PowerPoint Presentation

Magnet HospitalsAnd Patient OutcomesDo Magnet organizations provide a safer work environment with better patient outcomes?By Sandra Gilman, Stephanie Gulledge, Kim Proux & Sueann Unger

Magnet Program HistoryNursing shortage in the 1980sThe American Academy of NursingDeveloped a task force to determine why some hospitals were more successful than others in nursing recruitmentResults indicated 41 hospitals had Magnet characteristics

So in the 1990s American Nurses Credentialing Center (ANCC) established Magnet recognition Program

American Nurses Credentialing Center. (2012). History of the Magnet recognition program. Retrieved from http://www.nursecredentialing.org/MagnetHistory.aspx

Magnet Evolution14Standards 5ComponentsSources of Evidence 14 Forces

3 Current Magnet Structure

ANCC, 2012American Nurses Credentialing Center. (2012). Retrieved from: http://www.nursecredentialing.org

Current Magnet Facts392 Magnet Facilities (as of March 2012)AustraliaLebanonSingaporeUnited States

ANCC, 2012

American Nurses Credentialing Center. (2012). History of the Magnet recognition program. Retrieved from http://www.nursecredentialing.org/MagnetHistory.aspx

Adoption of National Quality Forum Safe Practices by Magnet Hospitals Article #1Descriptive Summary

Researchers studied and compared Magnet hospitals adoption of safe practice versus Non-Magnet hospitals.Data collected from 218 Magnet hospitals and 2,308 non-Magnet hospitals.

Jayawardhana, J., Welton, J.M., & Lindrooth, R. (2011). Adoption of National Quality Forum Safe Practices by Magnet hospitals. The Journal of Nursing Administration, 41(9), 350-356, doi:10.1097/NNA.0b013e31822a71a7

Adoption of National Quality Forum Safe Practices by Magnet Hospitals Article #1Purpose of the study

To determine whether Magnet hospitals (MHs) were more likely to adopt the National Quality Forum (NQF) Safe Practices strategy to improve patient safety over non-Magnet hospitals (NMHs).Jayawardhana, J., Welton, J.M., & Lindrooth, R. (2011). Adoption of National Quality Forum Safe Practices by Magnet hospitals. The Journal of Nursing Administration, 41(9), 350-356, doi:10.1097/NNA.0b013e31822a71a7

Adoption of National Quality Forum Safe Practices by Magnet Hospitals Article #1Study FindingsIn 2004 MHs had higher mean Composite Safe Practice Score (CSPS) of 862 compared with the NMHs mean CSPS of 794In 2006 NMHs improved their CSPS at a greater rate moving to 892, whereas MHs improved from 862 to 928 It was also determined that MHs had higher nurse per patient ratio, and had advanced clinical technologies.

Jayawardhana, J., Welton, J.M., & Lindrooth, R. (2011). Adoption of National Quality Forum Safe Practices by Magnet hospitals. The Journal of Nursing Administration, 41(9), 350-356, doi:10.1097/NNA.0b013e31822a71a7

Critical AppraisalStrengths of this study included the use of:Use of nationally recognized surveysUse of appropriate measures to control for bias* Saiden Index (weighted measures to adjust for difference in technological services available)*Herfindahl-Hirschman Index (weighted measure to adjust for size of the institution)Limitations of the study included :Use of only Urban hospitals, rural hospitals were not usedLeapfrog group Survey is voluntaryReporting of NQF safety practices are voluntary (Heckman Correction Method was used to correct for this)

Overall this study was effective at showing a positive correlation between Magnet hospitals and adoption of safe practices

9Comparison of Patient Outcomes in Magnet & Non-Magnet Hospitals Article #2Descriptive SummaryThis descriptive design studied and compared patient outcomes between Magnet and non-Magnet hospitalsThe sample consisted of 19 Magnet and 35 non-Magnet university hospitals and affiliates and was based on data from 2005.Goode, C.J., Belgen, M.A., Park, S.H., Vaughn, T., & Spetz, J. (2011). Comparison of patient outcomes in Magnet and non-Magnet hospitals. The Journal of Nursing Administration, 41(12), 517-523, doi:10.1097/NNA.0b013e3182378b7c

