hospitals are really much better off than nurses elsewhere. Suzanne Gordon, inNursing Against the Odds(2005), says that she regards the Magnet program as an important effort, but she too questions how well it really works, suggesting that many of its voluntary guidelines may offer only the illusion of nurse empowerment. The Truth has heard many first-hand reports of some hospitals trumpeting their new Magnet status even as they proceed to betray some of the program's key principles. A July/August 2010studyby Alison Trinkoff and Meg Johantgen published in theJournal of Nursing Administrationfound that magnet hospitals do not have any better working conditions than non-magnet hospitals. But anOctober 2011 studyby Linda Aiken and colleagues found 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 hospitals." To the extent the Magnet program is not effectively promoting its important nurse empowerment goals, we would like to see it strengthened. In general, we hope that all nurses will work for strong, effective nursing credentialing programs to address the nursing crisis and improve patient care. Frankly, the Truth has heard from a number of nurses who are unhappy with the changes at their hospitals since the award of magnet status, and we have not heard from many who are happy. One report was that the nurse who had led the drive for magnet status was fired soon after the hospital received it, and that the magnet reforms quickly began to unravel. Others have said that their hospitals reverted to short-staffing and excluding nurses from decision-making processes soon after receiving magnet certifications. Such reports support the claims that some hospitals are treating magnet status mainly as a promotional tool, and that the program is not effectively monitoring compliance.

The Truth's suggestions on how to improve the Magnet Program

In June 2006, the Truth About Nursing's founder and executive director, Sandy Summers, sat on an expert panel about the Magnet Program for The World Congress Leadership Summit for Chief Nursing Officers in Chicago, Illinois. In this presentation she encouraged the Magnet Program to incorporate the following ideas: Safe Facilities Green and organic environments Improve hospital policies to protect and support nurses Strengthen Nursing Strengthen Nursing Managers Staffing Employee Benefits Media Strengthen credentialing process Collaboration between the professions Magnet hospitals should be nursing institutions Magnet hospitals should exist to provide humane care to all patients Ethics Overall changes to the magnet program Discussion

Safe Facilities Magnet facilities should not be reservoirs for dangerous organisms such as MRSA. Each magnet facility should: 1. Create health care environments using evidence-based designs to promote better patient outcomes and less stress on nurses. For guidance, seek help fromThe Nursing Institute for HealthCare Design.

2. provide uniforms for all staff who have contact with patients; 3. wash these uniforms at temperatures sufficient to render them clean; 4. provide adequate showering facilities for all staff so that all organisms are not brought out into the community and home to families; 5. require that all staff change out of uniforms and shower before leaving the facility. See our analysis on this issue. Each Magnet facility should be a safe place for patients and nurses. They should be: 1. Latex-free facilities 2. Mercury-free facilities 3. Free of toxic cleaning chemicals that lead to illness. Guidelines for creating safe facilities can be found onSustainable HospitalsandHealth care without harm

Green and organic environments Magnet hospitals should be green facilities, that recycle, compost, separate out electronic waste and serve only cholesterol-free organic food in their food facilities. SeeHealth Care Without Harm;and Greening the NICU: An Expert Interview With Kathi Randall, RNC, MSN, CNS, NNP-BC on Medscape.

Improve hospital policies to protect and support nurses 1. Each institution should have"no lift policies"and appropriate lifting equipment. (See Franken bill on no lifting.) 2. Magnet hospitals should haveneedleless IV systemsandsafe needles. 3. There should be zero tolerance for abuse practices and procedures. 4. Critical incident stress debriefing sessions should be offered to all employees who suffer physical or sexual assault of any kind. 5. Hospital attorneys should pursue with police and the district attorney, the cases of employees who have been assaulted, physically or sexually, while at the hospital.

6. Adequatelyaddressnurse fatigue. 7. When considering patient assignments, patients being admitted or discharged should count as 2 patients to account for thehigher mortalityassociated with bed turnover.

Strengthen nursing 1. All care should be delivered by Registered Nurses (RNs)such as is the case at Hahnemann Hospital in Philadelphia. 2. The nursing model should be aprimary care nursing model, not a team model. 3. Magnet hospitals should have at least one-year nursing residencies for all new nursing graduates. (Studies (1,2) show that nurses who went through residencies had about a 90% retention rate. Without residencies, a third to more than half of nurses leave the profession.)See our discussion of nursing residencies. 4. Each unit of each hospital should have at least one clinical nurse specialist on duty 24 hours per day, seven days per week. 5. Magnet hospitals should not recruit nurses from nations with shortages more dire than their own. When hospitals increase staffing by taking nurses from countries that desperately need them, it violates nurses'ethical obligationsto the needs of our patients around the globe. 6. Each nursing manager should be a clinical nurse specialistin a relevant fieldfor his unit. 7. Each nursing manager should have a full-time administrative assistant to help with paperwork and budgetary duties to allow managers the time to focus onnursing excellence, instead of clerical duties. 8. Nursing managers should practice clinical nursing on his/her unit at least 16 hours per week. 9. Over 50% of staff nurses on each unit should be certified in their fields. 10. Each facility should have at least three centers for nursing professional improvement; one each to strengthen nursing research, nursing clinical practice and nursing education within the hospital. 11. Efforts should be made to provide zero distractions to nurses as they perform critical tasks such as medication administration. (see article.)

