The nursing shortage remains one of the key problems facing health care systems in the developed world. Not surprisingly, more hospitals are focused on developing effective strategies to attract and retain highly qualified nurses. Hospital leaders act from a variety of perspectives to cure the nursing shortage crisis. The Magnet framework proposed at the beginning of the 1980s promises to enhance the quality of various organizational initiatives and deliver excellent nursing care. Since the beginning of the 1980s, the Magnet status has been granted to dozens of hospitals in the United States and beyond for their successes in retaining the most prospective nursing staff. Drenkard (2010) writes that “Magnet status is not a prize or an award; it is a credential of organizational recognition of nursing excellence” (p.263). The purpose of this paper is to review the methods and principles used by Magnet hospitals to recruit and retain nurses.
Nursing Shortage or Emerging Employment Opportunities?
Nursing shortage remains one of the most popular topics in the professional literature. The causes and consequences of nursing shortages have been abundantly documented. According to Yang, Yu and Wang (2013), despite the differences in health care systems across countries, the problem of nursing shortage is the same everywhere. While the role of nurses continues to expand and the demands imposed on the increase, many of them find it difficult to cope with the emerging workplace difficulties (Yang et al., 2013). The most serious are the problems in inpatient acute settings, where nurses report greater dissatisfaction with the quality of mentorship, workplace conditions, and educational support compared with ambulatory care (Buffington, Zwink, Fink, Devine & Sanders, 2012). Yet, not everyone agrees that the nursing part of the healthcare system is in a state of crisis: some researchers report the growing number of nurses employed in the U.S.
Staiger, Auerbach and Buerhaus (2012) suggest that, in the conditions of economic depression, job gains in certain industries occur faster than in the periods without a recession. Since the end of 2007, the American economy has lost a total of 7.5 million jobs (Staiger et al., 2012). In the meantime, the number of full-time registered nurses employed in U.S. health care increased by 243,000, being the largest increase in nursing employment in the past 40 years (Staiger et al., 2012). However, the sharp increase in the number of RNs working in American healthcare is just a sign of a deeper macroeconomic crisis. Reasons for which nurses seek full-time employment are not related to either successes or accomplishments in hospital environments. Rather, it is due to the growing economic uncertainty that many nurses who used to work part-time or sit at home join the nursing workforce (Staiger et al., 2012). The discussed changes do not alleviate the problem of the nursing shortage, because “this substantial expansion in the RN workforce is largely a temporary bubble that is likely to deflate during the next several years” (Staiger et al., 2012, p.1464). Therefore, hospitals will still have to deal with the problem of nursing shortage. In this sense, the Magnet hospital model represents a prospective approach to resolving the shortage dilemma (Yang et al., 2013).
The Magnet Hospitals Framework
The history of the Magnet Hospitals framework dates back to the beginning of the 1980s when the first study to explore the positive or negative factors of nurse professionalism and retention in hospitals was carried out. Since then, the Magnet Hospitals framework has emerged as the defining feature of nursing excellence in hospitals and healthcare institutions. Because nursing shortage represents one of the most serious problems affecting international healthcare, hospitals are expected to reduce the risks of high nurse turnover, low job satisfaction, and reduced patient outcomes. The Magnet Hospitals framework rests on the assumption that nursing is a highly valuable professional field, which enables nurses to learn the fundamentals of critical thinking, science, decision making, and superior customer service (Buffington, Zwink, Fink, Devine & Sanders, 2012). In Magnet hospitals, nurses are claimed to have enough autonomy and power to make critical decisions (Buffington et al., 2012). Nurses have enough incentives to pursue improvements in professional practices, while hospitals develop sophisticated strategies to hire the most professional and talented nursing students (Buffington et al., 2012). Finally, Magnet hospitals rely on the premise that retention of nurses and nurse educators is vital to improving the quality of care (Buffington et al., 2012). The discussed criteria make up the basic framework that guides retention decisions in Magnet hospitals.
Drenkard (2010) treats the Magnet program as a framework for achieving excellence in nursing services. The researcher provides compelling evidence that the Magnet framework increases RN retention, lowers nurse burnout, decreases the rates of RN vacancy and RN turnover rates, reduces cases of staff needlestick rates, the rates of musculoskeletal and other injuries, and increases RN satisfaction, while improving patient care quality and safety. The current state of research treats Magnet hospitals as particularly successful in achieving better retention rates, compared with non-magnet hospitals (Drenkard, 2010). Magnet hospitals score better in organizational support, job satisfaction, workload, and decision to stay (Drenkard, 2010). Many hospitals across the United States experience a temporary relief in their shortage problem, but Magnet hospitals report historically low vacancy rates and higher levels of nurse retention, regardless of the economic and social circumstances of life in the country (Drenkard, 2010). In 2009, the vacancy rate across Magnet hospitals was 3.64 percent compared with 8.1-16 percent in non-Magnet hospitals (Drenkard, 2010). An important factor of nurse satisfaction in Magnet hospitals is the reduction in occupational injuries and their risks. According to Drenkard (2010), nurses working in Magnet hospitals face a one-third reduction in needlestick injuries compared to non-magnet facilities.
