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RUNNING HEAD: MAGNET STATUS: IS IT WORTH PURSUING? 1

Magnet Status: Is it Worth Pursuing?

Research Report

Robert Swallow

Southwestern College Professional Studies

BUS-510 Business Research

Dr. Joseph Hamlett

November 8, 2015

MAGNET STATUS: IS IT WORTH PURSUING? 2

Table of Contents

List of Illustrations…………………………………………………………………….…………..3

Executive Summary……………………………………………………………………………….6

Introduction………………………………………………………………………………………..7

Problem Statement………………………………………………………………………………...8

Background of Problem….………………………………………………………………………10

Research Design and Methodology……………………………………………………………...11

Limitations………………………………………………..……………………………………..12

Literature Review…………………………………………………………………………..……12

Survey Results and Analysis…………………………………………………………………….15

Conclusion……………..………………………………………………………………………..39

Recommendations………………………………………………………………………………39

References……………………………………………………………………………………….40

Appendixes………………………………………………………………………………………42


List of Illustrations

Surveys……………………………………………………………………………………….42-43

Survey 1………………………………………………………………………………….42

Survey 2………………………………………………………………………………….43

Survey Responses…………………………………………………………………………….16-18

Table A: All Response for Part 1………………………………………………………..16

Table B: Magnet Responses for Part 1……….………………………………………….16

Table C: Non-Magnet Responses for Part 1 ………….…………………………………17

Table D: All Responses for Part 2……….………………………………………………17

Table E: Magnet Responses for Part 2………..………………………………………….18

Table F: Non-Magnet Responses for Part 2………..………………………………….…18

Survey Analysis …….………………………………………………………………………..19-38

Graph 1: All Participants Safety…………………………………………………………19

Graph 2: Magnet Participants Safety Importance ....…………………………………….19

Graph 3: Magnet Participants Safety Satisfaction …..…………………………………..20

Graph 4: Non-Magnet Participants Safety Importance …………………………………20

Graph 5: Non-Magnet Participants Safety Satisfaction…………………………………21

Graph 6: Magnet Participants Teamwork Importance…………………………………..21

Graph 7: Magnet Participants Teamwork Satisfaction………………………………….22

Graph 8: Non-Magnet Participants Teamwork Importance…………………………….22

Graph 9: Non-Magnet Participants Teamwork Satisfaction…………………………….23

Graph 10: Magnet Participants Sense of Control Importance...........................................23


Graph 11: Magnet Participants Sense of Control Satisfaction…………………………..24

Graph 12: Non-Magnet Participants Sense of Control Importance……………………...24

Graph 13: Non-Magnet Participants Sense of Control Satisfaction……………………..25

Graph 14: Magnet Participants Collaboration Importance………………………………25

Graph 15: Magnet Participants Collaboration Satisfaction……………………………...26

Graph 16: Non-Magnet Participants Collaboration Importance…………………………26

Graph 17: Non-Magnet Participants Collaboration Satisfaction………………………...27

Graph 18: Magnet Participants Voice Importance………………………………………27

Graph 19: Magnet Participants Voice Satisfaction………………………………………28

Graph 20: Non-Magnet Participants Voice Importance…………………………………28

Graph 21: Non-Magnet Participants Voice Satisfaction………………………………...29

Graph 22: Magnet Participants Quality Importance……………………………………..29

Graph 23: Magnet Participants Quality Satisfaction…………………………………….30

Graph 24: Non-Magnet Participants Quality Importance……………………………….30

Graph 25: Non-Magnet Participants Quality Satisfaction…………………………….…31

Graph 26: Magnet Participants Management Support Importance………………….…..31

Graph 27: Magnet Participants Management Support Satisfaction…….…………..……32

Graph 28: Non-Magnet Participants Management Support Importance………………...32

Graph 29: Non-Magnet Participants Management Support Importance…………...........33

Graph 30: Magnet Participants Recognition Importance……………..………………….33

Graph 31: Magnet Participants Recognition Satisfaction………………………….…….34

Graph 32: Non-Magnet Participants Recognition Importance……....………………......34

Graph 33: Non-Magnet Participants Recognition Satisfaction…………………..……....35


Graph 34: Magnet Participants Professional Growth Importance………………..…..…35

Graph 35: Magnet Participants Professional Growth Satisfaction………………………36

Graph 36: Non-Magnet Participants Professional Growth Importance…………..……..36

Graph 37: Non-Magnet Participants Professional Growth Satisfaction………….…..…37

Graph 38: Pie Chart: Magnet Participants Overall Approval Rating………………..…..37

Graph 39: Pie Chart: Non-Magnet Participants Overall Approval Rating……………...38

Quadrant Analysis

Graph 40: Magnet Participants Quadrant Analysis……………………………………..44

Graph 41: Non-Magnet Participants Quadrant Analysis………………………………..45


Executive Summary

In an effort to prevent registered nurses (RNs) from fleeing the acute care facilities,

healthcare systems are investing resources to provide an environment that supports RN

satisfaction, in hopes to lowering the turnover rate. Hospitals around the world are seeking

Magnet designation status believing that this is the answer to the RN retention problem that the

world now faces. In an effort to shed light on the differences in environment at Magnet hospitals

vs. non-Magnet hospitals this research review will provide results from a literature review and a

mock survey. The literature review provided little data that supports the Magnet status increases

retention of RNs while the survey revealed a high reliability organization (HRO), such as a

Magnet hospital, supports retention by having an exceptional work environment. In conclusion

the principles of a Magnet designation environment supports RN retention, but Magnet

designation is not necessary to achieve such an environment. Providing an environment that

follows the principles of a Magnet designation facility would eliminate the Magnet designation

cost and mitigate the risk of losing RNs to other facilities or leaving the practice.