10Comparison of Patient Outcomes in Magnet & Non-Magnet Hospitals Article #2Purpose of the study

Focusing on: Patient OutcomesStaffing in Magnet and Non-Magnet hospitals

Goode, C.J., Belgen, M.A., Park, S.H., Vaughn, T., & Spetz, J. (2011). Comparison of patient outcomes in Magnet and non-Magnet hospitals. The Journal of Nursing Administration, 41(12), 517-523, doi:10.1097/NNA.0b013e3182378b7c

Comparison of Patient Outcomes in Magnet & Non-Magnet Hospitals Article #2Study Findings Non-Magnet hospitals had better patient outcomes than Magnet hospitals. Magnet hospitals had slightly better outcomes for pressure ulcers, but infections, postoperative sepsis, and postoperative metabolic derangement outcomes were worse in Magnet hospitals. Magnet hospitals also had lower staffing numbersGoode, C.J., Belgen, M.A., Park, S.H., Vaughn, T., & Spetz, J. (2011). Comparison of patient outcomes in Magnet and non-Magnet hospitals. The Journal of Nursing Administration, 41(12), 517-523, doi:10.1097/NNA.0b013e3182378b7c

Critical Appraisal Strengths of this study include:*Solid data from NDNQI (national database nursing quality indicators)*Sufficient sample of 5,388 units in 636 hospitals*Evaluated nurse staffing, hospital Magnet status, and patient fallsWeaknesses of this study include:*Results showed the opposite of what was expected with more LPN and NA hours associated with more falls *Data was from 2004, prior to mandating reporting falls

Overall, results were consistent that the fall rate was 5% lower in Magnet hospitals compared to non-Magnet hospitals

Workplace Empowerment and Magnet Hospital Characteristics as predictors of Patient Safety Climate Article #3

Armstrong, K., Laschinger, H., & Wong, C. (2009). Workplace empowerment and Magnet hospital characteristics as predictors of patient safety climate. Journal of Nursing Care Quality, 24(1), 55-62, doi:10.1097/NCQ.0b013e31818f5506Descriptive Study Focus of the studyThe use of Kanters theory of workplace empowerment to improve the work environment and patient safety climateThis is a replication of a previous study using a larger more representative sample of nurses.

.

Workplace Empowerment and Magnet Hospital Characteristics as predictors of Patient Safety Climate Article #3Purpose of the study

The purpose of the study was to provide nurse leaders with ideas for improving the patient safety climate by improving the quality of nurses work environmentsArmstrong, K., Laschinger, H., & Wong, C. (2009). Workplace empowerment and Magnet hospital characteristics as predictors of patient safety climate. Journal of Nursing Care Quality, 24(1), 55-62, doi:10.1097/NCQ.0b013e31818f5506

Workplace Empowerment and Magnet Hospital Characteristics as predictors of Patient Safety Climate Article #3Study FindingsOverall empowerment was positively related to overall Magnet hospital characteristics Total empowerment was significantly positively related to perceptions of patient safety climateMost strongly related to patient safety climate were nursing foundation for care, manager ability, and nursing participation in hospital affairsCombination effect of increased access to empowerment structures and higher levels of Magnet hospital characteristics were significantly related to higher perceived patient safety climateArmstrong, Laschinger, & Wong, 2008Armstrong, K., Laschinger, H., & Wong, C. (2009). Workplace empowerment and Magnet hospital characteristics as predictors of patient safety climate. Journal of Nursing Care Quality, 24(1), 55-62, doi:10.1097/NCQ.0b013e31818f5506

Critical Appraisal Strengths of this study include:*Adequate sample size * questionnaire was previously tested, validated and cost effective* Limitations of this study include:*Concern for bias because a questionnaire was used

Kanters theory of organizational empowerment was found to be reinforced by this study due to the relationship between nursing practice environments and patient safety

Patient Falls: Association with Hospital Magnet Status and Nursing Unit Staffing Article #4Descriptive Summary The relationship between hospital Magnet status, nursing unit staffing and patient falls were examined in a cross-sectional study using 2004 National Database of Nursing Quality Indicators (NDNQI)Data was obtained from 5,388 units in 108 Magnet and 528 non-Magnet hospitals

