The Myth of the Magnet Hospital

Recently, I spoke with a reporter from one of our Western States. She had reached out to the members of our health care journalist list asking for feedback on the Magnet Hospital program. As a columnist I shared with her both my personal and professional opinion (note to readers a columnist is entitled to an opinion, while a reporter is charged with reporting the facts). As our conversation drew to a close the reporter commented that she was somewhat surprised when this particular hospital became a Magnet hospital, since in their community it is considered the worst of the two hospitals their town has to offer. My point exactly, I told her that is why among nurses the significance of “Magnet” status can be and continues to be so hotly debated. Why do nurses seem to be so divided on this issue? You’d think that nurses would rally around the Magnet program, but in reality many nurses view the Magnet Hosptial designation with suspicion and trepidation, while others welcome it with open arms and sing its praises. Why?

The Magnet Hospital designation has been promoted as the “gold” standard for a hospital’s nursing staff much like achieving Joint Commission (formally JCAHO) is considered the proverbial “Good Housekeeping Seal of Approval” for hospitals. The American Nurses Credentialing Center (ANCC) (a sub-organization of the American Nurses Association [ANA]) created the Magnet Recognition Program. The objectives are simple and make for a persuasive argument for seeking such recognition. These objectives are:

➢ Recognize nursing services that use the Scope and Standards for Nurse Administrators (ANA, 2003) to build programs of nursing excellence for the delivery of nursing care to patients
➢ Promote quality in a milieu that supports professional nursing practice
➢ Provide a vehicle for the dissemination of successful nursing practices and strategies among health care organizations using the services of registered professional nurses
➢ Promote positive patient outcome

As my children are fond of saying, it doesn’t take a rocket scientist to realize that the above objectives are not only admirable but objectives that all nursing teams, whether at a hospital, clinic, or doctor’s office, should want to achieve. The question that one must ask is whether or not this program is achieving the goals that they promote, or is it yet another program that is run and defined by paperwork, achieving a “magic” number, and generating revenue for an outside organization?

Nurses are very much divided when it comes to the value of a hospital seeking Magnet Hospital designation. In the Los Angeles and Orange County area there are only four and three hospitals, respectfully, that have been granted “Magnet” status. One in LA has a chronic nursing shortage, a second made the local news and not in a good way for problems that can be laid at the feet of the nursing staff. Hospitals trumpet far and wide when they receive their “Magnet” designation, and to my knowledge only one hospital, UC Davis Medical Center, has ever had its designation removed. After a recent and well publicized medication error occurred at a local area hospital a journalist posted a question to our mailing list asking what if anything happens to the Magnet status that had been awarded in such as case, or after a hospital received State sanctions or fines? Did the ANCC place the hospital in probation, did they reassess, did they publicize when a hospital looses its Magnet recognition? I found the response provided by another list member who is also involved with the ANCC rather shocking, but indicative of why so many of my fellow nurses take the vaunted “Magnet” designation with such a grain of salt. Her response was that the ANCC did nothing in such cases and that it was up to the hospital to “inform” the public. Such a passive position, in my opinion, only reaffirms the suspicion of many nurses that the Magnet designation is just one more scheme to generate funds to an outside agency and to see how many hoops they can make the nursing staff go through to please some “nameless” accrediting body. My readers may find this statement overly harsh, but as a registered nurse who prides herself as a professional and who has never worked in a “Magnet” designated hospital but who has had the privilege to work in many stellar hospitals during her career it offends me when a credentialing agency promotes a “seal of approval”, setting one hospital above another and then when one of their “meets a higher” standard hospital fails to maintain this goal does nothing to place that institution in a probationary status, require review before reaffirming the “seal of approval” or outright revocation of the “seal of approval”. This type of behavior only provides more reasons for nurses to be suspicious of the validity of such a program.

