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 to 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 vs. 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 (OR 0.86, 95% CI 0.76-0.98, p=0.02) and 12% lower odds of failure-to-rescue (OR 0.88, 95% CI 0.77-1.01, p=0.07) while controlling for nursing factors as well as hospital and patient differences. Conclusions Magnet hospitals have lower mortality than is fully accounted for by measured characteristics of nursing. Magnet recognition likely both identifies existing quality and stimulates further positive organizational behavior that improves patient outcomes.

Validação do Nursing Work Index-Revised entre auxiliares e técnicos de enfermagem

“…The presence of organizational attributes, such as autonomy, control over the environment and collaboration between physicians and nurses can make a practice environment more favorable of the development of care and also contribute to better outcomes for the patient, the professional and the institution. (1)(2)(3)(4) For the patient, these results translate not only into satisfaction with the care received, but reduced mortality rates (1,2,5,6) and a reduction of adverse events of care, such as medication errors, falls and hospital-acquired infections. (7) For the institution, the absence of characteristics that favor professional practice directly influences the rise of turnover and absenteeism rates.…”

“…(9,10) High levels of burnout among nursing professionals are associated to job dissatisfaction, intention to leave the job and patients' dissatisfaction with the care received, which directly influence the quality of the care provided and patient safety. (5) In light of this context surrounding the professional practice of nursing, some instruments have been developed to measure organizational components of the nursing practice environment, among them, the Nursing Work Index -Revised (NWI-R). The objective of this instrument is to evaluate the presence of environmental characteristics that favor professional practice.…”

Segurança do paciente em unidades de terapia intensiva: ambiente das práticas profissionais de enfermagem e satisfação profissional na ocorrência de eventos adversos

“…A organização dos horários e turno de trabalho representa uma estratégia que promove o equilíbrio do profissional, pois lhe permite maior flexibilidade em conciliar esses aspectos da vida profissional e da vida pessoal, qualifica o ambiente das práticas, promove a segurança e aumenta a satisfação profissional 90,129,139,141,143 .…”

“…Magnet para atender as necessidades dos profissionais e melhorar a organização do trabalho, também promoveu a qualidade da assistência e ambiente mais favorável às práticas profissionais, bem como a satisfação profissional e o vínculo do profissional com a instituição 81,90 .…”

“…Na literatura internacional, observa-se uma realidade sociocultural diferente da brasileira na formação em enfermagem, pois não há profissional nível técnico [75][76]80,90,145 , que somado a escassez de estudos brasileiros nesta linha, dificulta a comparação do nível de formação com o ambiente das práticas e satisfação profissional 116,[118][119] .…”