Strengthen nursing managers 1. The chief nursing officer should have at least a master's degreein nursing. 2. Nursing managers should have significant management training. 3. Nursing managers who do not receive positive evaluations by more than 80% of nurses who workunderthem should be replaced.

4. New nursing manager hires should be interviewed by the staff nurses they will supervise.

Staffing 1. Charge nurses should be allowed to set the staffing levels on their floors determined by what nurses feel they can take and filled by appropriate mix of nurses based experience and expertise. 2. Basic minimum nurse-to-patient ratios should be set no higher than those set by the current California legislation, whether or not the institution is located in California. 3. Nurse-to-patient ratios should be posted very visibly for visitors to see on every unit and updated every shift.

Employee Benefits 1. Nurses should receive full tuition reimbursement for education that will enable them to stay in nursing or public health. 2. Hospitals should pay for at least 15 hours of continuing education hours for each nurse per year. 3. From the day they begin work, all employees, including part-time employees, should be provided with health insurance for themselves and their families, and retirement benefits.

Media 1. At least half of the public relations officials at Magnet hospitals should be charged withsolelypromoting nursing. 2. When a hospital loses its magnet status, the Magnet Credentialing Center should send press releases to at least the two largest newspapers in the area, the four major television networks and local news radio stations regarding the removal of magnet status and the specific reasons why the status was removed.

Strengthen credentialing process 1. The Magnet Credentialing Center evaluators should come to evaluate hospitals at a surprise time. 2. The Magnet Credentialing Center should choose hospital staff members they wish to interview--not allow interviewees to be hand-picked by hospital managers. 3. The Magnet Credentialing Center should separately contact, through home mailing addresses, all nurses who works at the institution to inform them of policies by which they can report infractions by hospitals.

4. The Magnet Credentialing Center should have an anonymous tip line to report hospital misbehavior.

Collaboration between the professions 1. The professions should have recurrent training in how to function as a team. 2. Physicians should be expected to seek nursing input on patient rounds and morbidity and mortality rounds. 3. Physicians and medical students should follow nurses at work for at least 12 hours per year so that they can understand the value of nursing and how to collaboratively work with nurses. 4. Magnet hospitals should have anincivility and bullying hotlineto address all acts of reported incivility by a committee that is comprised of at least half staff nurses.

Magnet hospitals should benursinginstitutions 1. At least 51% of the board of trustees should be nurses. 2. The CEO of the hospital should be a nurse.

Magnet hospitals should seek to provide the best care possible based on the latest research 1. Magnet hospitals should be non-profit institutions. Corporate profits have no ethical place in the delivery of health care.Studiesshow that non-profit nursing homes provide better care than for-profit nursing homes. 2. Uninsured patients should pay no more for any service, procedure or item than the lowest amount accepted by the hospital from any private or government insurance program. 3. Absolutely no dumping of patients should occur. 4. Patients should not be woken to have labs drawn. If physicians want lab results with their rounds, they should come to the hospital at noon or later, so lab draws do not interrupt sleep and patient health.

Magnet hospitals should exist to provide humane care to all patients 1. Music in should be provided in rooms of all patients. Agrowing body of researchshows that music reduces pain, blood pressure, depression, physical signs of stress and cortisol levels. See this interesting research in many different studies by nurses from Japan, South Korea and Sweden. 2. Noise should be reduced as much as possible.See the nursing research.


1. Magnet hospitals and each person who works in them including physicians, should adhere to the principles of accepting no gift from any pharmaceutical company or medical supply company, and be a member ofNo Free Lunch. 2. Being that hospitals are nursing institutions, the ethics committee should be comprised of at least half nurses. 3. Magnet hospitals should follow theCode of Ethics for Nurses.

Overall changes to the magnet program

The Magnet program should be a government program to which all hospitals must adhere.

Read more:

Working Conditions for Nurses: Does Magnet Status Make a Difference?

