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New Study Confirms: Lower Mortality Rates in Magnet Hospitals

Building on pioneering research from the early 1990s, Linda Aiken, PhD, FAAN, FRCN, RN, and colleagues at the University of Pennsylvania report patients are at less risk of dying at Magnet-designated hospitals vs. other hospitals, something the team largely attributes to better nurse work environments and more educated nursing staff.

Matthew McHugh: Magnet hospitals have lower mortality rates
Matthew D. McHugh, PhD, JD, MPH, RN, said Magnet hospitals have lower mortality because of investments in nursing.

“There remains a difference between Magnet and non-Magnet hospitals in terms of mortality,” said Matthew D. McHugh, PhD, JD, MPH, RN, a faculty member in the Center for Health Outcomes and Policy Research at the University of Pennsylvania School of Nursing in Philadelphia and lead author of the new report. The report found mortality rates were 14 percent lower at Magnet hospitals, after accounting for clinical factors, and Magnet hospitals had better performance on “failure to rescue,” deaths of patients with complications.

The Magnet Recognition Program is a voluntary recognition/certification program administered by the American Nurses Credentialing Center (ANCC), which currently lists 390 Magnet-designated hospitals in the United States, plus five in other countries.

“What makes the difference with Magnet is that it keeps patient care and concerns at the forefront of what you do, and Magnet continually raises the bar,” said Linda Cassidy, MSN, EdM, APRN-CNS, CCNS, CCRN-CSC, director of clinical practice and nursing research at Holy Cross Hospital, a Magnet-designated facility in Fort Lauderdale, Fla. “Magnet is about keeping the patient in the center and how we get better.”

The researchers linked patient, nurse and hospital data about more than 600,000 surgical patients from 56 Magnet hospitals and 508 non-Magnet hospitals in California, Florida, Pennsylvania and New Jersey in 2006-2007 to learn if Magnet hospitals still achieved better patient outcomes--something Aiken first reported in 1994--and to identify characteristics of Magnet hospitals that led to improved outcomes. The original and current studies, both by the same research team, were published in Medical Care.

McHugh, a Robert Wood Johnson Foundation Nurse Faculty Scholar, called the current study an extension of that early research. But at that time, he explained, it was difficult to determine the Magnet advantages, because there were few measures associated with the nurse work environment.

“Now we have good measures as far as composition of the nurse work environment,” McHugh said. The team looked at 12 different nursing measures.

Nurse staffing, education and work environment account for much of the superior patient outcomes at Magnet hospitals.

“The work environment pulled the biggest weight and accounted for the biggest differences between Magnet and non-Magnet hospitals and, ultimately, their mortality difference,” McHugh said. “And that falls in line with the idea of what Magnet is intended to do in terms of changing work environments for nurses.”

In addition, there was a residual mortality rate advantage attributable to the ongoing process of maintaining Magnet recognition status.

“We anticipate it’s something associated with going through the Magnet process,” said McHugh, theorizing that it may be associated with innovativeness and organizational support.

Linda Cassidy: Magnet-designated hospitals keep striving for improvement.
Linda Cassidy, MSN, EdM, APRN-CNS, CCNS, CCRN-CSC, indicated that Magnet reminds hospitals to keep the patient first and to strive to do better.

Cassidy said that Magnet guides hospitals in how to approach quality improvement interventions and measure outcomes as well as workplace initiatives such as shared governance.

“[Magnet] always reminds you to strive forward and keep what’s most important at the forefront,” Cassidy said.

The Penn researchers accounted for differences in hospital structure, such as size, location, case mix and academic status--things that are difficult to change--and the Magnet mortality advantage held.

“Magnet provides a blueprint for changing the organizational culture and the work environment for nurses,” McHugh adds. “There is evidence the hospitals change [during the Magnet journey].”

This is the first study to suggest that the Magnet application process itself is an intervention that promotes better quality of care, he said.

Jeroan Allison, editor-in-chief of Medical Care, wrote that “this large study makes an important contribution to an emerging literature attempting to understand what makes some hospitals superior in terms of patient outcomes they obtain, how to best manage hospitals, and whether or not the Magnet designation process as it now exists truly designates institutions where patients fare better.”

McHugh said he thinks patients should be aware of the Magnet value for safety and quality, and nurses can differentiate work environments and staffing levels by looking for that designation.

“The main message is not just about Magnet but about focusing on the work environment of nurses to benefit patients,” McHugh said. “These are things that can be changed. Magnet is a process a hospital can choose to go through. There are choices that can be made that translate into real benefits for patients and nurses.”

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