What Magnet Hospitals Do to Recruit and Retain Prospective Workforce
One of the most important questions is what exactly Magnet hospitals do to retain talented and motivated nursing staff. Kelly, McHugh & Aiken (2011) provide evidence that Magnet hospitals create and maintain a better work environment than non-magnet hospitals: with a greater number of highly educated nurses, the nurse-patient ratio in these hospitals is much lower than in the hospitals that do not have the Magnet status. Nothing, or almost nothing, has changed in the last two decades: Magnet hospitals keep up to the highest standards of excellence in treating their nurses and showing superiority in nurse environments and working outcomes (Kelly et al., 2011).
One of the main differences between Magnet and non-Magnet hospitals is that the former provide easy access to support, information, resources, and opportunities for professional growth and learning (Laschinger & Tuer-Hodes, 2013). The Magnet hospital characteristics are closely associated with the concept of nurse empowerment (Laschinger & Tuer-Hodes, 2013). Such successes are based on strong alliances created between nurses and physicians, which support the value of the nursing profession and practices for patients and the community.
Trinkoff et al. (2010) add to the picture of favorable workplace environments in Magnet hospitals, suggesting that, despite very few differences in how nurses in Magnet and non-Magnet hospitals operate, the former are still more satisfied with their work and have better opportunities for personal and professional growth. For example, nurses in Magnet hospitals are less likely to report on-call and mandatory overtime work, although they work the same number of hours as their colleagues in non-Magnet hospitals (Trinkoff et al., 2010). Also, nurses in Magnet hospitals confess they face fewer physical demands than their colleagues in non-Magnet hospitals (Trinkoff et al., 2010). The lack of considerable differences between Magnet and non-Magnet hospitals does not mean that their working conditions are similar. The fact is that Magnet hospitals invest most of their resources in improving the factors and aspects of work that are not directly related to job demands on nurses and work schedules, including organizational support, supervisor satisfaction, adequate staffing, and others (Trinkoff et al., 2010). As a result, the working conditions in Magnet hospitals are more appealing to nurses than in other hospital settings, and they remain the determining factor of improved nurse retention across the Magnet hospitals network.
For instance, Magnet hospitals create and maintain a workplace culture of justice and trust. “Just culture seeks to mitigate system failures in organizations with inherently high-risk levels, such as healthcare facilities, because they’re operated by human beings – all of whom are fallible” (Bashaw, 2011, p.42). Just culture enhances learning opportunities, by letting nurses report and learn from mistakes that are inevitable (Bashaw, 2011). In a just culture, accountability is created by identifying and reporting the behaviors, which expose the hospital to mistakes and risks, while building a greater level of resilience to improve the quality and safety of patient care (Bashaw, 2011). In such organizations, mistakes are rare, but even if they occur, they have few or no negative outcomes for nurses (Bashaw, 2011). On the contrary, mistakes are treated as a source of new learning opportunities. Nurses are motivated to report their failures for transparency, trust, and high-quality care.
Not surprisingly, Magnet hospitals are known for the lower levels of patient falls, medical errors, mortality, and hospital-acquired pressure ulcers (Bashaw, 2011). In Magnet hospitals, nurses are much more likely to report errors and engage in the process of decision-making and problem-solving, because the organizational culture of justice and trust empowers them to obtain constant support from their administrators and supervisors (Bashaw, 2011). In a just culture, nurses are united by shared responsibility for patient safety and quality of care. Retention improves as a result of excellent morale and trust within the organization. Nurses in Magnet hospitals function as a team, while the opportunities for organizational and collective learning are constantly maximized (Bashaw, 2011). Each error is treated as a chance to learn new skills and approaches to quality care, thus improving employee and patient outcomes at all levels of the organizational structure (Bashaw, 2011).
The benefits of having a Magnet status for hospitals are obvious. Basically, they have greater chances to advertise themselves through presentations and publications rather than traditional advertisements (Drenkard, 2010). However, achieving the Magnet status for the hospital is not an easy matter. Nurse retention is a complex product of multiple forces, efforts, and strategies that justify the Magnet status. Bashaw (2011) suggests that to be recognized among the Magnets, a hospital must create a culture of collaboration and support across staff members and organizational units. Nurses must have an opportunity to contribute to organizational improvements, and they are motivated to report errors and problems (Bashaw, 2011). The culture of justice and trust has the potential to raise the level of job satisfaction among nurses, thus increasing the likelihood that they will be willing to stay at their current workplace.
The purpose of this work was to consider how Magnet hospitals recruit and retain the most qualified nurses. The results of this analysis suggest that Magnet hospitals remain a standard of excellence in recruiting and retaining the most professional nursing staff. The working conditions in Magnet hospitals differ greatly from those in non-magnet facilities. Nurses working in Magnet hospitals face greater professional development and learning opportunities. Magnet nurses are empowered to participate in various decision-making and problem-solving activities. The organizational culture in Magnet hospitals is that of justice, openness, and accountability, where errors serve as another opportunity for learning. With a high degree of organizational and supervisor support, nurses in Magnet hospitals report greater satisfaction with their jobs. Nurses are less likely to report overtime or on-call work than their colleagues in non-Magnet hospitals. As a result, the likelihood that they will be willing to stay in their current workplace also increases.
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