By Debra Wood, RN, contributor September 10, 2010 - Magnet hospitals, as recognized by the American Nurses Credentialing Center (ANCC), have been attracting more attention and greater stature in recent years, based on their efforts to create working environments that attract and retain well-qualified nurses and help them excel. Since 1994, more than 370 facilities have gone through the process to achieve official Magnet designation. ANCCs Commission on Magnet Recognition recognizes healthcare organizations providing nursing excellence, but a new study from researchers at the University of Maryland School of Nursing in Baltimore has found that Magnet status does not necessarily mean better working conditions for nurses. While the work and role of nursing may be improved, because it is a Magnet hospital, we found that consideration of nurses work schedules is not really incorporated into the Magnet hospitals, said Alison Trinkoff, ScD, RN, FAAN, a nursing professor at the University of Maryland and lead author of the paper published in the Journal of Nursing Administration. The University of Maryland researchers compared schedules and working conditions in hospitals that have obtained Magnet status and those that have not and found they did not vary much. Nurses in Magnet facilities reported working less mandatory overtime and on-call time, but the hours they put in per day and per week was similar, as was nursing practice, a patient safety culture and overall job satisfaction.

The researchers found no difference in psychological demands reported by nurses in the two types of hospitals. Magnet hospital nurses said physical demands were lower than their peers, but the authors concluded that the difference was of little practical significance. Karen Drenkard, PhD, RN, NEA-BC, FAAN, director of the Magnet Recognition Program at the American Nurses Credentialing Center (ANCC), said that while we are supportive of research and embrace all research, this study had some issues. She raised concern about the age of the data, from the 2004 Nurses Worklife and Health Study, and that the hospitals studied had achieved accreditation status in 2005. Since 2008, ANCC has required Magnet facilities to report clinical outcomes and nurse and patient satisfaction. Drenkard expects a more current analysis would produce different results.

Linda Plank, PhD, RN, NEA-BC, a lecturer in nursing at the Baylor University Louise Herrington School of Nursing in Dallas, said she was surprised to hear about and read the article showing comparable working conditions in Magnet and non-Magnet hospitals, citing a number of published articles confirming that Magnet hospitals are desired places for nurses to work. We have all heard that turnover is less, vacancy rates are lower, retention is longer and support is better, Plank said. This study does not dispute any of the findings of previous studies. Drenkard also voiced concern about elements the researchers evaluated, which are not Magnet measurements. The authors of the paper acknowledge that, writing, Magnet journey focuses on structures and processes that do not typically address the work schedules and job demands of nurses. Most hospitals now schedule nurses for a 12-hour shift, Trinkoff said. However, some nurses find working that long taxing, and others have childcare or other personal responsibilities that make shorter days more attractive. Hospitals could offer other options to people, said Trinkoff, adding that shorter shifts, such as eighthour days or a 10 a.m. to 2 p.m. assignment, might bring in nurses who would not otherwise join the workforce. Nurses and hospitals can take steps to improve the work environment, Trinkoff added. For instance, nurses can turn down overtime and make sure they take breaks. And hospitals should not schedule meetings at the end of the workday. They should provide enough staffing so nurses can eat meals off the unit and leave on time and should not ask nurses to work overtime. Nurses need time for sleep and to recover, Trinkoff said. Phone calls from work requesting they come back in can be disruptive.

One explanation for the similarities is that there is nothing stopping non-Magnet hospitals from adopting some of the principles associated with Magnet status without going through the expense and time commitment necessary to achieve the designation. As the success of Magnet hospitals have been pointed out, of course others want to emulate that, Plank said. Becoming a Magnet hospital is expensive and takes time and energy and effort away from what you are trying to do, which is take care of patients, so some of them may have decided to not go through the steps but still try to be the best they can be. Drenkard agreed, adding that one cannot assume that organizations that are not Magnet-recognized do not exhibit Magnet characteristics, which makes it hard to compare. Trinkoff concurred that non-Magnet hospitals could be adopting some of the evidence-based attributes of Magnet facilities. She urged all hospitals to pay attention to job demands and scheduling, since they contribute to nurses leaving the field. We wish all hospitals would think about ways to address conditions to improve work for nurses, Trinkoff said. And also to consider that by having alternatives to 12-hour shifts, you can improve the health and performance of nurses and attract others looking for better and healthier schedules and conditions.

The Importance of Magnet Status and Nursing

Blog by: Melanie T. Gura, RN, MSN, CNS, CCDS, FHRS, FAHA and Jane A. Soposky, RN, MSN, NEA-BC , Administrative Director, Patient Care Services, Summa Health Systems, St. Thomas Hospital The American Nurses Credentialing Center (ANCC) developed the national Magnet Hospital Recognition Program in 1980.[1] Hospitals that receive a magnet designation are referred to as Magnet Hospital. It is the highest honor a hospital can receive for its nursing service. The purpose of magnet status is to recognize healthcare organizations that provide excellence in nursing, growth and development of the nursing staff, and an environment that supports professional nursing practice. The term magnet refers to the concept of attracting and retaining quality nurses and the ability of creating a work environment that recognizes and rewards professional nursing practice. This designation fosters a positive work environment and a sense of pride among the nurses. The core values include empowerment, pride, mentoring, respect, nurturing, integrity and teamwork. The ANCC developed eligibility criteria[2] which should exist within the healthcare organization: Nursing leadership is a single governing authority (chief nurse officer [CNO]) ultimately responsible for standards of nursing practice in all areas, and the CNO must participate in the organization's strategic planning/decision making; The American Nurses Association's Scope and Standards (2004) for nursing administration should be implemented;

