JONA
Volume 37, Number 4, pp 199-205
Copyright B 2007 Wolters Kluwer Health | Lippincott Williams & Wilkins
THE JOURNAL OF NURSING ADMINISTRATION
Nursing Support, Workload, and Intent
to Stay in Magnet, Magnet-Aspiring,
and Non-Magnet Hospitals
Susan R. Lacey, PhD, RN
Karen S. Cox, PhD, RN, FAAN
Kathleen C. Lorfing, MSN, RN
This study examined the differences between nurses’
(N = 3,337) scores on organizational support, work-
load, satisfaction, and intent to stay between
Magnet, Magnet-aspiring, and non-Magnet hospi-
tals. The study was conducted using the Individual
Workload Perception Scale, a valid and reliable tool
with 32 Likert scale items, with nurses from 11
states, 15 institutions, and 292 diverse units. Results
indicate that nurses at Magnet hospitals had sig-
nificantly better scores on all subscales. Further-
more, nurses from Magnet-aspiring hospitals had
better scores than did nurses from non-Magnet
facilities. Conclusions of the study indicate that the
Magnet program is meeting its intended goal: to
provide a professional practice environment for
staff nurses. Nurse executives may consider using
the Individual Workload Perception Scale as a way
to assess their organization’s culture as it relates
to professional practice of the registered nurse.
Authors’ affiliations: 2006 Robert Wood Johnson Executive
Nurse Fellow, Assistant Professor, School of Nursing, University
of Alabama at Birmingham, and Clinical Researcher, Children’s
Hospital System, Birmingham, Ala (Dr Lacey); Senior Vice
President, Patient Care Services, Children’s Mercy Hospitals and
Clinics, and Assistant Dean for Clinical Partnerships, University
of Missouri, Kansas City School of Nursing (Dr Cox); Nursing
Practice Special Projects Coordinator, Trauma Medical Center
(Ms Lorfing); Advanced Clinical Research Coordinator (Ms
Teasley and Ms Sexton); Pharmacy Service Manager, Children’s
Mercy Hospital and Clinics, Kansas City, Mo (Dr Carroll),
Children’s Mercy Hospitals and Clinics, Kansas City, Mo.
Corresponding author: Dr Lacey, School of Nursing, Uni-
versity of Alabama at Birmingham, NB 402, 1530 3rd Avenue
South, Birmingham, AL 35294-1210 (laceys@uab.edu).
JONA  Vol. 37, No. 4  April 2007
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Susan L. Teasley, RN
Cathryn A. Carroll, PhD
Kathy Sexton, MA, BSN, RN
In its inception, the Magnet Recognition Program
provided a template for organizing and supporting
nurses with a professional work environment where
nurses are true partners in care.1 This early work was
based on literature that retention of nursing staff
is more likely when they work in an environment
that promotes professional nursing practice in inpa-
tient settings.2 Over time, the Magnet Recognition
Program has expanded to include nurses in long-term
care settings. In addition, Magnet status has become
recognized as a seal of excellence for organizations
that foster not only a positive work environment for
nurses but also better patient outcomes.3,4
Evaluation criteria for the attainment of Magnet
status are described in the American Nurses Associa-
tion’s Scope of Standards for Nurse Administrators.5
Successful attainment of the criteria contained in
this report is believed to ensure that organizations
have demonstrated excellence in (1) the delivery of
nursing care to patients, (2) the development of sup-
port systems for nursing professionals, (3) the con-
duct and dissemination of research to share best
practices, and (4) enhanced patient outcomes.6
Preparing to pursue Magnet status requires
intense commitment and resources on the part of
the organization and, in particular, nursing service.
Therefore, it is prudent to accurately assess the
organization’s support of nursing staff before the
formal application. Currently, tools for the evalu-
ation of these supports exist and include the
Kramer and Schmalenberg Essentials of Magnetism
Evaluation, the Nursing Work Index, and the
Nursing Work Index-Revised tools.7,8
199
 The Essentials of Magnetism tool evaluates 8
organizational attributes reported to be essential to
quality care. These 8 essential criteria include sup-
port for education, working with other nurses who
are clinically competent, positive nurse-physician
relationships, autonomy in nursing practice, an
organizational culture that values concern for
the patient, control of and over nursing practice,
adequacy of nurse staffing, and high-quality nurse-
manager support.9,10 Although this tool is used by
many who start the Magnet process, the focus is on
the higher-level needs rather than the more basic
needs of staff nurses, such as adequate restroom
breaks and a safe work environment.
Objectives
Understanding nurse perceptions of basic work
requirements (ie, manager support, appropriate
workload, etc) can be a fundamental prerequisite
to addressing higher-level needs of nurses, such as
practice councils and clinical ladders. The overall
purpose of this study was to determine differences
in registered nurses’ perceptions of manager, peer,
unit support, workload, intent to stay, and satis-
faction between 3 types of institutions: Magnet,
Magnet-aspiring, and non-Magnet. The study used
a valid and reliable instrument, the Individual
Workload Perception Scale (IWPS), a 32-item
Likert scale survey. Subscales for the IWPS include
manager, peer, unit support, workload, intent to
stay, and nurse satisfaction and are explicated in
the ‘‘Methods’’ section of this article.
The following were the specific research questions:
1. Are there significant differences on the sub-
scale scores on manager, peer, unit support,
workload, intent to stay, and nurse satisfac-
tion between these 3 hospital types: Mag-
net, Magnet aspiring, and non-Magnet?
2. If there are significant differences found,
which 2 types of facilities had the most sig-
nificant differences?
3. Is the IWPS a credible tool for nurse execu-
tives to use in assessing the organization’s
nursing environment, either in preparation
for the Magnet journey or as a tool for
reassessing the environment once Magnet
status is achieved?
Methods
Participants
This study examined the differences between
nurses’ scores on organizational support, work-
load, satisfaction, and intent to stay in Magnet,