Does this mean that such a “seal of approval” should be designed or furthered? Hardly, nurses share the common desire of other professionals to have the organization they work for be recognized for outstanding performance, and having a specific segment (such as nursing) singled out even furthers a feeling of pride in one’s institution, team and self. Unfortunately, like with so many “seals of approval” they are more often than not a paper tiger. I know that many supporters of the Magnet recognition program often express frustration and bewilderment when nurses, such as myself, show a profound lack of acceptance and respect for this program and its lofty goals. However, I believe that the skepticism is justified and warranted based on our experience either working in such institutions, knowing the overall character/skills of the nursing staff at some of these organizations, and in some cases having been a patient or knowing someone who has been cared for by the nursing staff at these “Magnet” designated hospitals. A common complaint that I hear from nurses that have both experienced the evaluation process or worked within a Magnet hospital is that once the Magnet recognition is received by the hospital the staff, administration and hospital often pretty much fall back into their old routines and thus making the positive changes set forth by the Magnet program moot in many cases. Many nurses often express the same opinion and frustration with the Joint Commission process.

I know that supporters of the Magnet recognition program will often cite published research that support the assertion that hospitals with Magnet recognition are “better” at attracting and keeping quality nurses and that this then translates to better patient outcomes. Without a doubt reading such articles, and I read the many that come across my desk, one has to also balance such studies with the bias (and we all have them) that the researchers, their funders, and yes the publications may have and how this may affect the outcomes. One way to deduce the potential for bias is to know the author of the paper and their institutions, another is to request the study tool that was designed and utilized. This does not mean that such studies are inherently flawed, on the contrary they may be well designed but by educating yourself on what the assumptions were in designing the study that lead to the published outcomes can help you understand how the conclusions were derived. My son, an actor/independent film-maker, likes to remind me that even documentaries have an inherent bias, because the moment the director chooses which angle to shoot from, where to plant the camera, or which scenes to cut or not cut the documentary becomes biased.

Could a program such as Magnet recognition serve as a marker of distinction, without a doubt? However, I think the program as it is currently used, and implemented has many flaws that the ANCC continues to turn a blind eye to and the most serious flaw is what to do when a hospital’s nursing staff turns out to be less than the exceptional model set forth in the goals of the Magnet Recognition program. Nurses who participate in the evaluation and accreditation process need to be able to attach a value to the entire program, and one way to achieve this is for the ANCC to also publicize when a hospital that has been designated a Magnet fails to maintain the highest expectations of the organization and the credentialing program. For example when UC Davis lost its Magnet recognition designation the local newspaper reported that the ANCC had taken this action in part because of the unionization of the hospital (when UC Davis had initially received the designation it was non-union), and had responded to calls from the nursing team that had contacted the ANCC independently. The logic was that if the nurses felt the need to seek union representation that this must mean that the nursing structure was not fulfilling the fundamental goals set forth by the Magnet program, and thus they decided to remove the Magnet recognition, which to this day UC Davis has failed to recapture (though they may have chosen to reapply). The union argued that the removal was arbitrary and unwarranted, and on the one hand they have a point since the fact that it was the nurses working as a team chose to contact the ANCC does somewhat validate some of the core principals of the Magnet recognition program.

I see the potential of the Magnet program, however in its current incarnation I also think that it is far too often a “soft” tool and has too much of a subjective appearance, much like so many of the other “this is a great hospital” programs available today. Programs with the lofty goals, such as the Magnet Recognition, really need to also have some teeth, so that once the recognition is achieved the hospital and nursing administration and nursing team know that they cannot allow any falling back into the way it was or else they risk loosing this very unique and rare designation. As the near-tragic Heparin overdose occurrences at Cedars-Sinai Hospital in December of last year, a quick search of the ANCC website shows that Cedars still retains its Magnet designation. One would think that the near fatal overdosing of three infants, the admission of the break down in procedure by the hospital administration, the findings from the State that Cedars failed to implement its own policy, hefty fine, and the admission of the nurses that they did not read the information on the vial would warrant at least a probationary status or a re-evaluation. One may think this rationale overly harsh, I think not. If we are to accept that Magnet Recognition is the epitome of what the nursing profession can and should aspire to, that hospitals that pay large sums of money to go through such a recognition process and meeting the set goals in order to recognized as an institution that has enshrined these ideals and put them into practice; then in turn when such an institution fails to uphold or continue to meet this standard there should be serious repercussions.

Otherwise examples such as these leave nurses with the feeling that Magnet Recognition is more myth then reality – and it doesn’t have to be that way.