Protected feedback policies/procedures must be in place; Data collection must include nurse-sensitive quality indicators; There must be regulatory compliance with local, state, and federal laws; and The organization must not have any unfair labor practice claims for at least 3 years (from the time of application). Each Magnet Hospital must demonstrate 14 standards based on the forces of magnetism, which include quality nursing leadership, effective organizational structure, effective management style, promotional opportunities for nurses, professional models of care, quality care, quality assurance, expertise available to staff, high level of autonomy, active community outreach, positive teaching experiences for nurses, positive perceptions of nurses, positive nurse-physician relationships and high emphasis on personal growth and development. However, in 2008, the process was simplified and the 14 forces were categorized into five components. They include empirical outcomes, new knowledge innovations and improvement, transformational leadership, exemplary professional practice and structural empowerment. The focus of the new model is to demonstrate the outcomes made possible through the organizations nursing service structure and processes for the patient, nursing workforce, organization and consumer. In our profession, pursuing magnet status is equivalent to an Olympic gold medal.[3] Magnet status will assure patients a proven level of quality of nursing care and should result in acquiring the most advanced medical technology as well as the knowledge to apply it. It should also result in a proven patient safety record and shorter lengths of stay for patients.

Magnet Designation for Initial Applicants

Note: this page is for initial applicants. For existing Magnet organizations, please visit Magnet Redesignation page.

Submission Dates

You may submit your application on any day of the year AND the online application, application fee, and supporting documents (e.g., CNO Vitae, organizational chart, nationally benchmarked nurse satisfaction survey tool, list of nurse manager credentials) must be received no later than 3 months prior to the month intended for written documentation submission. You may choose to submit your written documentation on the 1st business day of any of these months: February, April, June, August or October.

Example: If you wish to submit written documentation April 1, 2012, the application, fee, and supporting documents must be received by the Magnet Program Office no later than midnight January 1, 2012.

Document Submission

Application Minimally 3 Months in Advance November (previous year) January March May July

February April June August October

Submission Process
Step 1 The Online Magnet Recognition Application must be used to apply for the Magnet Recognition Program. The application:

Establishes your organization's status as a Magnet applicant. Collects information to enable the appropriate appraisal team composition and availability.

Step 2 Submit the online application receipt with a nonrefundable application fee, payable to "ANCC," to: ANCC Magnet Recognition P.O. Box 505063 St. Louis, MO 63150-5063 To send a payment via courier (UPS, DHL, FEDEX) , use this address:* Bank of America Lockbox Services 505063 800 Market Street St. Louis, MO 63101 *PLEASE NOTE: The site street should only be used for lockbox remittances delivered via courier. Phone Number: use your own in case of delivery problems. Step 3 Email the following as attachments to

Chief Nursing Officer's curriculum vitae or resume. Current facility organizational chart showing the CNO and nursing's relationship to the entire facility.

Provide copy of the unit-based, nationally benchmarked survey tool (questions, not responses) used to assess nursing satisfaction.

Organization Eligibility Requirements

The applicant organization must exist within a healthcare organization.

Nursing Leadership
The applicant organization must include one or more nursing settings with a single governing authority and one individual serving as the Chief Nursing Officer (CNO). The CNO is ultimately responsible for sustaining the standards of nursing practice in all areas in which nurses practice. All entities (hospitals, long term care, rehab center, hospice, surgicenters, ambulatory clinics, etc.) and all settings (MedSurg, OB, NICO, ICU, CCU, Step-Down, Rehab, Pediatrics, Psych, ER, Dialysis, Home Care, Long Term Care, etc.) where the CNO is ultimately responsible for sustaining the standards of nursing practice in the environment in which nurses practice must be included. See the Magnet Recognition Program Manual - Recognizing Nursing Excellence, Eligibility Criteria page 6. The CNO must participate on the applicant organization's highest governing decision-making and strategic planning body.

Educational Eligibility Criteria (at the time of Application)

Chief Nursing Officer Effective 2003, the CNO must hold at a minimum, a master's degree at the time of application. If the master's degree is not in nursing then either a baccalaureate degree or doctoral degree must be in nursing. The requirement must be maintained throughout the application phase, review phase, and designation as a Magnet organization. Appointees as interim CNOs must also comply with this requirement. Nurse Managers A Registered Nurse with 24/7 accountability for the overall supervision of all Registered Nurses and other healthcare providers in an inpatient or outpatient area. The Nurse Manager is typically responsible for recruitment and retention, performance review, and professional development; involved in the budget formulation and quality outcomes; and helps to plan for, organize and lead the delivery of nursing care for a designated patient care area.