Introduction

Suffering from a trauma, laying in an emergency room, with months of recovery in your

future, who will care for you? The professional registered nurses (RNs) are leaving acute care

facilities, including emergency rooms, intensive care units, and nursing units, due to burn-out.

Prior to the mid-1990s there were very few employment options for the RN population around

the world. Acute care facilities (hospitals) were the dominant employer, while the physician

offices, and long term care facilities (nursing homes) employed a minor percentage. The

landscape has changed over the past 2 decades, increasing the opportunities for RNs, reducing

the number of RNs that are available for the high demand, high stress, acute care facilities.

Hospitals seek ways to recruit new RNs while retaining the current RNs that are on staff.

Magnet designation is a designation that is awarded to hospitals that have conquered

environmental factors that are at the root of RN burnout. However, Magnet designation takes

years to accomplish and a significant amount of resources during a time that hospitals have

neither time nor money to give. This paper will argue that Magnet designation hospitals provide

an environment that is much more supportive than hospitals that are non-Magnet. However this

paper will also argue that it is not necessary to be certified as a Magnet designated facility to

improve the environment and increase nurse retention. The environment that is needed to retain

RNs can be created without being Magnet.


Problem Statement

Struggles in the healthcare sector

If you work in healthcare it is likely that you have heard the term “magnet status”. Hospital

administrators, mainly Chief Nursing Officers (CNOSs) across the country are pursuing magnet

designation in hopes that it is the answer to many of the problems that healthcare faces.

Hospitals find four major areas of concern in today’s acute care setting: 1) patient outcomes:

nurses are required to have a higher level of critical thinking skills to care for the complex

patient population, 2) staff satisfaction: nurses are facing burn-out due to the highly technical and

labor intensive demands resulting in high turnover rates, 3) patient satisfaction: patients must

have a good hospital experience including satisfaction in order for the system to receive full

reimbursement, and 4) profit margins: insurance and Centers for Medicare & Medicaid (CMS)

reimbursement changes will impact the bottom line.

Patient Outcomes

Ambulatory Surgery Centers (ASCs) and physician owned Specialty Hospitals have been

growing in number over the past twenty years across the nation. This trend has reduced the

number of “healthy” patients that entire into an acute care setting, such as a hospital. Nursing

associates in the acute care setting are forced to care for multiple patients with multiple co-

morbidities concurrently. The nursing care that is required to care for this patient population is

extremely technical and requires a high level of critical thinking. The literature shows that

patients that have been cared for by a nurse holding a BSN verses an associate’s degree (ADN)

have better outcomes. Aiken, Clarke, Cheung, Sloan, & Silber (2003) found, “a 10% increase in

the proportion of nurses holding a bachelor's degree was associated with a 5% decrease in both

the likelihood of patients dying within 30 days of admission and the odds of failure to rescue” (p.

1617). This is concerning to healthcare systems since 6.9% of the nursing workforce holds a

diploma while 37.9 % have an Associate’s degree as their highest level of education (HRSA,

2013). The statistics show that nearly 50% of the nursing workforce are undereducated and

provide care that is suboptimal.

Staff satisfaction

The pressure on the nursing associates to perform at such a level while keeping their patients

satisfied has caused the nursing associates to face burn-out and has increased the turnover rate of

the hospitals. According to Hylton, Batcheller, Schroeder, & Donohue (2015) moral distress is a


significant predictor in burnout. The distress more prominent in the acute care setting. Hylton,

Batcheller, Schroeder, & Donohue (2015) performed surveys on 114 nurses in a high acute care

setting using survey instruments Maslach Burn-out Inventory–Human Services, analyzing the

data using SPSS software. Emotional exhaustion was the highest predictor of burnout scoring a

32.21 on a standardized scale of 0-63. According to Hylton, Batcheller, Schroeder, & Donohue

(2015) the high emotional exhaustion score was directly related to powerlessness, lack of

autonomy, or lack of control. Sawatzky, & Enns, (2012) performed a cross-sectional survey on

261 RNs across 12 emergency departments (EDs) that resulted in twenty six percent of the RNs

stating they were definitely leaving their jobs related to burnout. The major factors that

contributed to the burnout in the ED study was again related to lack of engagement (Sawatzky, &

Enns, 2012). The stress of the acute care setting and the feeling of loss of control, powerlessness,

and lack of engagement has RNs leaving the acute care setting and/or the nursing profession

altogether. The loss of experienced RNs in the acute care hospitals will have an impact on patient

care as well as patient satisfaction.

