Lower Mortality in Magnet Hospitals

Abstract

Background Although there is evidence that hospitals recognized for nursing excellence—Magnet hospitals—are successful in attracting and retaining nurses, it is uncertain whether Magnet recognition is associated with better patient outcomes than non-Magnets, and if so why. Objectives To determine whether Magnet hospitals have lower risk-adjusted mortality and failure-to-rescue compared with non-Magnet hospitals, and to determine the most likely explanations. Method and Study Design Analysis of linked patient, nurse, and hospital data on 56 Magnet and 508 non-Magnet hospitals. Logistic regression models were used to estimate differences in the odds of mortality and failure-to-rescue for surgical patients treated in Magnet versus non-Magnet hospitals, and to determine the extent to which differences in outcomes can be explained by nursing after accounting for patient and hospital differences. Results Magnet hospitals had significantly better work environments and higher proportions of nurses with bachelor's degrees and specialty certification. These nursing factors explained much of the Magnet hospital effect on patient outcomes. However, patients treated in Magnet hospitals had 14% lower odds of mortality (odds ratio 0.86; 95% confidence interval, 0.76–0.98; P = 0.02) and 12% lower odds of failure-to-rescue (odds ratio 0.88; 95% confidence interval, 0.77–1.01; P = 0.07) while controlling for nursing factors as well as hospital and patient differences. Conclusions The lower mortality we find in Magnet hospitals is largely attributable to measured nursing characteristics but there is a mortality advantage above and beyond what we could measure. Magnet recognition identifies existing quality and stimulates further positive organizational behavior that improves patient outcomes.

The impact of primary nursing care pattern: Results from a before–after study

“…The results of previous studies have indicated that attention should be paid to professional interactions (McGlynn, Griffin, Donahue, & Fitzpatrick, 2012), and our data seem to suggest that the introduction of PN can improve the team climate, which can eventually increase job satisfaction. These results appear to be of paramount importance because good staff-related outcomes can also bring about positive changes in patient outcomes (Aiken et al, 2011;McHugh et al, 2013), and job satisfaction is a critical factor that indicates nurses' intention to leave (Chan, Tam, Lung, Wong, & Chau, 2013). Furthermore, a previous Cochrane review (Butler et al, 2011) indicated that PN may reduce staff turnover.…”

Leveraging the Work Environment to Minimize the Negative Impact of Nurse Burnout on Patient Outcomes

“…To achieve this, we used hospitals with a minimum of 10 nurse respondents. Previous research has shown that having at least 10 nurse respondents per hospital provides an accurate summary of nurse-sensitive hospital features [ 1 , 39 , 40 ] and our study sample had, on average, 39 nurses per hospital, further minimizing our concern for bias in these measures. Additionally, this is the first study, to the authors’ knowledge, examining the impact of the work environment and Magnet status on the relationship between nurse burnout and patient outcomes, providing greater context for the interpretation of results in addition to highlighting solutions for hospital leaders.…”

“…The analytic sample included 20,496 nurses across 523 nonfederal, acute care hospitals from California, Pennsylvania, Florida, and New Jersey, of which 83 were Magnet hospitals. Consistent with previous empirical work, hospitals were included if they had at least 10 nurse respondents to aggregate individual reports of nurse burnout and the work environment to the hospital level [ 39 , 40 ]. In total, the patient sample included 1,939,878 surgical in-patients aged 18–99.…”

“…In total, the patient sample included 1,939,878 surgical in-patients aged 18–99. We included patients that underwent vascular, orthopedic, or general surgery, as these groups include common procedures across hospitals and there are validated risk adjustment procedures [ 40 , 41 , 42 , 43 ].…”

Association of the nurse work environment with nurse incivility in hospitals

“…The large proportion of less experienced nurses aged 31 or less at the BSN-education level in our sample likely reflects the demographics of hospitals with nursing accreditation. (McHugh et al 2013) Hospitals face unique retention challenges with new to practice nurses. Newly licensed registered nurses with an average age of 27 who experience coworker incivility reported poorer mental health (Laschinger et al 2013).…”