Effective 1/1/2011 (at time of application) 75% Nurse Managers must have a degree in nursing (baccalaureate or graduate degree) Effective 1/1/2013 (at time of application) 100% Nurse Managers must have a degree in nursing (baccalaureate or graduate degree)

Nurse Leaders Those nurse leaders with line authority over multiple units that have RNs working clinically and those nurse leaders who are positioned on the organizational chart between the nurse manager and the CNO.

Effective 1/1/2013 (at time of application) 100% of nurse leaders must have a degree in nursing (baccalaureate or graduate degree)


CNO will attest to this eligibility requirement on application. When written documentation is submitted the organizationwill include a table that identifies each nurse manager and nurse leader and their highest nursing degree. Download the template titled Nurse Manager and Nurse Leader Eligibility Documentation. Use this tool to document the highest nursing education, baccalaureate or graduate degree, of nurse managers and leaders, to demonstrate compliance with eligibility criteria. Provided at time of written documentation submission.

Standards for Nurse Administrators

Applicant organizations must have the Nursing Administration: Scope and Standards of Practice (ANA 2010) currently implemented throughout nursing.

Protected Feedback Procedures

Applicant organizations must have policies and procedures that permit and encourage nurses to confidentially express their concerns about their professional practice environment without retribution. Policies and procedures that discourage nurses to express their concerns about their professional practice environment are prohibited.

Regulatory Compliance
Organizations must comply with all federal laws and regulations administered by the Occupational Safety and Health Review Commission (OSHRC, the Equal Employment Opportunity Commission (EEOC), the U.S. Department of Health and Human Services (HHS) or other federal agencies that administer healthcare programs, the U.S. Department of Labor (DOL), and the National Labor Relations Board (NLRB) as they relate to registered nurses in the workplace. Institutions that have their Magnet designation revoked, or are prevented from continuing the application process due to an adverse decision, are prohibited from reapplying for Magnet designation for a period of 1 year.

Data Collection
Applicants for Magnet designation must collect nurse-sensitive quality indicators at the unit level and benchmark that data against a database at the highest/broadest level possible (i.e., national, state, specialty organization, regional, or system) to support research and quality improvement initiatives. The intent is to collect data that is applicable and value-added for the particular unit and organization. Organizations must contribute their own data (patient and nurse satisfaction, clinical nurse sensitive indicators) to a national database that compares the organization's data against cohort groups at the national level.

System Eligibility Requirements

Applicants applying as a system must meet each of the following requirements in addition to the requirements for individual organizations. System Applications: For those organizations submitting as a system a separate Demographic Information Form (DIF), Research Table, and Nurse Manager Education Eligibility Table must be completed for each component organization of the system and submitted electronically via email to the Magnet Program Office at time of documentation submission. System Written Documentation - In addition to the above required documents the data for 0012 and EP3EO (Nurse Satisfaction), 0023 andEP32EO (Nurse Sensitive Clinical Indicators), and 0026 and EP35EO (Patient Satisfaction) must be presented separately for each organization submitted in the system application. Separate tables and graphs must be presented for each organization. For NK4EO one completed research study must be presented for each organization or there must be clear representation by each organization if a combined study is presented. The outcome data must show an impact for each organization.

Transformational Leadership

There must be one organizational mission, vision, and set of values for the entire system. There must be one chief executive officer for the entire system. There must be one governing board for the entire system. The same shared leadership/participative decision-making mechanism must be operationalized throughout the entire system. There must be one chief nursing officer (CNO) for the entire system. The CNO must have at a minimum, a master's degree at the time of application. If the master's degree is not in nursing then either the baccalaureate degree or doctoral degree must be in nursing. The requirement must be maintained throughout the application phase, review phase and designation as a Magnet organization. Appointees as interim CNOs must also comply with this requirement. Each component entity shall have a designated RN executive leader who: - Is prominently responsible for nursing service at that entity; - Has detailed knowledge and control over the day-to-day operations of the clinical practice of nursing within that entity; and - Meets the CNO educational requirements.

Organizational Structure

There must be an established nursing council/committee in which representatives from all component entities participate in shared decision-making and developing strategy for system-wide nursing initiatives. The component entities must demonstrate how nurses participate in shared decision-making.

Structural Empowerment

The same educational opportunities, to include orientation, certification, clinical ladders, and financial support in budget, must exist across the entire system. There must be an integrated nursing education department serving the entire system. There must be an established system-wide patient and family education committee. The same support for nursing research, to include personnel and finance, must exist throughout the entire system. There must be system-wide nursing participation in a community advisory committee. There must be system-wide nursing participation in community-sponsored events. There must be system-wide marketing and integration of publications that are promoted to the community and nursing staff.