Lake, E.T., Shang, J. Klaus, S., & Dunton, N. (2010). Patient falls: Association with hospital Magnet status and nursing unit staffing. Research in Nursing & Health, 33(5), 413-425, doi:10.1002/nur.20399

Patient Falls: Association with Hospital Magnet Status and Nursing Unit Staffing Article #4Purpose of the study

To compare the relationships of nurse staffing, RN composition, hospitals Magnet status and patient falls

Lake, E.T., Shang, J. Klaus, S., & Dunton, N. (2010). Patient falls: Association with hospital Magnet status and nursing unit staffing. Research in Nursing & Health, 33(5), 413-425, doi:10.1002/nur.20399

Patient Falls: Association with Hospital Magnet Status and Nursing Unit Staffing Article #4Study FindingsBivariate results showed average fall rates were 8.3% lower in Magnet than non-Magnet hospitalsMultivariate models showed fall rate was 5% lower in Magnet than non-Magnet hospitalsAn additional registered nurse hour per patient day resulted in 3% lower fall rate in ICUsAn additional licensed practical nurse or nursing assistant hour was associated with a 2-4% higher fall rate in non-ICUsPatient safety may be improved with the creation of Magnet or Magnet-like hospital standards

Lake, E.T., Shang, J. Klaus, S., & Dunton, N. (2010). Patient falls: Association with hospital Magnet status and nursing unit staffing. Research in Nursing & Health, 33(5), 413-425, doi:10.1002/nur.20399

Critical Appraisal Strengths of this study include:*Accuracy of total hours per patient day and skill mix*Use of a database to separate productive and non-productive hours*Sample consisted of only teaching hospitalsLimitations included:*small sample size of Magnet hospitals and the sample composition of teaching hospitals

Overall the study proved that pressure ulcers were lower in Magnet hospitals, but the study found that non-Magnet hospitals have better outcomes in all other areas than Magnet hospitals.

Evidence in PracticeMagnet recognized hospitals have the highest standard of excellence including nursing quality, professional work environment, evidence-based practice and positive patient outcomes.

Results of our collation of research studies reveal Magnet hospitals were more likely to achieve higher rates of National Quality Forum safe practices than non-Magnet hospitalsLittle difference was found in patient outcomes between Magnet and non-Magnet designationStaff empowerment was positively related to Magnet status and patient safety outcomes are the result Patient fall rates were 5% lower in Magnet credentialed hospitals and patient safety may be improved by creating a magnet-like environment

Evidence in PracticePatient falls and pressure ulcers are nurse sensitive indicators, there are current standards in place at most institutions to decrease the incidence of bothSome of us are from a Magnet institution or an institution that is in their Magnet journey. Evidence that we currently use is:*Nursing Empowerment, which does seem to have an impact on patient outcomes, as nurses are involved in the improvement of patient care process*As a nurse who was part of the Magnet journey, we can say from personal perspective that there has been a positive correlation in patient outcomes and satisfaction.

Overall, the evidence given is useful for institutions to determine if there is a benefit to their staff and patients to pursue Magnet designation.

The Influence of Magnet DesignationNursing CareEvidenceBasedPractice

Improved PatientCare ResearchEvidenceGenerated

Great Outcomes

RecommendationsPatient outcome evidence is limitedResearch is prior to Magnet focus changeCurrently there are new Magnet designation requirementsNurse OutcomesWorkforce OutcomesPatient OutcomesClinical Outcomes

Ponte, P. & Luzinski, C. (2012). Letter to the editor: Comparison of patient outcomes in Magnet and non-Magnet hospitals. The Journal of Nursing Administration, 42(2), 65-66, doi: 10.1097/NNA.0b013e318244bdc0

25 RecommendationsMore studies that focus on patient outcomes are neededResearchers need to enhance sample sizes, strengthen data collection and analysis methods along with identify key variables to explain findings. The evidence presented in this paper shows promise of the impact Magnet hospitals can have on positive patient outcomes but needs to be enhanced with additional research studies.

Ponte, P. & Luzinski, C. (2012). Letter to the editor: Comparison of patient outcomes in Magnet and non-Magnet hospitals. The Journal of Nursing Administration, 42(2), 65-66, doi: 10.1097/NNA.0b013e318244bdc0

References

References