Is Magnet status really about excellence in nursing
or simply a marketing tool?

If your hospital’s administrators are not already seeking Magnet recognition for nurses, chances are they’re thinking about it. Such status is considered to be the gold seal of approval for a hospital’s nursing care. While most hospitals are not rewarded for exceptional quality care provided by other health professionals, exceptional nursing care can be recognized by granting hospitals Magnet status. As a result, more and more hospitals are vying for Magnet recognition.
Magnet status is awarded by the American Nurses Credentialing Center (ANCC), which is a part of the American Nurses Association. Hospitals that apply for the status are judged on 14 characteristics called the “Forces of Magnetism.” These characteristics are supposed to reflect that the hospital is providing excellent nursing care, which in turn can help hospitals recruit and retain highly qualified nurses.

“Every hospital should strive to achieve conditions that warrant Magnet status whether they are designated Magnet or not,” says Joni Ketter, associate director for AFT Healthcare.

Unfortunately, not every hospital has an organizational culture that can support the principles of a Magnet facility.

AFT Healthcare, which represents more than 70,000 health professionals nationwide, recognizes the value of the Magnet Recognition Program but also acknowledges its shortcomings.

At the 2006 convention, AFT members passed a resolution on Magnet recognition that offers some guidance to nurses who participate in the process.

Smoke and mirrors
Nurses may be engaged in this or another process in good faith, believing their efforts will result in better patient care. They should realize, however, that some hospitals use this status as a marketing tool to recruit and retain nurses while failing to maintain Magnet standards.

“Our concern is that the principles [the Forces of Magnetism] are real, not just put into place in order to achieve Magnet status,” says Ketter. “During the Magnet process, work conditions may improve with beefed-up staffing, but once the hospital receives its status, staffing could go back to what it once was.”

“The process has potential but there are still concerns,” says Candice Owley, chair of AFT Healthcare’s program and policy council, and an AFT vice president. “This process is at the whim of the employer: If the administration changes, nursing practices can change. Once the status is granted, there needs to be a clear system in place to raise issues or concerns and to have the status removed if circumstances should change.”

The University of Kansas Hospital in Kansas City (KU), which has 900 nurses represented by the Kansas University Nurses Association (KUNA), part of the AFT’s healthcare division, was awarded Magnet certification in December 2006.

Sharon Brown, a registered nurse in the ICU and a member of KUNA, took part in the process. She says the new status hasn’t changed things at KU much.

“The nurses all agree on one thing: The level of care has not changed,” says Brown. “We have always operated like a Magnet facility. There were no special efforts to get our designation. We did the same thing we’ve always done.”

Brown admits the hospital does have some staffing concerns, but says, “Staffing problems are not independent of our hospital. It’s difficult to address when the problem is nationwide.”

Counting the cost
While many nurses are enthusiastic about the program, there are growing concerns about how much money is being spent to obtain Magnet status, and about hospitals that pursue the recognition but do not live up to its standards.

“Hospitals are rewarded in a number of ways for having this status, and many are eagerly seeking status though the process is costly, says AFT Healthcare’s Ketter

“The application process is not cheap,” says Katherine Cox, health policy analyst for the American Federation of State, County and Municipal Employees (AFSCME), which is organizing nurses at Resurrection Health Care hospitals in the Chicago area. The Resurrection system is running a virulent anti-union campaign while seeking Magnet status.

RNs Working Together, a coalition of 200,000 unionized nurses including those represented by AFT Healthcare, wrote a letter to ANCC officials to relay their concerns about hospitals that simultaneously pursue Magnet recognition and fight union organizing drives, but has not seen any change.

“It should be clear that a genuine collaborative process to improve nursing and quality of care is impossible if a hospital’s management is engaged in an active anti-union campaign,” the letter states. In such a situation, “the majority of nurses are afraid to voice their honest opinions, making the entire process pointless at best, and at worst an attempt by management to conceal problems behind a slick marketing campaign,” the letter goes on to say. The letter also points to the campaign at Resurrection as an example of a healthcare organization where the anti-union effort “has poisoned the atmosphere in the hospitals and scuttled any effort at shared governance and open communication. Yet Resurrection Hospitals are still actively pursuing Magnet recognition.” The lack of response has led Cox to believe Magnet status is simply “a rubber-stamp marketing program—a way to attract nurses as hospitals scramble for a tiny pool of nurses.”

“They should reallocate the money into patient care instead,” Cox says. “The places where this really works are places where the nurse-management relationship was working well before the application. The recognition is then just a feather in their cap,” she adds.

Make it meaningful
New Jersey, which has the most hospitals with Magnet status, the state’s largest healthcare union, Health Professionals and Allied Employees/AFT, is wary of the process. HPAE created contract language to make it clear that nurses who participate on committees are not negotiating for the union, nor can the nurses be classified or considered supervisors because of their collaboration with management.

“Where it does work, it can be a good thing because many nurses see it as a nod to their professionalism,” says Bernie Gerard, vice president of HPAE.

“Our concern is that there is no mechanism for enforcement of magnet characteristics, and there are no ramifications by the ANCC if the hospital doesn’t keep up its end of the bargain,” says Gerard. “The only way to guarantee compliance is by having a collective bargaining agreement in place, which gives the nurses the ability to speak out if the hospital is not living up to the standards.”

Two HPAE hospitals have Magnet status. The nurse local at Jersey Shore University Medical Center in Neptune worked with the hospital to get the status, but upon renewal felt the hospital was not fulfilling its promise as a Magnet facility. When the time came to renew its status , the nurses used the opportunity to improve working conditions and make effective changes for the sake of patient care.

Like most Magnet facilities, Englewood (N.J) Hospital proudly publicizes its status. Ironically, however, after the hospital’s Magnet status was renewed last year, hospital management locked out the nurses. The nurse union and hospital management could not find common ground during contract negotiations, causing the nurses to go on strike.

During the strike, many nurses contacted the ANCC to let them know what was going on. The ANCC declined to get involved, saying it was a labor dispute.

“The reaction brought into focus what the designation means,” says Stephanie Orrico, who was president of the local at the time. “I think many of our members realized that this was not recognition of nurses but more a PR position for nursing administration and management.”

Months before the strike, when Englewood Hospital began its effort to renew its status, union members reviewed the hospital reapplication. They found that the hospital was touting union initiatives such as the mentorship program for new nurses, the acuity system and the preceptor program. The problem was that the hospital never gave the nurses the time needed to develop any of the programs. There was an absolute lack of commitment from the hospital, says Orrico. The only time nurses were given was time to work on the Magnet application.

“We’ve had the mentoring program in place for nearly four years, and it has not taken off like it should because the nurses have not been given the time needed for it to blossom. On paper it looked like things came easily, but it really was a fight. They put up roadblocks,” says Orrico. The application had “the look of involvement, but it’s really the hierarchy making all of the decisions.”

Orrico believes the designation can be meaningful. “It sounds wonderful, but unless there is a true working relationship where the management values the input of its nurses, it doesn’t mean anything.”