Exemplary Professional Practice

The same mission, vision, and values must be used throughout the system. The same performance appraisals must be used throughout the system.

The same pay practices must be used throughout the system. The same policies and procedures must be used throughout the system. The same policies supporting career development and advancement must be used throughout the system. The same credentialing and privileging process for advanced-practice nurses must exist throughout the entire system. The same clinical documentation system(s) must be used throughout the system to support integration of evidence-based practice into clinical and operational processes. The same policies and procedures governing interdisciplinary relationships must be applied across the entire system. The same performance improvement methodology/structure must exist throughout the entire system.

Knowledge Improvement
The same clinical documentation system(s) must be used throughout the system to support integration of research into clinical and operational processes.

A single application will be submitted for the system.

Written Documentation
Each component entity, a stand-alone group that is part of a multi-hospital or diversified single hospital system, must submit written documentation addressing each required source of evidence with examples occurring within that entity. For the purposes of the Magnet Recognition Program, the number of component entities within a system is equal to the number of designated RN executive leaders who are responsible for separate stand-alone groups within that system. This evidence must independently demonstrate the full implementation of the Nursing Administration: Scope and Standards of Practice (2009) and the existence of a Magnet environment for nurses in the workplace. The documents and exhibits compiled to demonstrate compliance with the system eligibility requirements must be included in the written documentation submitted by each component entity. A separate DIF must be completed for each component entity.

Site Visit
Each component entity whose written documentation is scored within the range of excellence will receive a site visit by the team of appraisers who reviewed those written documents. The Magnet requirements must be fully evident across each component entity and at every level of each component entity.

System Recognition
If a healthcare organization with multiple entities opts to apply for Magnet recognition as a system and if any component entity fails to meet Magnet requirements, the system will not be designated as Magnet.

Biennial Monitoring
Each component entity must complete interim monitoring requirements with evidence specific to that entity. If during the period of recognition any component entity ceases to meet Magnet requirements as determined as a result of investigation by the Commission on Magnet Recognition (COM), the system loses Magnet recognition.

Application Fee
Main application fee is $4,200

Appraisal Fees
Acute Care In-Patient Settings and Long Term Care Licensed Bed Size 100 or less 101-299 300-399 400-499 500-749 750-949 950+ Price $13,750 $15,100 $24,150 $35,000 $45,280 $54,350 $57,850 + $65 per bed over 950

Ambulatory Independent Outpatient (Home Care/Hospice/Surgical Centers

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Documentation Review Fee

Team Leader - $2,500 Team Member - $2,000 each
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Site Visit Fee

Daily Fee: $1,850 per appraiser All travel, hotel and per diem expenses for each Magnet appraiser are covered by the applicant.
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Extension Fee
The date selected (on the application form) by the applicant organization for documentation submission is confirmed once the application is processed by the Magnet program office. The date selected is significant and is considered a reservation for your documentation submission. Specific coordination of scheduled conference calls and communication centers around this date. The date is also used by the Magnet office to assure timely communication about the application phase and to prepare the organization for documentation submission, including selection of the appraisal team. If at a later time the organization decides to change the documentation submission date an extension may be

requested. A fee of $5000.00 is assessed. The extension is for one time only and the new date for submission must be within 6 months of the previous scheduled date. The new submission date can only be selected from the established submission dates indicated on the website: February, April, June, August, or October, first day of the month, unless it falls on a weekend or holiday, then the next available business day applies.
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International Organizations
Interested applicants should send a letter or email to the Magnet Program Office including descriptions of the organization's location, size, number of facilities, and populations served. Staff will review the inquiry prompty and draft an initial cost quote or contact the organization for additional information.
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Program Overview

The Magnet Recognition Program recognizes health care organizations for quality patient care, nursing excellence and innovations in professional nursing practice. Consumers rely on Magnet designation as the ultimate credential for high quality nursing. Developed by the American Nurses Credentialing Center (ANCC), Magnet is the leading source of successful nursing practices and strategies worldwide.

Benefits of Magnet Designation

Attract and retain top talent Improve patient care, safety and satisfaction Foster a collaborative culture Advance nursing standards and practice Grow your business and financial success

Learn more

National Recognition of Magnet

US News & World Report utilizes Magnet designation as a primary competence indicator in its assessment of almost 5,000 hospitals to rank and report the best medical centers in 16 specialties.

