Pursuing Magnet designation: Pros and cons

Magnet designation is considered the gold standard for many U.S. hospitals, but it’s not for everyone

By Debra Anscombe Wood, RN

Still, achieving Magnet status can be a lengthy and costly process, and some hospital administrators wonder if it’s worth the time and effort. Magnet supporters, however, have little doubt about the merits of the program and believe the benefits of Magnet far outweigh the costs. “It’s central to our nursing culture,” said Cindy Sayre, PhD, RN, chief nursing officer at the University of Washington Medical Center in Seattle, which became the first Magnet hospital in the country in 1994 and has achieved redesignation six times. “There are many benefits.” The ANCC, which administers the Magnet program, considers several factors in determining if a facility meets the rigorous standards of Magnet designation, including the empowerment and autonomy of nurses; a collaborative work environment; nurse and patient satisfaction; nurse education and research; patient outcomes that exceed national benchmarks; and nursing-sensitive indicators that measure how nurses’ actions impact patient outcomes. A total of 478 U.S. hospitals, or about 8.4% of all U.S. hospitals, hold Magnet status. Eight hospitals in five other countries also have achieved Magnet recognition with significant interest around the globe. Rebecca Graystone, MS, RN, MBA, NE-BC, director for the Magnet Recognition Program® at the ANCC in Silver Spring, Md., said organizations use Magnet standards as an evidence-based road map for excellence, serving as a framework for delivering nursing care. “Magnet status serves as a peer-reviewed credential,” Graystone said. “It is recognition for work they have done and are doing.”

Some hospitals have chosen a different path than Magnet. While 95% of existing Magnet hospitals apply for redesignation, about 5% do not. Morton Plant Mease Health Care system in Florida was one of the exceptions. Morton Plant Mease was the first four-hospital health system in Florida to earn Magnet status in 2003. It was redesignated in 2008. Morton Plant Mease was a founding organization of BayCare Health System, Inc., which added additional hospitals over the years. Nursing leaders decided that rather than reapply for Magnet the health system should pursue Pathway to Excellence, another ANCC designation for healthcare facilities that they felt better aligned with BayCare. Pathway to Excellence focuses more on the nursing practice environment and less on research than does Magnet, and this was a major reason why BayCare decided to make the change, according to Lisa Johnson, MSN, RN, NEA-BC, senior vice president and CNO for BayCare in Clearwater. “As a system, we are committed to nursing research, but with each hospital standing alone, that becomes challenging,” Johnson said. Johnson said she believes BayCare can better achieve its nursing goals through Pathway rather than Magnet. All BayCare hospitals are expected to achieve Pathway by 2019, she said. Magnet supporters, however, believe Magnet’s emphasis of research and evidence-based practice enhances nursing excellence and improves patient care. Sayre said the research component of Magnet engages nurses in finding solutions to problems, rather than simply identifying problems. She said the UW Medical Center considers every nurse a nurse researcher. “[Magnet] helps us keep advancing nursing practice,” Sayre said. “The research component is a great thing.” Sayre reported that many nurses seek work at her hospital because it is Magnet recognized. “It helps us attract the best registered nurses,” Sayre said. “They know for us to be Magnet we have to have structures and processes in place to support nursing practice.”

Benefits to hospitals

Choose a different path

Cost vs. benefits

Cost is a factor for facilities considering Magnet. Application and appraisal fees are based on the size of the organization. Healthcare organizations must apply and then document evidence that they are meeting Magnet standards. An appraisal team will make an on-site assessment, talking to nurses, physicians and others, before the commission determines if the organization has met the Magnet standards. The application fee represents only a small portion of the cost associated with Magnet. It also takes a commitment of staff time to prepare the Magnet documentation and support shared governance and research. It takes hospitals an average of 4.25 years to complete the Magnet process, with an average total investment of $2.125 million, according to estimates cited in a 2014 study conducted by researchers at the University of Georgia and University of Colorado. Sayre acknowledged there are additional costs, staff time and documentation associated with achieving Magnet status, but believes the benefits outweigh the costs. “What is more costly is not having staff engaged in improving the patient experience or having suboptimal outcomes,” said Sayre, adding that being a Magnet hospital is “the right thing to do.” In their 2014 study, researchers from the University of Georgia and University of Colorado found that, despite the financial costs, achieving Magnet designation can help the bottom line in the long term. The study found hospitals receive an adjusted net increase in inpatient income of between $104.22 and $127.05 per discharge after achieving Magnet status and totaling more than $1.2 million in additional revenue annually. “Since Magnet Hospitals have better patient outcomes, we suspect that these increases in revenue reflect increased reimbursement rates from private insurers, relative to non-Magnet Hospitals,” said Richard C. Lindrooth, PhD, one of the researchers and an associate professor at the University of Colorado, in a news release by the Robert Woods Johnson Foundation, which funded the study. “That increased premium is related to the perceived higher quality of care and the desirability of including high-quality hospitals in insurers’ networks.” Graystone said sometimes the investment in Magnet cannot only be measured in dollars and cents, but in the satisfaction of staff and the quality of care that patients receive. “This is an investment in patients and nurses,” she said. “That’s the ultimate outcome; doing what’s right for patients and providing a work environment for the group of healthcare professionals who have the biggest outcome on care.”