Patient satisfaction

Very few people choose to use the services that an acute care hospital provides. The service

of a hospital is thrust upon someone in a moment of time that someone is at their most vulnerable

and is in a weak state of mind. For many patients a hospital visit represents a loss of autonomy

and control, for some it is a loss of autonomy that will exceed far beyond the walls of the

hospital, leaving them with limitations that they didn’t have prior to the visit. With all of the loss

of autonomy and control, patients relate their hospital experience based on the care and

relationship with the nursing staff. A secondary analysis of data acquired from the At Safe study

in 2008 and 2009 at four Finnish hospitals, including a university hospital (highly acute) and

three specialty hospitals was performed to determine the factors that influenced patient

satisfaction (Kvist, Voutilainen, Mäntynen, & Vehviläinen-Julkunen, 2014). The conclusion of

the analysis was that there was a direct correlation between nursing staff satisfaction and patient

satisfaction. As evaluated by patients, nursing staff with a high level of job satisfaction is

important for high quality care (Kvist, Voutilainen, Mäntynen, & Vehviläinen-Julkunen, 2014).

Value-based purchasing: HCAHPS

Hospitals in 2015 are facing issues that didn’t exist ten years ago. In the past hospital

payments were based upon the work that was performed during a patients visit to the hospital.


This payment did not hold hospitals responsible for the care provided and financially rewarded

hospitals for providing additional care, such as unnecessary lab-work or radiological studies. The

payments provided no financial incentive to provide exceptional outcomes or provide an

environment where patients would be satisfied with care received. Value-based purchasing is the

new payment system set up by Centers for Medicare and Medicaid (CMS) that changes all the

rules on reimbursements. Value-based purchasing bases the payment to the hospitals on

outcomes, including how the patient rates their satisfaction during their stay in the hospital

(NBCH, 2011). Patients receive a Hospital Consumer Assessment of Healthcare Providers and

Systems (HCAHPS) survey in the mail or by telephone by an approved vendor after they are

discharged from the hospital that ask them about their hospital experience (Zusman, 2012). The

manner in which they answer the questions determines a portion of the payment that has been

deemed an incentive fund. This incentive fund is one percent of the payment; seventy percent of

which is based on medical outcomes related to the visit while thirty percent is based on the

HCAHPS score. Hospitals must receive a nine out of ten on their HCAHPS score to receive any

of the thirty percent. The purpose of the HCAHPS is to incentivize hospitals in finding ways to

make patients more satisfied during their stay.

Background

Nursing retention is the key to the success of hospitals around the globe. According to the

Bureau of Labor Statistics, nurses outnumber doctors ten to three (bls.gov, 2015). The

importance of the doctor to nurse ratio statistic is to provide an understanding that nurses provide

a large proportion of the care that patients receive. Nursing retention provides a stable

environment in an acute care setting and affords the patient the best opportunity to have a

desirable outcome, allows the patient to have the best experience possible, allowing the hospital

to be more profitable. However, hospitals continue to struggle retaining nurses. Li & Jones

(2013) reported that the national average turnover rate for bedside RNs is 14% and almost 28%

for RNs in their first year of employment. This inability to retain nurses and benefit from it, has

hospital executives searching for ways to create an environment that improves RN satisfaction.

The American Nurses Credentialing Center (ANCC, 2015) has provided a certification for

“Magnet Designation” that recognizes hospitals for excellence in nursing. This Magnet

designation requires hospitals to change their governing structure and invest money on nursing


continuous education as well as “non-productive” meeting times. The investment to go down the

Magnet journey is costly and data to support the funding is necessary.

Research Design and Methodology

A literature review from secondary resources was initially conducted to begin the research

for this project. The secondary sources were limited to internet searches on EBSCO host and

Google Scholarly. The initial search for “retention of RNs in Magnet Status facilities” resulted in

over 15,000 findings. Narrowing down the search to experienced RN retention in an acute care

Magnet facility vs. non-Magnet facility reduced the findings to a manageable 140 results. In

review, the articles that did not provide results from a study, appeared to have a biased towards

Magnet or non-Magnet facilities, or was a redundant study was removed from the group. Careful

consideration was given to each article to ensure the authenticity of the study. This filtering

resulted in 6 articles being used for this review. The summary of those articles are in the

literature review section.

The survey that was conducted was a mock survey that was given to a sub-group of students

in the research class. The sub-group only had an n = 5. The survey participants were divided into

2 groups based on their place of employment. Aircraft companies are HROs and the two students

in the HROs would represent the hypothetical 2/5 results of the Tulsa, Oklahoma RNs in Magnet

facilities. The three students that were in the other category would represent the 3/5 results of the

Tulsa, Oklahoma RNs in non-Magnet facilities. The survey was performed in 2 parts, one made

up of demographics, survey questions regarding the importance of the environmental issues, and

one open ended question. The demographics were used to place the participants in the Magnet or

non-Magnet category, while excluding those that worked on their units less than a year, or had

been an RN less than a year. The 11 core questions were to determine the importance of the

environmental factors that the ANCC states are important for RN retention. An open ended

question was asked to allow the participants to provide any other factors that may impact the RN

retention. This survey was conducted electronically and the results were taken at face value. No

editing was performed to reach the results that are provided in the survey results and analysis

section.

