Magnet status aids recruitment, retention

While most same-day surgery programs are struggling to recruit and retain nurses, managers at some facilities are watching nurses jump at positions, even when the specific positions weren’t their first choice.

What’s their secret? Magnet status.

The Magnet Recognition Program administered by the American Nurses Credentialing Center (ANCC) in Washington, DC, is designed to publicly recognize nursing systems within health care organizations that involve nurses in patient care decisions and promote a professional environment for nurses. The rigorous certification criteria has been met by the 65 hospitals throughout the country that have achieved magnet status.

With the ongoing paperwork required by other accreditation and regulatory bodies, why would a hospital’s nursing staff take the time and spend the money to achieve certification in another program?

Being able to include the magnet certification logo on brochures, in advertisements, and on the web site has had a positive effect on recruitment and retention of nurses, says Miriam Jolly, RN, BSN, CPAN, post-anesthesia care unit (PACU) and day surgery coordinator at Catawba Valley Medical Center in Hickory, NC. Not only does her hospital enjoy a low turnover rate of less than 2% when the national average is more than 20%, but managers also have found that even when nurses do leave, more than half of them return within a year, she says.

The magnet logo alone doesn’t create staffing success, and what makes those facilities successful can be adapted by other facilities, points out Jolly. "Even before you apply for certification, you have to have policies, standards, and practices in place that are conducive to excellent nursing," she says. Nurses want to work in a program that emphasizes respect, professionalism, and communication between co-workers within the same and between different departments, she explains.

The process of preparing the application for magnet certification differs from program to program. While Jolly’s facility used a team approach, the staff at Capital Health System in Trenton, NJ, appointed one person at the "magnet guru" to oversee the whole process, explains Doreen A. Donohue, RN, MSN, director of perioperative services.

One thing to remember as you prepare the application is that the ANCC wants to see specific examples of how your organization encourages a professional environment for nursing, Donohue says. "Anything you do to encourage your staff, promote nursing excellence, or create a positive nursing environment should be added to a file so that you can easily pull out examples when needed," she says.

For example, her organization offers reimbursement for tuition, conferences, classes, or seminars that improve nursing or nurse management skills, she says. Because reimbursement programs often are among the first items cut in budget crunches, Donohue is proud that it has not been affected at her facility. By keeping track of nurses who take advantage of the program and the amounts of money the organization has committed to the nurses, she can demonstrate a commitment to nursing excellence, she explains.

It is important to review the Scope and Standards for Nurse Administrators (Washington, DC: American Nurses Association; 1996) to assess whether your program is at a point at which you can apply, says Jolly. "You can’t just decide that you are going to become a magnet program overnight by completing the application," she says. "You have to already have everything in place when you apply."

At first, the thought of applying for magnet status was overwhelming because the only other hospital in the area with magnet status is a large teaching hospital, she explains. "But once we started going through the list of standards, we realized that we already did everything that was required," Jolly says. It took 18 months to gather all the documentation and complete the application, she adds.

In addition to providing policies and descriptions of committees that involve nurses in key decisions, the facility has to provide examples of the opportunities nurses have to affect patient care, points out Jolly. "One example from the same-day surgery program was the development of a single, interdisciplinary patient education form so that nurses, therapists, surgeons, and any other staff member responsible for teaching the patient can see what information has been given by someone else," she says.

Another example of a nurse-initiated change in practice is the provision of chlorhexidine to physicians’ offices for patients undergoing back or abdominal surgery, says Jolly. "In an effort to further reduce postoperative infections, we’ve always given chlorhexidine to patients to use when they shower at home prior to surgery," she says.

Patients whose preadmission visit occurred over the telephone rather than in the preadmission area did not receive the chlorhexidine, so nurses suggested providing the anti-infective agent at no cost to the physicians’ offices, she adds. Now, there are few patients who do not use the chlorhexidine as instructed, she adds.

Once ANCC determines that the facility appears to meet the criteria, based upon the application, a site visit is scheduled, says Donohue. "The surveyors want to confirm that your nursing environment is as you described in the application," she says. "The focus is on patient care, but it’s not the same as survey by an accrediting body such as the Joint Commission [on Accreditation of Healthcare Organizations]," she adds.

The surveyors want to see that nurses have an impact on patient care, so they ask questions of staff members such as, "Do you have a voice in the care of your patients? How do you collaborate with physicians? Why is this a good place for nurses to work?"

"The honesty of your staff is important," says Donohue. For this reason, there is no way to prompt answers, but you do need to make sure all nurses are aware of the surveyors visit and the possibility that any one of them will be asked about nursing practices, interdepartmental communications, and involvement in patient care, she adds.

Although the process involves staff time as well as application and survey fees, it is worth the effort and expense, says Donohue. (See "Resources" at the end of this article.)

"The process of looking at how we, as nurses, affect patient care is important to morale," she says. "It gave us a chance to be proud of what we do."


For more information on magnet hospitals, contact:

Miriam Jolly, RN, BSN, CPAN, PACU and Day Surgery Coordinator, Catawba Valley Medical Center, 810 Fairgrove Church, Road S.E., Hickory, NC 28602. Telephone: (828) 326-3290. E-mail:

Doreen A. Donohue, RN, MSN, Director of Perioperative Services, Capital Health System, 750 Brunswick Ave., Trenton, NJ 08638. Telephone: (609) 394-4520. E-mail:

The Magnet Certification Program is open to any nursing service system within a health care organization. The application fee is $1,000. Survey fees for hospitals and long-term care inpatient facilities are based upon number of beds and begin at $3,700. For information about fees for nonhospital settings, contact the staff. For more information, contact:

American Nurses Credentialing Center, 600 Maryland Ave. S.W., Suite 100 West, Washington, DC 20024-2571. Telephone: (800) 284-2378 or (202) 651-7000. Fax: (202) 651-7001. E-mail Web: