In 2024, Stanford Medicine Children’s Health was proudly again awarded Magnet designation. While this was not the first time the hospital had been recognized for its journey to nursing excellence, the continued recognition shows that the organization is taking positive steps to ensure the best nursing practices and the best possible patient outcomes.
While every hospital’s nursing program is unique, designations like these represent a commitment to nursing excellence. A commitment to growth. A commitment to be better tomorrow.
Nursing is a profession filled with life-long learning. As one of my colleagues said in a recent interview with Daily Nurse, learning is a basic tenant of nursing. We constantly learn new things, gain professional knowledge, and apply this education to improve outcomes.
Building and leading nursing practices is no different. Magnet recognition is an important designation that validates nursing contributions and commitment to providing quality patient care through innovation.
Here are a few best practices and thoughts for nursing leaders aiming to bring a holistic, multidisciplinary approach to nursing with a continued investment in the practice.
Bolster Resilience and Decompression for Transformational Change
Nursing is both incredibly rewarding and challenging at the same time. This equation hasn’t changed since my time by the bedside more than two decades ago. That said, nursing and nursing practices have evolved to prove very resilient. The facts bear this out.
According to reports, nurses show strong resilience; however, they can struggle with decompression. Resilience is at the heart of strong nursing and nursing leadership. The industry deals with high levels of emotion, stress, and fatigue. As a result, nurses must have time to decompress and be prepared to perform their best. With it, optimal care practices and improved patient outcomes are possible.
There are a few ways this can be exhibited:
Appointment of “wellness” positions: A theme with progressing as a nursing practice and an organization is being deliberate about what you say and do. Without this approach, there is no focus or commitment to following through. The same applies to an organization’s journey to build an environment conducive to nursingwellness. Organizations with the capacity should advocate for and hire positions whose focus and intent are directly tied to wellness. Examples of these positions as a part of our journey are the Director of Resiliency and Wellness and the Resilience Education Program Manager. This keeps wellness at the forefront of leaders’ minds and gives them the time and space to focus specifically on supporting nurses.
Carve out time for extracurricular activities and programs: In a fast-paced environment, blocking time for activities that don’t directly impact patient outcomes can be hard. It’s an investment required by the organization and every one the program serves. Nurses have shown a willingness to capitalize on these opportunities and participate in activities that benefit their health and wellness. Examples that help nurses find their center include wellness retreats, resilience assessments, and other stress-alleviating sessions, such as “moments of calm,” in which nurses are given space (individually or with their peers) away from the job.
Advocate for nursing involvement in technology decision-making: Nurses and nursing leaders know that technology integration has been the center of many organizational conversations over the past three to five years. The problem? When nurses aren’t involved in technology decision-making, chances are that it risks being ineffective (or not as effective as it could be) when put into practice. Nursing leaders must advocate for nurses to have a seat at the table, and organizations must trust the individuals and teams who use technology by the bedside every day. For example, nurses should be made aware of the application of artificial intelligence (AI). Trials are going on looking at how AI can support documentation at the bedside. However, without the perspectives of those who use the tools the most, organizations risk the tools adding stress and complication versus giving nurses back time in their day and promoting ease.
Nursing leaders must be intentional about helping nurses and nursing staff boost resilience. Efforts that aren’t intentional will have a short shelf life. They will succumb to the pressures and rigors of daily work.
Nursing Leadership and DEI (Diversity, Equity, and Inclusion) Begin at the Schooling, Education, and Recruitment Levels
While nursing leaders must maintain focus on the organization they are trying to build today, they must keep one eye on the future. According to the American Association of Colleges of Nursing (AACN), a few sobering statistics firmly etch recruiting and talent atop nursing leadership’s priorities.
Data shows that the median age of registered nurses is approximately 46, with more than 25 percent planning to leave the industry or retire over the next five years. Furthermore, it is projected that over 200,000 nursing jobs will be created annually through 2030. Finally, there is a growing demand for nursing and nursing-related roles due to advancements in preventative care and increasing rates of chronic health conditions.
This shows gaps not only in future nursing positions but also in changing the guard as our industries’ tenured workers exit for a well-earned rest. A critical part of filling this gap and improving patient outcomes is becoming more diverse.
Good news—the industry has recently taken leaps towards this goal. I am proof of that: a male, Hispanic nursing leader. Statistics show that nurses are becoming more diverse. According to an HRSA survey, non-Hispanic Black and non-Hispanic Asian RNs now constitute 11 percent and 9 percent of the nursing workforce, up three and four percentage points, respectively. Furthermore, male registered nurses now comprise a larger percentage of the workforce, up to 12 percent. But there is plenty more work to be done.
Prioritizing recruiting strategies regionally and nationally: Building the workforce an organization needs through a DEI lens will mean broadening recruiting efforts. Diverse hiring at the bedside will be required to meet an increasingly diverse patient pool, such as those from Hispanic, Latinx, and Black communities. This isn’t a quick flip of the switch, but in today’s “hybrid” work world, nursing leaders must work closely with their organizations to identify ways to broaden the candidate pool beyond local appointments. This can be through “remote” appointments for positions that don’t require frequent bedside attention. It can also offer relocation bonuses or support for nurses and nursing leaders looking to relocate or stay at an academic-affiliated health center while studying or advancing education.
Build a culture that fosters curiosity: Remembering that nursing is a lifelong learning journey, organizations need to give nurses avenues to continue their education and hone their skills. Building a culture of curiosity and inquiry promotes the pursuit of new knowledge and innovation. Again, as is a familiar guidepost, these efforts must be intentional. There are strategic plans and programs that nursing leaders can put in place to build a lane for nurses to flex their curiosity. For example, a professional nurse development plan recognizes and rewards nurses who strive for excellence in delivering the highest quality of patient care while demonstrating commitment to nursing.
Focus on improving outcomes based on research: The healthcare industry is trained to engage in data-based care practices. It must be a part of everything leaders do. For example, emphasize the development of elevated patient care standards rooted in research and evidence-based practices. One way is through councils, such as Research and Evidence-Based Practice (REBP) or Nursing Shared Governance Councils. These programs use research, science, and clinical care standards to position nurses of all backgrounds to impact the patients they serve positively. The journey to holistic care and building a nursing staff representative of the patient population also allows nurses to bring their unique selves to the bedside without fear.
It is important to select the best clinical care and have diversity in background. Nursing leaders have been preaching the importance of holistic care for decades. To achieve it, the staff must mirror the people that the industry serves.
Succession Planning Extends Beyond Bedside Care
In my multi-decade career in nursing and healthcare leadership, I have engaged with hundreds (if not thousands) of nurses. I have found the following to be true: every individual nurse has a unique career path and different motivators that inspire them most. Nursing leaders must embrace this individualism and empower nurses to position themselves for success today, tomorrow, and every day. This could be bedside, clinical research, education, care coordination, or a position waiting around the corner.
As discussed earlier, recruiting and hiring outside the organization is critical and, in many cases, helps meet the shifting demographics of the patient population. However, nursing leaders must also look internally for growth opportunities. These individuals know the organization and are steeped in its best practices. As a bonus, advancement opportunities are attractive for current and future hires.
We know we are lucky at Stanford to have access to and the means to put this into practice. However, every organization has the potential to do so in some shape or form. In meeting with fellow nursing leaders over the past few years, identifying ways to promote from within has been front and center of conversations.
Here are a few considerations:
Search for candidates within the clinical nursing pool: Look internally for growth opportunities. From experience, this has been considered a pillar of Magnet excellence and shows a continued investment in an organization’s nursing staff. To provide context, about 70% of current nursing leaders were initially clinical nurses before being internally promoted. Positions include Nurse Educator, Assistant Patient Care Manager, and Patient Care Manager. It shows organizations are willing to invest in their people and reward them with opportunities.
Identify opportunities for interim roles: When it comes to succession planning or advancing nurses and nursing leaders, it’s not always a matter of diving into the deep end. The industry is changing so much that interim opportunities benefit the organization and staff and give a great chance to get a feel for what skill sets each nurse has (or is interested in acquiring). It can also provide nurses with an intentional pause from their current role or energize them with the opportunity to take on something new. Half of our hospital’s current nursing leadership have had the chance to take on an interim role during their tenure. For many, it clarified a career path or path to leadership. For others, it reinforced a love for their current role while giving them new skills to advance the practice.
Turn to formalized programs through partnership: The healthcare industry is no stranger to partnerships – and working together to achieve a common good. Nursing development is no different. The proper infrastructure must be in place. Hospitals should look for alliances that allow nurses to participate in programs or leadership courses — or engage in fellowships or internships. For example, partnering with local academic hospitals to offer curricula or courses focused on leadership advancement. Or they are partnering with leadership institutes to carve out intentional personal and professional growth time.
Don’t forget. Nursing leaders must ask nurses for feedback on the effectiveness of succession planning initiatives. Without it, you cannot evolve the program over time.
Reminder: It’s Okay to be Uncomfortable
Get outside your comfort zone to get the most out of nursing staff and establish a resilient, successful, and diverse practice. Not everything discussed is easy, but the rewards are valuable for nurses, nursing leadership, and care teams.
Here’s an example: There was a nurse I worked with for an interim opportunity. They were a little fearful that they didn’t have the skill set to take on this task. It was undoubtedly a new domain, but I had seen enough to know that they could thrive in that role. There were multiple conversations where we talked through scenarios and expectations, and we even quelled fears about elements of the job. This nurse took a leap of faith just as I had trusted them. The result was increased volume, a renewed sense of self, and personal leadership growth.
Moral of the story. Without discomfort, growth risks falling by the wayside.
Every organization is slightly different, as is every nursing staff and every patient population.
Ultimately, the goal is to create the best workplace that delivers the best possible patient outcomes.
This is what matters to us as nurses and nursing leaders.
And, most importantly, it matters to our patients.
It’s a long journey, but one that we’re well on our way to achieving.
Thank you to all the nurses and nursing leaders around the nation.
If you can’t attend, we’ve got you covered in advance as we sat down with Debbie Hatmaker, PhD, RN, FAAN, the Chief Nursing Officer at the American Nurses Association (ANA)Enterprise, to discuss the ANA’s role in addressing the nurse staffing crisis and how nurses can use the Magnet model to better their careers.
What follows is our interview, edited for length and clarity.
American Nurses Association (ANA) Chief Nursing Officer, Debbie Hatmaker, PhD, RN, FAAN
-Earlier this year, the ANA urged Congress to address the nurse staffing crisis and the work environment issues. Can you discuss the need for a national dialogue and ongoing collaboration between nurses, Congressional leaders, and other key stakeholders to support our nursing workforce, patients, and our nation’s health and well-being?
The nurse staffing crisis continues to demand a national dialogue with nurse-led approaches to help ease the enduring work environment challenges that nurses face across numerous specialties and healthcare settings. We support enforceable minimum nurse-to-patient ratios that reflect key factors such as patient acuity, intensity of the unit practice setting, and nurses’ competency, among other variables. And this is just one part of a larger solution to solve this.
We continue to work on addressing other challenges that have significantly made the nurse staffing issue worse, such as burnout, workplace violence, mandatory overtime, and barriers to full practice authority.
Nearly 400 ANA members convened at the U.S. Capitol, representing the nation’s more than 4 million registered nurses, to petition Congress to address the national nurse staffing crisis this summer. In addition to advocating, ANA is also advancing solutions from the 2022 Nurse Staffing Think Tank2022 in partnership with other leading organizations, which produced a series of actionable strategies that healthcare organizations could implement within 12 – 18 months.
We continue to advocate on behalf of nurses and remain a collaborative partner. Our goal is to empower nurses and position them for success. We continue calling on Congress to enact meaningful legislation and policies that improve nurse staffing and work environments.
–How can nurses use the Magnet Model to better their nursing leadership and shared decision-making?
The Magnet process fosters a collaborative culture that spurs shared decision-making. Magnet organizations are even provided with a multiyear framework for quality improvement and a structured way to engage staff in decision-making. This tool can help energize and motivate teams. In fact, team building, collaborating across disciplines, regular open community, and building staff engagement, while difficult to quantify, are often what happens during the Magnet process.
-What are some questions to ask before accepting a job at a Magnet hospital? Can you offer some tips for helping nurses choose which Magnet hospital to work in?