The survey was analyzed used a cross-tabulation analysis. The cross tabulation analysis

allowed the results to be separated into a comparative analysis of how RNs from a Magnet

facility answered the questions vs. RNs from a non-Magnet facility. The frequency tables


showed how often each respondent (RN) at the Magnet vs. non-Magnet responded to each

question and determine if there was a statistically significant difference in the way that each one

answered.

Limitations

This research effort provided a good start and a structure that can be used to perform an

actual research review. However, this research paper is inconclusive due to the limitations that

were presented. The research class this paper was written in was a 6 week accelerated class that

limited the time that could be spent on each section of this paper. The accelerated class limited

the ability to perform an actual survey on a group of RNs in a geographical location that would

allow actual results vs. the hypothetical results that are in this review. The time restraints and

geographical locations of the student population prevented a face-to-face survey from being

conducted. The survey that was performed on-line with an n = 5 which had a high potential of

skewing the results. The participants that took the survey were aware that the surveyor knew who

they were since the survey that was conducted was not anonymous. The risk of the participants

results being skewed, due to the small numerator and lack of privacy was mitigated by questions

that focused on the environmental factors and not the personal conduct of themselves, peers, or

leadership.

Literature Review

Joanna Briggs Institute

Best Practice (2010) published research from the Joanna Briggs Institute on the impact

that Magnet designation has on nursing retention. The review was conducted in four hospitals,

two of which were Magnet, one hospital was working towards Magnet, and the fourth was a non-

Magnet facility. The intent of the study was to determine what impact Magnet designation had

on professional nurse work environment, nursing satisfaction; including retention and

recruitment, patient outcomes, and if Magnet designation has a good return on investment. A

total of 143 abstracts were reviewed, 74 met the criteria for inclusion. The studies included

analysis and extraction descriptive comparative studies. Magnet nurses scored higher on two of

three subscales of the Conditions of Work Effectiveness, power and empowerment.


In a separate study a total of 2,092 critical nurses in 64 different facilities were surveyed

using the Perceived Nurse Work Environment (PNWE) Scale; a scale that compares nurse’s

perception of their work environment. The Magnet facilities scored higher mean scores than the

non-magnet facilities on three subscales; professional practice, nursing processes, and positive

scheduling climate. The remaining six subscales had no correlation between Magnet and non-

Magnet facilities.

Desiree Ritter

Ritter (2011) performed an extensive review of current literature to determine factors that

impacted the nursing work environment and its impact on retention. Ritter’s review was focused

on retention related to the impending nursing shortage and provided data that supported the need

for hospitals to create healthy work environments (HWE), which is a key factor in nursing

retention Ritter (2011). Part of the review was dedicated to the impact of Magnet designation on

HWE and the ability of Magnet hospitals to recruit and retain nurses. Ritter (2013) reported that

the Magnet hospitals were able to recruit and retain nurses based on the healthier work

environment and greater job satisfaction associated with Magnet designation.

Kramer, Maguire, and Brewer

Kramer, Maguire, and Brewer (2011) studied the effects on Magnet designation hospitals for

clinical nurses. The study sample was 12,233 nurses on 717 clinical units in 34 Magnet hospitals.

Kramer, Maguire, and Brewer (2011) used a survey tool called the Essentials of Magnetism II

(EOMII) to determine the health of the work environment for the 12,233 nurses based on the

HWE essentials of working with competent peers, collegial/collaborative nurse-physician

relationships, clinical autonomy (ability to make nursing decisions based on evidence-based-

practice), educational support, adequate staffing, support from management, control of their own

practice, and transmission and adoption of patient-centered culture (all decisions are based on

what is best for the patient). The study excluded any department that had less than a 40%

response and excluded nurses that had been on the unit less than one year. Five hundred and

forty units in 34 hospitals met the requirement. Fifty four percent (n=291) of the units confirmed

a very healthy work environment (VHWE), 28% HWE (n=150), with only 18% (n=99) claiming

to be work environments needing improvement (WENI). The average data from non-Magnet

hospitals; VHWE 16%, HWE 68%, and WENI 16%. In the study that Kramer, Maguire, and


Brewer (2011) performed the results were skewed towards the 34 Magnet designation hospitals

as having excellent, healthy environments.

Walker, Middleton, Rolley, & Duff

Walker, Middleton, Rolley, & Duff (2010) performed a study for a premier private hospital

in Sydney, Australia in preparation for Magnet designation application. Australia had only two

hospitals that held Magnet designation and both are public sector hospitals. The Practice

Environment Scale of the Nursing Work Index (PES-NWI) is supported by theoretical and

empirical foundations, conceptual integrity, psychometric strength and generalizability was

deemed to be the appropriate tool for the study. The PES-NWI is the only tool that allows the

comparison between the hospital that is being measured and the benchmark set by other Magnet

hospitals. The tool had to be modified for the Australian study due to the fact that Australia does

not use nursing diagnosis as the other benchmarked hospitals. The modified tool is known as the

PES-AUS. A total of 384 nurses completed the survey (84.5% response rate). The mean scores

for the Sydney hospital were significantly higher than the Australian non-Magnet hospitals and

American Magnet and non-Magnet hospitals in 3 of the 5 subscales of practice environment and

comparable to mean scores of Australian and American Magnet hospitals in the other 2. While

the Sydney hospital had not achieved Magnet designation it was performing at a level higher

than Magnet hospitals.

