More hospitals seek to be magnets’ for nurses

Autonomy, respect linked to lower injuries

One word describes hospitals that have the best overall work environment: Magnet.

Hospitals that give more autonomy to nurses and have less hierarchy — qualities that gained them designation by the Magnet Recognition Program of the American Nurses Credentialing Center in Washington, DC — have lower levels of "emotional exhaustion" and burnout, lower rates of needlestick injuries, higher job satisfaction, and better retention and recruitment of nurses, according to several recent studies.1

"In every dimension we’ve ever studied, the magnet hospitals look substantially different and better," says Linda Aiken, PhD, FAAN, FRCN, RN, director of the Center for Health Outcomes and Policy Research at the University of Pennsylvania School of Nursing in Philadelphia. Patients benefit as well as workers. Hospitals that achieve the standards of the magnet program also have better patient outcomes and satisfaction, she says.

In a time of labor shortages, those attractions are compelling. Magnet status is becoming a highly sought designation, as the number of applications nearly tripled from 2001 to 2002. There are 67 magnet hospitals, and more than 90 pending applications. Eighteen hospitals applied in the first few weeks of January. The magnet program began in 1994.

"As there are more magnets out there, more people hear about it and they have more access to mentors," says MaryMoon Allison, MHSE, BSN, RN, assistant director for accreditation and the magnet recognition program.

"We have good documentation that retention rates within magnets are significantly better than nonmagnets. In this time of nursing shortage, people are looking for any avenue to get or to keep their nurses," she says.

Attaining the "magnet" designation is not a simple process. It is based on the overall organizational structure and climate, not just on a checklist of equipment and policies. Hospitals can spend up to two years gathering documentation after their initial application and have spent as much as eight years completing the process, says Allison.

"It’s really about forces of magnetism, and about the internalization of those and the reflection of those within the organization and the function of the organization of the facility. It takes a long time," she says.

Even before they apply, hospitals must gauge how they compare to the magnet attributes — and what it would take to change. "Only about 19% of the hospitals in the U.S. have a good work environment that could potentially qualify them for magnet status," says Aiken.

Magnets avoid severe nursing shortage

The concept that some hospitals become a magnet for the best employees first emerged in a 1983 study by the American Nurses Association’s (ANA) American Academy of Nursing. While some hospitals faced severe nursing shortages, others continued to attract and keep their nurses. The common qualities of those hospitals proved to be the "magnet" elements of leadership, organizational structure, and good communication.

Today, the magnet criteria are based on the ANA’s Scope and Standards for Nurse Administrators, and the commonalities are well studied.

In a magnet hospital, "nurse leaders are dynamic, innovative, respected people within the hospital organizational environment," Allison says. "You’re talking about getting the right leadership team together and on the same track."

Nurses have more autonomy and a better relationship with physicians. Administrators are responsive to the concerns and suggestions of nurses, and create opportunities for career advancement, says Aiken.

As a result, magnet hospitals have better protective equipment and safer work practices, she says. "I’d be willing to venture that anything that facilitates clinical care magnet hospitals would be more likely to have," she says. "They are by definition very patient-centered, and they invest a lot in the people closest to patients: nurses.

"They have better staffing ratios. They don’t have to, but they do. We know they tend to have better equipment on the prevention of needlestick injuries. Everything we’ve ever looked at that has anything to do with making patient care better and creating a more satisfying work force, the magnet hospitals have it," she says.

One study compared magnet hospitals without a specialty unit for the treatment of AIDS with nonmagnet hospitals that have that specialty. The magnet hospitals had a lower mortality rate.2

"The positive organizational climate appeared to have a greater impact than did specialization on reducing death rate," concluded the authors of a literature review in the American Journal of Infection Control linking organizational climate to worker and patient safety.3

"Establishing a safety culture in an organization is the only way you can promote safety," says Gina Pugliese, RN, MS, vice president of the Premier Safety Institute in Chicago and one of the authors. "It has to be throughout your organization — how you plan safety into all the things you’re doing, how you provide opportunities to enhance reporting so it’s nonpunitive."

[Editor’s note: More information on magnet hospitals is available from the American Nurses Credentialing Center, 100 Maryland Ave. S.W., Suite 100 West, Washington, DC 20023-2571. Telephone: (202) 651-7262. E-mail: Web site:]


1. Aiken LH. "Superior Outcomes for Magnet Hospitals: The Evidence Base." In: Magnet Hospitals Revisited: Attraction and Retention of Professional Nurses, McClure ML, Hinshaw AS (eds.). Washington, DC: American Nurses Publishing; 2002.

2. Aiken LH, Sloane DM, Lake E. Satisfaction with inpatient AIDS care: A national comparison of dedicated units and scattered beds. Med Care 1997; 35(9):948-962.

3. Lundstrom T, Pugliese G, Bartley J, et al. Organizational and environmental factors that affect worker health and safety and patient outcomes. Am J Infect Control 2002; 30: 93-106.