Each Magnet-recognized organization will have its own hiring standards, so each nurse should review those as they apply for or accept a position. But they should know that whatever role they fill, a Magnet organization will invest in them and their potential. At ANCC, we’ve created a free resource for nurses looking for select practice environments and interview questions to ask.
Magnet Recognition means education and development through every career stage, which leads to greater autonomy at the bedside. A Magnet organization supports opportunities for nurses to pursue new skills and professional development, champions them in those pursuits, and rewards them for advancing in their profession.
We’ll be at the 2023 ANCC National Magnet Conference® October 12-14 at the at the McCormick Place Convention Center in Chicago, Illinois. Stop by booth #918. We look forward to seeing you there!
In a time of great competition in the post-pandemic healthcare marketplace, hospitals and other facilities are smart to find ways to differentiate themselves from the many choices consumers can access. We all vote with our feet and wallets when it comes to how we spend our healthcare dollars, and poor treatment at a hospital or clinic is a high likelihood that we’ll seek care elsewhere.
Likewise, employees also vote with their feet, and we can’t retain nurses when, despite special labels like Magnet, we allow bullying and other aberrant behaviors to thrive within a negative workplace culture.
Designations like Magnet status are ways healthcare organizations can demonstrate their striving for excellence. But what happens when an unhealthy or toxic organization hides behind something like a Magnet designation, ignoring systemic issues that fancy words, plaques, and awards won’t fix?
A Fox in the Magnet Henhouse
I recently spoke with a dedicated, well-educated, experienced, intelligent, and successful nurse who, up until earlier this year, worked for a Magnet facility somewhere in the U.S. The Magnet designation is designed to be a magnet for high-quality nurse clinicians, and this nurse is a person of great integrity and professionalism whom this employer was lucky to have on staff.
During her work on several hospital units, this individual was targeted by what we might call a “queen bully.” The bully nurse was highly experienced, had worked for the organization for many years, and was seen as a leader and an indispensable employee by the administration.
Tragically, the nurse I spoke with was psychologically traumatized by the bully and the other employees who colluded with her behavior. This nurse’s reports of being harassed were dismissed and ignored, and she eventually had to take a leave of absence to pursue psychological treatment for post-traumatic stress. Meanwhile, the bully kept her job and faced no consequences whatsoever.
Based on her egregious bullying behavior, this nurse bully should have been fired years ago. Still, managers and executives were likely scared to death of her, and if a union was involved, firing her might have proven a highly challenging avenue they were hesitant to pursue.
Sadly, this nurse was allowed to “rule the roost” for years as a frightening and controlling fox willingly set loose in the hen house, and the nurse whom I spoke with had been one of her main targets for months.
A bully can bring down the morale of an entire or multiple units. If bullies can thrive and spin their nasty webs throughout a facility or organization, the entire workplace ecosystem and culture can be poisoned.
Confronting the Shadows
In the final analysis, a Magnet designation doesn’t make an organization great. Magnet status is also not a magic bullet or blanket blessing from the authorities that deems a facility perfect and free from flaws.
Creating a just, civil, highly functional, and effective organization may be enhanced by designations or awards like Magnet status. Yet, the hard work of making a healthcare institution a safe and happy place to work doesn’t stop when the plaque goes on the wall.
When weeding out bad actors like bullies, the administration must have the will and the backbone to confront the issue head-on. Likewise, employees must feel safe to document and report such issues without fear of retaliation or having their complaints dismissed out of hand.
No matter if a bully is a great clinician with years of experience — there must be zero tolerance for aberrant behavior, and consequences must be swift, decisive, and universally applied.
Every employee deserves to feel supported in doing their best work. They likewise need to be able to trust that they will be protected from those who would do them harm. No staff member should live in fear of bullying, discrimination, harassment, or any other type of negative treatment, and it is the responsibility of the organization to create a culture that affirms positivity and trust and rejects anything less than perfect civility and kindness.
The work of achieving Magnet status is a lovely ideal with very real-world applications when truly operationalized. However, every workplace has a shadow, and it is from confronting that shadow and cleansing the organization’s darkest corners that a more civil, functional, and effective institution arises.