Russell

Russell (2012) published an article on the economics of Magnet designation. In the article

Russell provided two case studies on turnover rates of institutions prior to Magnet designation

and after Magnet designation. Scottsdale Healthcare, in Scottsdale Arizona had turnover rates of

20% prior to Magnet designation in 2006 down to 1.8% in 2009 after Magnet status had been

achieved. Children’s Medical Center, in Dallas Texas had a 20.9% turnover rate in 2006 prior to

Magnet designation and is currently at 9.67% in 2012.

Parsons & Cornett

Parsons & Cornett (2011) performed a study on sustaining Magnet designation once it has

been achieved. The sample size was 15 CNOs from 15 different hospitals. The 15 hospitals that

were part of the study were spread across the US and the average bed size of the facilities was

582. The CNOs were interviewed and asked what the barriers to recertification were. The top

barrier that prevented hospitals from recertifying was the changing of philosophy from the


executive leadership. Executive philosophy changes can occur that no longer support the quest

for quality and continued improvement. Financial concerns were the second barrier. Magnet

designation requires a higher nurse to patient ration and staff participation is required in

governance meetings, both have a financial impact on the hospital. Executive leadership turnover

is the third barrier. Magnet designation requires the direction of the clinical care to come from

the bottom up, with bedside nurses making decisions about their practice. A new CNO may not

be willing to give up this power, removing the programs that are required to sustain Magnet

designation. The fourth barrier to sustainability is change of support from the department leaders.

The department leaders may not want to give up the control to the shared governance committee.

Other barriers noted are failure to maintain governance structure, failure to maintain

infrastructure, failure of bedside nurses to keep up with best practice, and department leadership

turnover.

Survey Results and Analysis

The following survey was a mock survey that was taken performed on a small group of

students (n=5). The survey participants were broken down into 2 categories; the aircraft workers

(n=2) were put in the HRO (Magnet) and the other were placed in the non-HRO (non-Magnet)

(n=3). The survey was conducted to simulate feedback from Magnet and non-Magnet facilities.

THe mock survey was hypothetically performed on RNs in the Tulsa, Oklahoma area. 1500

surveys were sent to 5 different hospitals in the area, 2 of the hospitals are certified Magnet

facilities and 3 of the hospitals were non-Magnet facilities.

The questions were developed using the American Nurses Credentialing Center (ANCC) list

of environmental factors that impact nursing retention.

The survey consisted of 2 parts, part one (Appendix A) was designed to establish the

importance of environmental factors that impact retention in the facility.

The survey allowed the researcher to pull in demographics from the participants, determine

the importance of the environmental factors, and allow an opportunity to identify an

environmental factor that was important to the participants.

The results of survey 1 is in Table A. The results were narrowed down to experienced RNs

(> 1 year of experience), on an acute care unit, on the unit for greater than 1 year. This would


allow the surveyor to narrow the research to experienced acute care RNs that have knowledge of

how their unit runs.

Table A:

Overall 20 % reponse received from 1500 Surveys sent out. TotalNot very important Neutral

Somewhat Important

Very Important Total

How important for you is safety at work? 300 0% 20% 0% 80% 100%

How import is teamwork in your work environment? 300 0% 0% 40% 60% 100%

How important is having a sense of control in your environment? 300 0% 20% 40% 40% 100%

How important is collaborative relationships at work? 300 0% 0% 20% 80% 100%

How important is compliance with documentation standards? 300 0% 0% 0% 100% 100%

How important is it to have a voice in how your work is performed? 300 0% 20% 0% 80% 100%

How important is it to have integration of quality standards in your work? 300 0% 0% 40% 60% 100%

How important is it to feel supported by your management? 300 20% 0% 20% 60% 100%

How important is it to be recognized for a job well done? 300 0% 20% 20% 60% 100%

How important is it to have an opportunity for professional growth? 300 0% 20% 0% 80% 100%

Table B below is the response from the RNs that were employed in a Magnet facility. The RNs

that responded to the survey felt that 100% of the environmental factors on the survey had some

level of importance while Table C shows the response from non-Magnet facility RNs reveals

only 80% felt that a the environmental factors were important.

Table B:

Magnet Designation TotalNot very important Neutral

Somewhat Important













Table C:

non-Magnet designation TotalNot very important Neutral

Somewhat Important












The second part of the survey provides representation of how well the RNs felt their facilities

were performing with the environmental factors listed in survey 1. Appendix B is the second part

of the survey.

Table D through F displays the total results of the second part of the survey. Table D displays all

of the results, Table E displays the Magnet results, and Table F displays the non-Magnet results.