200
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Magnet-aspiring, and non-Magnet hospitals using
a secondary analysis of an existing large dataset
using the IWPS. This large dataset, begun in 2003,
is an ongoing project that collects demographic
information on the institution and nurse partici-
pants’ characteristics, as well as IWPS data. Chief
nurse executives were invited to use this instrument
with their staff nurses to determine if the nurses
perceived a basic infrastructure supportive of pro-
fessional nursing practice, a fundamental tenet of
Magnet facilities. In return for the institution’s
participation, they were provided comparison data
for all participating nursing units benchmarked to
other like units in the national IWPS repository.
Site coordinators from each participating institu-
tion were supported by a project manager at the
home site, and comprehensive manuals were pro-
vided for consistency in data collection.11 Institu-
tional review boards approved the study at each
participating institution, as well as the institution
coordinating the research. The staff nurses were
invited to participate and were directed to a secure
Web site to take the survey. Child Health Corpo-
ration of America (CHCA) assisted in the recruit-
ment of facilities as a service to their member
institutions. Inclusion criteria for this secondary
analysis was limited to 3,337 registered nurses
from 15 institutions, 11 geographically diverse
states, and 292 nursing units from the repository,
the number of nurses who had completed the IWPS
when the Magnet demographic question was added.
Data for this analysis were limited to those
collected from January 2003 to June 2005. The
investigators believed that this timeframe is accept-
able for inclusion in that no significant changes had
occurred in the healthcare industry, particularly
radical staffing changes, posing no historical
threats. For the purpose of this study, operational
definitions for each respective group of participat-
ing institutions were the following:
 Magnet: An organization with Magnet status
at the time of administering the IWPS
 Magnet aspiring: An organization that had
formally announced intentions and beginning
preparations of pursuing Magnet status at
the time the IWPS was administered
 Non-Magnet: An organization that had no
activity related to pursuing Magnet status at
the time the IWPS was administered
Instrument: IWPS
A comprehensive report of the development, test-
ing, and psychometric properties of the IWPS, a
32-item Likert scale instrument, is described in a
JONA  Vol. 37, No. 4  April 2007
previously published article.12 However, to provide
background for the reader, the psychometric prop-
erties of the IWPS were tested and established
from 2001 to 2003 on a sample of 987 staff nurses
from a 241-bed children’s hospital, a 230-bed acute
care teaching hospital, and a 306-bed community
hospital. The theoretical framework underpinning
development was Maslow’s Hierarchy of Needs.
The current study results found that " coefficients
ranged from .61 to .91 for all subscales: manager
support, .85; peer support, .82; unit support, .61;
workload, .70; intent to stay, .85; and nurse satis-
faction, .91. Operational definitions and " coeffi-
cients for each subscale can be found in Table 1.
The IWPS is in the public domain.
Analysis
Data were analyzed using version 12.0 of SPSS
developed by SPSS Inc, Chicago, Ill.13 Descriptive
statistics were used to characterize the demo-
graphics of the study participants and participating
facilities. Analysis of variance (ANOVA) was
conducted to determine differences in the mean
scores for subscales of the IWPS for staff nurses
working in each of the 3 types of institutions: (1)
Magnet, (2) Magnet-aspiring, or (3) non-Magnet
organizations. A series of post hoc comparisons
were conducted with all significant ANOVAs using
the Tukey post hoc test to determine which groups
account for this significance.14 Because pediatric
nurses represented such a large fraction (44%) of
the total sample, it was important to determine if
these scores skewed the results. To determine if
significance remained, we excluded these partici-
pants’ scores and reanalyzed the sample.
Results
The demographic characteristics of the study partici-
pants are reported in Table 2. Ninety-three percent
of the participants were women; 49% were baby
boomers, born between 1946 and 1964; 49%
were prepared at the bachelor’s level; and 38%
and 48% had been working at their institution
and units, respectively, for 1 to 5 years. The largest
numbers of participants had been working in
nursing for more than 15 years, and 72% were
working full time; 60% worked the day shift;
and 44% indicated that their primary unit was a
pediatric unit.
Hospital characteristics are included in Tables
3 and 4. Institutions from 11 states participated
in the study. Missouri had the most participants
(n = 775), whereas Ohio had only 51 nurse par-
ticipants. Fifteen institutions participated: 2 Mag-
net, 10 Magnet-aspiring, and 3 non-Magnet sites.
Six institutions identified themselves as pediatric
facilities, 3 as suburban, 3 as urban, 2 as rural, and
1 as an academic medical center. The bed size of
the institutions ranged from less than 200 to more
than 500 beds categorically. There were 3 institu-
tions with less than 200 beds (n = 271 nurses),
5 with 200 to 299 beds (n = 919 nurses), 3 with
300 to 399 beds (n = 324 nurses), 2 with 400 to
499 beds (n = 868 nurses), and 2 with more than
500 beds (n = 955 nurses).
The ANOVA results, provided in Table 5,
demonstrate that nurses employed by organizations
that have achieved Magnet recognition have sig-
nificantly more positive perceptions of support for
nurses than do nurses employed by organizations
that currently identify themselves as either Magnet
aspiring or non-Magnet. All subscales of the IWPS
were significantly better for the Magnet facilities
(higher means are more positive), all with a P value
of .000. The mean scores on all subscales were
consistently better in the Magnet facilities than in
the Magnet-aspiring facilities, and the Magnet-
aspiring facilities had better means scores than
the non-Magnet sites.