8 of the top 10 medical centers on the US News Best Hospitals in America Honor Roll are ANCC Magnet organizations. (2011-2012) 6 of the top 8 hospitals in the US News Children's Hospital Honor Roll are ANCC Magnet recognized. (20112012)

In the Leapfrog Hospital Survey , the nation's oldest survey comparing hospital performance in safety, quality and efficiency, Magnet designation automatically earns full credit for Safe Practice #9 Nursing Workforce. This section of the survey scores hospitals on their commitment to staffing with highly trained nurses and putting nurses in leadership positions that allow them substantial input on patient safety issues. View 2011 Leapfrog Hospital Survey See Hospitals Reporting Magnet Status to Leapfrog Magnet requires organizations to develop, disseminate and enculturate evidence-based criteria that result in a positive work environment for nurses and, by extension, all employees. In the Fortune 100 Best Companies to Work For, 8 organizations are Magnet-recognized facilities or have Magnet facilities in their system. (2011)

Goals & Guiding Principles

The Magnet Recognition Program advances three goals within health care organizations:

Promote quality in a setting that supports professional practice Identify excellence in the delivery of nursing services to patients/residents Disseminate best practices in nursing services.

Transformational leadership
"It is relatively easy to lead people where they want to go; the transformational leader must lead people where they need to be to meet the demands of the future."* Nurse retention at The Heart Hospital Baylor Plano (Texas) was relatively stable at 92.8%, but a re-occurring issue came up in exit interviews. There was a gap between what nurses felt they needed to move up in the organization and what they were receiving. "They felt they were not given resources to better themselves personally and professionally," said Melissa Winter, RN, MSN, CNO and vice president of patient care services at the facility. "So our Magnet coordinator and I sat down and came up with a yearlong nursing succession program, implemented [in] March 2010." The program was launched in the form of a fellowship, and Winter got the word out to the facility's nearly 300 nurses that there was a new opportunity for them to learn what they need to know to move up in any organization. To apply for the fellowship, nurses must have worked at the Heart Hospital for at least six months, be free of disciplinary actions and have met a minimum standard on their most recent performance review. They also need to have earned a BSN or be pursuing the degree.

The professional development program features expert speakers, tutorials, mentoring and other educational opportunities. Nurses learn, for example, leadership skills, job interview pointers, and the differences between a curriculum vitae and resume. Ten nurses have since completed the program, and 15 new fellows started in July. Of the first 10 fellows, four already have moved up in their roles. Three have been promoted to supervisor and one obtained a full-time charge position, Winter said. "They're just so unbelievably changed from the beginning to the end of the year. They know how to handle situations differently. I have two mentees that meet regularly with me, and one said just the other day that her coping and stress management skills are incredibly better. That's very rewarding because ultimately that's better for the patients." Baylor Health Care System plans to implement this program at two other facilities, and Winter has been named COO and CNO of the new 400-bed Baylor Medical Center at McKinney, opening next summer.

Staff empowerment
"Staff needs to be developed, directed and empowered to accomplish the organizational strategic plan, structure, systems, policies and programs."* Angela Creta, RN, MS, CNL, BC, Magnet site coordinator at The Miriam Hospital, Providence, R.I., said nurse empowerment is vital. "Shared governance is the organizational structure that allows nurses the opportunity to have a voice and be professionally engaged," she said. The Miriam Hospital, a 247-bed acute care teaching facility, which recently received its fourth Magnet designation, instituted the nursing finance council to help staff nurses make decisions about resource allocation and staffing. Nurses on the finance council redesigned the charge nurse preceptor program based on what they learned, Creta said. "The finance council helped improve the practice environment. We have our assistant managers, charge nurses and staff nurses attending those meetings and getting an understanding of the larger picture of resource allocation at the unit level," she said. "Their engagement and sharing during the meetings allows them to make day-to-day operational decisions." When nurses identified the need for a nursing ethics committee, Miriam launched a nurse-specific branch of the hospital ethics committee. "From that, nurses have become more proficient in dealing with complicated ethical issues," Creta said. "We also have a program that was initiated from the nursing ethics committee called Walking Ethics Rounds. The rounds resulted from one nurse's idea that staff nurses can't always come to the luncheons to listen to these cases; so, maybe we should go to the nurses and talk to them-more on a rounding type basis." Nurses participating in Miriam's evidence based practice council also identify practice issues and initiate changes, Creta said. "We've instituted bedside-nurse-driven protocols, including oral care and Foley catheter discontinuation. Additionally, we are currently developing a hypoglycemic protocol that is nurse driven," she said. The evidence based practice council examines best practices, recommended practice and current research and compares those to what exists in the workplace. "When there is a gap between recommended guidelines and practice, nurses can really have an impact in advocating for change," Creta said.

