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Study examines link between Magnet status, outcomes


Lower mortality and other improved patient outcomes achieved at designated Magnet hospitals partially are explained by better nurse staffing, education and work environment, according to a study.

“Magnet hospitals have lower mortality because of investments in nursing,” the study’s lead author, Matthew D. McHugh, RN, PhD, JD, MPH, of the University of Pennsylvania School of Nursing in Philadelphia, said in a news release.

“Magnet recognition likely stimulates positive organizational behavior that improves patient outcomes.”

In the study, scheduled for publication in the May issue of the journal Medical Care, researchers compared patient outcomes at Magnet hospitals versus non-Magnet hospitals in California, Florida, Pennsylvania and New Jersey in 2006-07. Magnet hospitals are recognized for quality patient care, nursing excellence and innovations in professional nursing practice. The Magnet Recognition Program is a voluntary recognition/certification program administered by the American Nurses Credentialing Center, an arm of the American Nurses Association.

McHugh and colleagues linked patient, nurse and hospital data on 56 Magnet hospitals and 508 non-Magnet hospitals. Their goals were to determine whether Magnet hospitals achieved better patient outcomes and to identify characteristics of Magnet hospitals that led to improved outcomes.

The results showed important differences in nursing at Magnet hospitals, the researchers wrote. “Magnet hospitals had significantly better work environments and high proportions of nurses with bachelor’s degrees and specialty certification.” Magnet hospitals also had higher nurse-to-patient staffing ratios.

Key patient outcomes were better at Magnet hospitals. On analysis of more than 600,000 surgical patients, mortality rates were 20% lower at Magnet hospitals, after accounting for clinical factors. Magnet hospitals also had better performances in “failure to rescue,” the mortality rate among patients with recognized complications.

Nurse staffing, education and work environment explained much of the superior patient outcomes at Magnet hospitals, the researchers said. In addition, there was a residual mortality advantage attributable to the ongoing process of maintaining Magnet recognition status. The researchers noted that even after controlling for differences in nursing, hospital and patient characteristics, surgical patients in Magnet hospitals were 14% less likely to die in the hospital within 30 days of admission and had 12% lower odds of failure-to-rescue when compared with patients in non-Magnet hospitals.

The analysis provides new evidence that patients treated at Magnet hospitals have better outcomes, and that more favorable nurse staffing, more nurses with bachelor’s degrees and better work environments are important contributing factors, the researchers noted. However, the mortality advantage of Magnet hospitals also seems related to their membership in a network of institutions where innovation is encouraged through the ongoing process of Magnet redesignation. “This is the first study to suggest that the Magnet application process itself is an intervention that promotes better quality of care,” McHugh said.

Medical Care is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health. The study is available at


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