Table D:


Table E:

Magnet designation TotalStrongly Disagree Disagree Neutral Agree

Strongly Agree Total

I am satisfied with the safety at my place of employment. 120 0% 0% 0% 0% 100% 100%

I am satisfied with the teamwork at place of employment. 120 0% 0% 0% 100% 0% 100%

I have a strong sense of control at place of employment. 120 0% 0% 0% 100% 0% 100%

I am satisfied with the collaboration at place of employment. 120 0% 0% 0% 50% 50% 100%

I have a voice when it comes to how I perform my job. 120 0% 0% 0% 100% 0% 100%

I have integration of quality standards at my place of employment. 120 0% 0% 0% 0% 100% 100%

I feel supported by my manager at place of employment. 120 0% 50% 0% 50% 0% 100%

I feel supported by the executives at place of employment. 120 0% 0% 50% 50% 0% 100%

I feel supported by the senior offi cers at place of employment. 120 0% 0% 50% 50% 0% 100%

At my place of employment there is room for professional growth 120 0% 0% 0% 0% 100% 100%

The company I work for does a good job of recognizing high performers. 120 0% 0% 0% 50% 50% 100%

Table F:

non-Magnet designation TotalStrongly Disagree Disagree Neutral Agree

Strongly Agree Total

I am satisfied with the safety at my place of employment. 180 0% 0% 33% 0% 67% 100%

I am satisfied with the teamwork at place of employment. 180 33% 33% 0% 0% 33% 100%

I have a strong sense of control at place of employment. 180 0% 0% 0% 100% 0% 100%

I am satisfied with the collaboration at place of employment. 180 0% 67% 0% 0% 33% 100%

I have a voice when it comes to how I perform my job. 180 0% 0% 0% 67% 33% 100%

I have integration of quality standards at my place of employment. 180 0% 0% 0% 33% 67% 100%

I feel supported by my manager at place of employment. 180 33% 0% 0% 0% 67% 100%

I feel supported by the executives at place of employment. 180 33% 0% 33% 33% 0% 100%

I feel supported by the senior offi cers at place of employment. 180 33% 0% 33% 33% 0% 100%

At my place of employment there is room for professional growth 180 0% 0% 0% 33% 67% 100%

The company I work for does a good job of recognizing high performers. 180 0% 0% 33% 33% 33% 100%

Graph 1 reveals the response from data point 1 from all respondents:

The graph shows that only 80% of the RNs surveyed felt that safety at work was important.

Graph 2 is the response from the RNs at a Magnet facility and Graph 3 shows how the

respondents felt the hospital was performing with safety. Graph 4 & 5 are the same responses

from RNs at non-Magnet facilities. The Magnet facility responses showed that 100% of the RNs

cared that they were working in a safe environment, while only 67% of those in non-Magnet


facilities cared. The amount that the RNs cared is reflected in how well the facilities were

performing.

Graph 1: All respondents

Not very important Neutral Somewhat Important Very Important0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

0%

20%

0%

80%

How important for you is safety at work?

Graph 2: Magnet designated RN responses


20%

40%

60%

80%

100%

120%

0% 0% 0%

100%



Graph 3: Magnet

Graph 4: non-Magnet


10%

20%

30%

40%

50%

60%

70%

80%

0%

33%

0%

67%



Graph 5: non-Magnet

Strongly Disagree

Disagree Neutral Agree Strongly Agree0%

10%

20%

30%

40%

50%

60%

70%

80%

0% 0%

33%

0%

67%

I am satisfied with the safety at my place of employment.

Graphs 6 – 9 show the results of data point 2. The non-Magnet facilities felt that teamwork was

more important than that of the Magnet facilities, but were not performing as well in this

category. In fact only 33% of the non-Magnet respondents felt their work environment had good

teamwork, while 100% of the Magnet facilities agreed they had good teamwork.

Graph 6: Magnet


10%

20%

30%

40%

50%

60%

0% 0%

50% 50%

Chart Title


Graph 7: Magnet

Strongly Disagree


20%

40%

60%

80%

100%

120%

0% 0% 0%

100%

0%

I am satisfied with the teamwork at place of employment.

Graph 8: non-Magnet


10%

20%

30%

40%

50%

60%

70%

80%

0% 0%

33%

67%

Chart Title


Graph 9: non-Magnet

Strongly Disagree


5%

10%

15%

20%

25%

30%

35% 33% 33%

0% 0%

33%

I am satisfied with the teamwork at place of employment.

Graph 10-13 show the responses from data point 3: How important is it having a sense of control

in your environment, and I have a strong sense of control in my environment. 100% of the RNs

in Magnet facilities agreed that it was somewhat important to have a sense of control while 67%

of the non-Magnet RNs felt it was very strong and 33% were neutral. All respondents at Magnet

and non-Magnet felt agreed that they had a sense of control in their environment.