Magnet status is something to reach for, but only in the context of the hard work it takes to create a workplace to be proud of that is safe for all who walk through its doors.
We’ll be at the 2023 ANCC National Magnet Conference® October 12-14 at the at the McCormick Place Convention Center in Chicago, Illinois. Stop by booth #918. We look forward to seeing you there!
The Magnet designation for hospitals emerged in 1990 under the auspices of the American Nurses Credentialing Center (ANCC) as a strategy for catalyzing and recognizing the highest possible standards for quality nursing care.
Since its inception, Magnet has given ambitious hospitals something concrete to strive for. Magnet has also allowed nurses to identify facilities that deliver optimal patient care while creating positive workplace cultures for nurses who care about their work and what their employers stand for.
Walking the Talk
As of this writing, fewer than 600 hospitals hold Magnet status, and since there are over 6,000 hospitals in the U.S., we can see that Magnet status remains the exception, not the rule.
Magnet standards make sense when we consider what makes a hospital stand out. We can understand why some nurses are drawn to seeking employment at facilities prioritizing achieving and maintaining Magnet status.
From another perspective, while Magnet designation is an impressive achievement, we can be sure there are plenty of excellent non-Magnet hospitals where nurses lead satisfying and robust careers while delivering outstanding care. However, there are Magnet-designated hospitals where things may not be as perfect as they might like us to believe, and much work remains to be done for those institutions to walk their talk.
As boots-on-the-ground professionals, nurses know the inner workings of healthcare employers and facilities. While a certificate from a certifying body is all well and good, nurses want to see the evidence in their day-to-day environment. What aspects of Magnet do nurses want to see and experience? A few might include:
Shared governance
Quality improvement initiatives
Advancement of nursing practice
An emphasis on evidence-based practice
Transformational leadership
Career advancement and a leadership track
No matter where they work, nurses want to feel respected, acknowledged, and rewarded for their dedication. They want a workplace free of incivility and to be treated as more than just cannon fodder on the front lines of the battle against disease.
Hospital organizations that walk their talk hold nurses in the highest esteem. Seasoned nurses are recognized for their expertise and institutional memory, and new nurses are embraced as the representatives of the future that they truly are. Everyone’s place should be valued, and nurses should feel that they are part of something bigger than themselves, but where individual gifts hold meaning.
Like Attracts Like
When we consider the nature of a magnet, we think of how a magnet attracts objects with similar properties. In contrast, those unlike the magnet are repelled or completely unattracted by the magnet’s force.
Imagine being a fly on the wall of the brainstorming sessions that occurred in the late 1980s when the ideas that led to Magnet status were still gestating. The concept of magnetism may have yet to emerge immediately during those conversations. Nevertheless, many ideas may have been floated in those early days, and who knows how the process eventually resulted in magnetism bubbling to the surface.
These days, we’re accustomed to the notion of a Magnet hospital. Acute care facilities want their nurses to be the best, and savvy patients aware of the Magnet designation may seek care at facilities holding such status.
Focus on Quality Nursing Care
If approximately 10 percent of American hospitals are Magnet-designated, what are the remaining 90 percent focused on, and what do their nurses experience? Do they feel that something is missing? Perhaps. Are there non-Magnet community hospitals without the resources to dedicate to pursuing Magnet status that still shines like healthcare stars? Without a doubt. Are there facilities where satisfied patients receive optimized, high-quality care from incredible nurses devoted to doing their best every day? Absolutely!
We all know that certification is no panacea — institutions are bureaucracies made up of people, and human beings (and many bureaucracies) are inherently flawed. Still, doing one’s utmost to achieve a worthwhile goal can give meaning to our work, and a collective dedication to Magnet certification can empower everyone.
If you work at a Magnet facility, consider whether it meets your expectations. And if you work at a non-Magnet hospital, how does your hospital show up on the positive side of the quality equation? Hopefully, your employer sees you for who you are, values your contributions, recognizes your gifts and pays you well for your dedicated service.
You can be a human magnet for positivity, excellent nursing practice, high-quality patient care, and a happy, satisfying career. And if the Magnet process is part of making your career successful, all the better.