Exemplary professional nursing practice

"The true essence of a Magnet organization stems from exemplary professional nursing practice. This entails a comprehensive understanding of the independent and dependent role of nursing."* This component encompasses all things in the practice environment that allow nurses to do what they do in excellent

fashion, said Patricia Reid Ponte, RN, DNSc, FAAN, NEA-BC, senior vice president of patient care services and CNO at Dana-Farber Cancer Institute, and executive director of oncology nursing and women's services at Brigham and Women's Hospital, Boston. For the past decade, Dana-Farber has committed to consistently encouraging nurses to talk about their successes and challenges, and taking action on issues raised during those conversations, Ponte said. Informal opportunities for nurses and leadership occur during executive patient safety rounds and practice rounds, she said. During these rounds, Ponte, along with the chief medical officer and chief operations officer, make it a point to chat with nurses. "We ask them questions like: What's going well? What's not going well? What's keeping you up at night? What's getting in your way of safe effective practice?" she said. These informal, yet deliberate, interactions produce ideas that lead to excellence, she explained. For example, nurses brought up a recent challenge: The staff had moved into a new ambulatory center and it was stressful for patients and staff to settle into the environment. "One of the suggestions from the staff was, 'Well, if we're going to try to figure this out, let's figure it out with one of our patients in the room," Ponte said. "We have such a commitment here, in that patients and families actually sit with our nursing staff and others and help develop improvements in how we do things." Nurses stay in Magnet environments because of the standards and programs that support them, according to Ponte. "They know they'll have an opportunity to interact with senior leadership if something's bothering them. We'll figure out the solutions together. There is a nursing council a place to go that's formal. But there's also a place to go that's informal," she said. The results are staff satisfaction, less staff distraction, safer and higher quality care, and patient satisfaction, she said.

New knowledge, innovations and improvements

"This concept is intended to move beyond a basic application of research to include evidence of redesign, new models of care, application of new evidence to guide practice, and visible contributions to the science of nursing."* Bedside nurses at Duke University Hospital, which recently earned Magnet redesignation, routinely meet with the hospital's clinical practice council to discuss ways to incorporate new knowledge into practice, according to Mary Ann Fuchs, RN, DNP, chief nursing and patient care services officer for Duke University Hospital and Duke University Health System, Durham, N.C. "This frontline group of staff has been trained to identify current evidence; compare that with our internal practice standards; update and educate the organization around those practice standards; and incorporate what's new as a best practice," Fuchs said. These nurses also help to determine and fill gaps in knowledge by conducting research. "We have a whole list of ... formal research studies that are now published that really have been generated by bedside nursing providers, who have used our institutional resources [to conduct research]," she said. For example, Duke University Hospital nursing staff led a pilot study in two hospital ICUs, looking at using chlorhexidine gluconate bath cloths to determine if the practice would help prevent central-line infections and could be used throughout the organization. "The group not only looked at this from a clinical practice perspective, but also to determine the time it took and how expensive it was for our organization. Broadly, we determined ... that it would be wise to bring this bath cloth into our ICUs. We've seen decreases in infection, no real increases in expense, and the time that it takes the nurses in the intensive care setting to provide patient care has decreased," Fuchs said. "Our nurses have also partnered with our physicians and infection prevention staff to develop a comprehensive program for insertion and maintenance care of central lines. Our ability to form teams as such, was highlighted as an

organizational exemplar during Magnet redesignation site visit," she said.

Empirical outcomes
"The question for the future is not 'What do you do?' or 'How do you do it?' but rather, 'What difference have you made?'"* Deborah Zimmermann, RN, DNP, NEA-BC, CNO at Virginia Commonwealth University Health System in Richmond, described empirical outcomes this way: "Empirical outcomes are the 'So what?' to the story. We know as a profession we are continually rated as the most trusted of the professions, and people love our authenticity and value our practice. However, does the practice really make a difference? How do we know if we're improving the lives of those that we serve?" The proof is in the empirical outcomes, she said. The VCU Heath System includes a 779-bed hospital, recently re-designated as a Magnet facility. The facility's focus, according to Zimmermann, is to become the safest hospital in America. Everyone who works in the hospital, including bedside clinicians, work toward that goal, she said. "Nurses demonstrate the goal through our prevention of hospital-acquired infections; specifically, urinary tract infections, ventilator-associated pneumonia and central-line infections," Zimmermann said. In their quest to eliminate hospital-acquired infections, VCU nurses not only apply the evidence, but also create it. For the past seven years, they've looked at best practices and found where the research is lacking. One example: Nurses found gaps in research related to oral care in the prevention of ventilator-associated pneumonia. They wondered if the method they used to brushed their patients' teeth affected infection risk. So those nurses launched a research study on the practice. That's part of this component, Zimmermann said: supporting nurses when they want to find answers to their questions. "What we encourage in rounds, staff meetings and in our shared governance structure is the raising of the questions," she said. "We currently have 62 research studies underway in which nurses are the primary investigators." The empirical outcomes: VCU Health System has reduced hospital-acquired infections over the past seven years by 85%, and nurses now know they're making a difference. * "Magnet: The Next Generation Nurses Making the Difference"