Graph 10: Magnet


Graph 11: Magnet

Graph 12: non-Magnet



Graphs 14-17 are the results of data point 4 regarding collaborative relationships. The RNs at

Magnet facilities felt that it was important, while the nurse in the non-Magnet felt that it was

very important. The Magnet facilities RNs felt they had good collaboration while the non-

Magnet RNs did not; 67% disagreed that their environment was collaborative.

Graph 14: Magnet

Graph 15: Magnet





Graphs 18-21 are the results of data point 5; how important is it to have a voice in how your

work is performed, and do you have a voice in your current environment. 100% of the Magnet

RNs felt it was very important to have a voice and agreed that their facilities allowed them to

have a voice. 67% of the non-Magnet RNs felt it was very important while 33% were neutral and

all felt their voice was being heard 67% agreeing and 33% strongly agreeing.

Graph 18: Magnet

Graph 19: Magnet





Graph 22-25 are the results of data point 6; how important is it to have integration of quality, and

how well does my environment integrate quality. Both Magnet and non-Magnet RNs felt it was

important as well as felt their facility performed well.

Graph 22: Magnet

Graph 23: Magnet





Graphs 26-29 display the results of data points 6 – 9 regarding support from leadership from the

management, senior leaders, and the officers of the facilities. The answers were combined to

show an aggregate score for the graphs, but were separated on the survey to allow the facility to

understand where the area of need was. The Magnet RN responses revealed a desire to have

support with 100% responding somewhat important-very important, while only 67% of the non-

Magnet RNs thought that support from leadership was important, 33% responding that it was not

very important. Both Magnet and non-Magnet RNs felt that there was a need for improvement in this

area.

Graph 26: Magnet


Graph 27: Magnet


Graph 29: non Magnet


Graphs 30-33 show the responses from data point 10: how important is it to be recognized for a

job well done, and how well does your facility perform recognizing a job well done? Magnet

RNs felt that it was important 50% responding somewhat important, 50% responding very

important. A higher portion of the non-Magnet RNs felt stronger about being recognized 67%

responded very important, while 33% were neutral. The Magnet RNs felt the facility was doing a

good job while the non-Magnet facilities scored lower.

Graph 30: Magnet

Graph 31: Magnet





Graphs 34-37 show the responses to data point 11; how important is having an opportunity for

professional growth and my place of employment provides professional growth. 100% of the

Magnet RNs felt it was very important and strongly agreed that their facilities provided an

opportunity. Only 67% of the non-Magnet RNs felt that it was very important while 33% were

neutral. The non-Magnet RNs did respond that their facility provided growth opportunity.

Graph 34: Magnet

Graph 35: Magnet





Graph 38 shows that Magnet facility RNs gave their facility their approval on 86% of the

environmental factors, with only a 9% disproval rating (5% neutral).

Graph 38:


Graph 39 shows that the non-Magnet facility RNs gave their facility a lower rating of approval

than that of the Magnet RNs. The approval rating was at 71% with a 16% disapproval rating

(13% neutral).

Graph 39:

The quadrant analysis (Appendix C) shows that the RNs at Magnet facilities felt that all of the

environmental factors were important and that their facilities performed well. The quadrant

analysis for the RNs at the non-Magnet facilities (Appendix D) show that the RNs felt that each

environmental factor had some level of importance, but scored it much lower than that of the

Magnet facility RNs. The non-Magnet RNs also felt that 3 of their environmental factors were

below the acceptable line: Data points 2 & 4 that are regarding teamwork and collaborative

relationships were failing in the non-Magnet facilities. Data point 7 regarding management

support was also failing in the non-Magnet facilities. The results of the survey show how the

impact of team members not working together and lack of support from leadership can impact

the way an RN feels about their work environment and how it will influence them leaving a

facility.

The analysis provides a clear picture that the RNs at the Magnet facilities feel that their

environment is a better environment to work in and would support retention of the RN staff.

Other issues that were mentioned that impact the environment were 1) the ability for the

environment to support a work/life balance, 2) the recognition of teams in an environment, 3)

and the educational support of the environment.


Conclusion

The literature review and the survey results support the HRO facilities such as a Magnet

designation health care facilities. HROs excel at environmental factors that impact the retention

of their employees. While the literature review provides only one large study and two case

studies to support a higher retention rate for RNs at Magnet facilities it is evident that the

facilities are performing at a higher level on the ANCC environmental factors that impact

retention. The studies that are provided in the literature review shows a correlation with the

environmental factors and the RN satisfaction. It is also evident based on the study in the

Australian study that the environment can be improved without being a Magnet facility, but

having a clear focus on the factors that the ANCC promotes as causation to loss of RNs. The

hypothetical survey that was taken reveals a distinct difference in how the survey was answered

by the participants in an HRO vs. a non-HRO. The HRO participants scored their environment

an 86% approval rating while the non-HRO participants only scored their environment at a 71%

approval rating. The HRO focus is the key to the success of retention in any industry including

hospitals.