Minority Nurse is thrilled to welcome Keith Carlson, “Nurse Keith,” a well-known nurse career coach and podcaster of The Nurse Keith Show as a guest columnist. Check back every other Thursday for Keith’s column.
We’ll be at the 2022 ANCC National Magnet Conference® October 13-15 at the Philadelphia Convention Center in Philadelphia, PA. Stop by booth 2018. We look forward to seeing you there!
Hospital administrators across the nation advocate the merits of Magnet designation. The American Nurses Credentialing Center (ANCC), an affiliate of the American Nurses Association, awards Magnet status to hospitals that satisfy designated criteria that measure the strength and quality of the institution’s nursing care.
What Are Magnet Hospitals?
Magnet-designated hospitals are regarded as the pinnacle of nursing practice, leadership, and innovation. A Magnet designation stands on five pillars: transformational leadership, structural empowerment, professional practice, innovation, and empirical outcomes.
More than ever, hospitals seek to attract the best nurses, physicians, and ancillary medical staff. Magnet hospitals appear to fare better with these recruiting metrics, but do the benefits outweigh the costs? The return on investment requires measurable patient care metrics, a superior nursing environment involved in hospital decision-making, and higher net patient revenue than non-Magnet hospitals. With consumers looking to hospitals for quality, hospitals seek to raise the bar with a Magnet designation as a roadmap for excellence.
Finding a Hospital with Magnet Status
With nurses becoming more valuable amid the growing shortage, nurses can leverage their demand by exploring open nursing jobs and finding a Magnet hospital that meets their needs. How do you apply to a Magnet hospital? As with any hospital, search the institution’s website and locate the nursing employment link. Use our Magnet Showcase to review Magnet-designated hospitals to research your next employment opportunity.
Safety Across the Board
Hospitals are constantly striving to improve patient safety. However, a safer work environment extends beyond patient safety through lower nurse-to-patient ratios. A Magnet appointment is an investment into a safer physical work environment for the nurses. Reduced physical injuries and decreased blood and body fluid exposure rates translate into healthier nurses and reduced costs.
Improved Outcomes
When nurses have an elevated level of job satisfaction, patient outcomes improve. Low staff nurse turnover, a path to grievance resolution, decentralized decision-making, participation in data collection, and involvement in patient care delivery encourage and reward nurses through advancement in nursing practice. A Magnet designation validates the hospital’s mission.
Reducing Burnout
The COVID-19 pandemic left the nursing landscape littered with shortages and premature departures. Nurses seek engagement and empowerment; competition is fierce for high-quality, professional nurses. As health care grows, patients are becoming more complex. Shift work is demanding, with long pressure-filled hours. If you include the mental, physical, and emotional factors that fuel attrition in nursing, obtaining a Magnet designation can lead an institution toward an increase in the quality of the work environment.
Professional Improvement
Within health care, quality improvement is a sustained culture of practice improvement. The professional development of nurses is a tenet of Magnet: having employers support nursing autonomy and empowerment can lead to cooperation in leadership and vision. To succeed in health care, interdisciplinary communication and a collaborative mission of nursing practice can result in better partnerships with hospital leadership.
The Costs
Obtaining Magnet status can be expensive for smaller institutions. It takes over four years to complete the process, with an average of over two million dollars invested by the hospital. Proponents will argue that Magnet designation will offset the associated cost with higher net patient revenue and improved outcomes. A Magnet-designated hospital receives an adjusted net increase in inpatient income of $104.22–$127.05 per discharge. This translates into an added $1,229,770–$1,263,926 in income per year. Hospitals achieve payback from Magnet Status in two to three years using this data.
Critics argue little evidence exists that Magnet hospitals’ nurses are better off compared to their non-award-bearing competition. More than an impression of nursing excellence is needed to justify the added time and cost for what some professionals consider a marketing gimmick. For nurses weighing the claimed benefits of a supportive work environment, autonomy, less risk of burnout, opportunities for education and research, and the real-world practice environment of a Magnet hospital is imperative. So, nurses, do your research.
We’ll be at the 2022 ANCC National Magnet Conference® October 13-15 at the Philadelphia Convention Center in Philadelphia, PA. Stop by booth 2018. We look forward to seeing you there!
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