Recommendations

The research suggest that improving the environmental factors that are outlined by the ANCC;

teamwork, shared governance, physician collaboration, documentation compliance, control over

practice, quality standards, management support, and recognition will increase the likelihood of

retaining the RN staff. A focus on these issues and standardizing processes to support these

environmental factors is the key to succeeding in the retention of the RN workforce. Hospitals

that are seeking Magnet status have a clear focus on these environmental factors, pumping

resources into achieving it. Having that same focus on improving the environment the same as

the Sydney Australia hospital can accomplish the same goal. Providing an environment that is

highly reliable can be accomplished independent of Magnet designation.


References

Aiken, L., Clarke, S., Cheung, R., Sloan, D., & Silber, J. (2003). Educational Levels of

Hospital Nurses and Surgical Patient Mortality, Journal of American Medical

Association, 290, 1617- 1623.

ANCC. (2015, September 1). Find a Magnet Hospital. Retrieved September 29, 2015, from

http://www.nursecredentialing.org/FindaMagnetHospital.aspx

Bls.gov. (2015). Summary. Retrieved October 10, 2015, from

http://www.bls.gov/ooh/healthcare/registered-nurses.htm

Evidence on determining the impact of Magnet designation on nursing and patient outcomes.

(2010). Best Practice, 14(11).

HRSA. (2013, April 1). The U.S. Nursing Workforce: Trends in Supply and Education.

Retrieved October 3, 2015, from http://bhpr.hrsa.gov/healthworkforce/reports/

nursingworkforce/nursingworkforcefullreport.pdf

Hylton Rushton, C., Batcheller, J., Schroeder, K., & Donohue, P. (2015). Burnout and

Resilience Among Nurses Practicing in High-Intensity Settings.

American Journal of Critical Care, 24(5), 412-421. doi:10.4037/ajcc2015291

Kramer, M., Maguire, P., & Brewer, B. (2011). Clinical nurses in Magnet hospitals confirm

productive, healthy unit work environments. Journal of Nursing Management, 19, 5-17.

Kvist, T., Voutilainen, A., Mäntynen, R., & Vehviläinen-Julkunen, K. (2014). The relationship

between patients’ perceptions of care quality and three factors: Nursing staff job satisfaction,

organizational characteristics and patient age. BMC Health Services Research BMC Health

Serv Res, 466-466. Retrieved October 5, 2015.

Li, Y., & Jones, C. B. (2013). A literature review of nursing turnover costs. Journal of Nursing


Management, 21(3), 405-418. doi:10.1111/j.1365-2834.2012.01411.x

NBCH. (2011). Value-based Purchasing: A Definition. Retrieved October 3, 2015, from

http://www.nbch.org/Value-based-Purchasing-A-Definition

Parsons, M., & Cornett, P. (2011). Sustaining the pivotal organizational outcome: Magnet

recognition. Journal of Nursing Management, 19, 277-286.

Ritter, D. (2010). The relationship between healthy work environments and retention of nurses in

a hospital setting. Journal of Nursing Management, 19, 27-32.

Russell, J. (2010). Journey to Magnet™: Cost vs. Benefits. Nursing Economic$, 28(5), 340-342.

Sawatzky, J. V., & Enns, C. L. (2012). Exploring the key predictors of retention in emergency

nurses. Journal of Nursing Management, 20(5), 696-707. doi:10.1111/j.1365-

2834.2012.01355.x

Walker, K., Middleton, S., Rolley, J., & Duff, J. (2010). Nurses report a healthy culture: Results

of the Practice Environment Scale (Australia) in an Australian hospital seeking Magnet

recognition. International Journal of Nursing Practice, 16, 616-623.

Zusman, E. (2012). HCAHPS Replaces Press Ganey Survey as Quality Measure for Patient

Hospital Experience. Neurosurgery, 71(2). Retrieved October 5, 2015, from

http://www.aahs.org/medstaff/wp-content/uploads/hospitalsurvey2013.pdf


Appendix

Appendix A:

1 Name of the hospital you work at: __________________________________________________

2 Name of the unit you work on: __________________________________________________

3 How long have you been a nurse?

___< 1yr ___1-5 yrs ___6-10 yrs ___10-15 yrs ___> 15yrs

4 How long have you been on your current unit?

___< 1yr ___1-5 yrs ___6-10 yrs ___10-15 yrs ___> 15yrs

5 What is your highest degree held?

___ Diploma RN ___ ADN ___ BSN ___ Masters ___ Doctorate

6 How important is patient safety?

Not very important____ Neutral____ Somewhat Important___ Very Important___

7 How import is teamwork in your work environment?


8 How important is having a sense of control in your environment?


9 How important is nurse/physician collaborative relationships?


10 How important is it to have a voice in practice standards?


11 How important is it to have integration of quality standards in your practice?


12 How important is it to feel supported by your management?


13 How important is it to be recognized for a job well done?


14 How important is it to have an opportunity for professional grwoth?


15 Other than compensation and benefits what else is important that was not asked on this survey?

____________________________________________________________________________________

Nurse Satisfaction Survey Part 1


Appendix B:


Appendix C:

Most Importance

q5 q1 q9

q7 q3 q2 q4 q8 q6

Least Succesful Most Succesful


Appendix D:

Most Importance

q4

q6

q2

Least Succesful q7 q1 q8 q3 q5 q9 Most Succesful

Least Importance

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