Table 1. Individual Workload Perception Scale Subscales, Definitions, and ! Coefficients

Subscale Operational Definition " Coefficient

Manager support The extent to which nurses perceive that their supervisors are helpful and concerned .85
about their needs
Peer support The relationship that the nurses have with each other .82
Unit support The extent to which nurses feel they have access to the supplies, materials, resources, .61
and services they need to do their jobs
Workload The extent to which pressure and urgency dominate the work environment .70
Intent to stay A predictive subscale that attempts to measure the likelihood that nurses will stay .85
in their current job for the next year
Nurse satisfaction The overall nursing satisfaction score is derived through an averaging of the .91
subscales above

Higher scores on each of the subscales are more positive scores.

JONA  Vol. 37, No. 4  April 2007 201

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 Table 2. Participant Demographics Table 3. Characteristics of Participating
(N = 3,337) Sites (N = 15)
Frequency Percentage Number and Type
State Frequency Percentage of Facility
Year born
1909Y1945 152 4 California 223 7 1 Magnet
1946Y1964 1,644 49 District of 142 4 1 Non-Magnet
1965Y1979 1,296 39
1980Ypresent 219 7 Columbia
Missing 26 1 Georgia 370 11 1 Magnet aspiring
Preparation Kentucky 229 7 2 Magnet aspiring
Diploma 440 13 Massachusetts 592 18 2 Magnet aspiring
Associate’s 1,077 32 Michigan 131 4 1 Magnet aspiring
Bachelor’s 1,641 49 Missouri 775 23 1 Magnet, 1 Magnet
Master’s 150 5 aspiring
Other 8 G1 Ohio 51 1 1 Magnet aspiring
Missing 21 1
Texas 601 18 1 Magnet aspiring,
Years in current department
G1 359 11 1 Non-Magnet
1Y5 1,608 48 Virginia 107 3 1 Non-Magnet
6Y10 552 16 Wisconsin 116 4 1 Magnet aspiring
11Y15 305 9 Total 3,337 100 15
915 493 15
Missing 20 1
Years in current employment
G1 285 8
1Y5 1,282 38
6Y10 587 18 The results of the Tukey post hoc tests, which
11Y15 388 12 illuminate where this significance is embedded, can
915 775 23
Missing 20 1 be found in Table 6. Of the 18 planned compari-
Years in nursing sons, 13 remained statistically significant at the
G1 123 3
1Y5 765 23 .000 level. In addition, there were 3 subscales that
6Y10 602 18 remained significant, although greater than .000.
11Y15 399 12
915 1,429 43 They were manager support and peer support
Missing 19 1 between Magnet and Magnet-aspiring hospitals,
Employment status
Full time 2,399 72 both at .003, and workload between Magnet-
Part time 713 21 aspiring and non-Magnet hospitals, at .002. Only
PRN 202 6
Missing 23 1
Shift primarily worked
Days 2,013 60
Nights 714 21
Day/Night rotating 125 4 Table 4. Characteristics of Participating
Other 131 4 Sites and Numbers of Participants by Type
Evenings 200 6 (N = 15)
Weekend option 107 3
Missing 47 2 Number of
Primary unit
Medical/Surgical 592 18 Frequency Percentage Hospitals
ICU 227 7
OB-MB 134 4 Magnet status
OB-L/D 114 3 Magnet 529 16 2
Surgery 276 8 Magnet aspiring 2,456 74 10
Rehabilitation 45 1 Non-Magnet 352 10 3
ED 130 4 Total 3,337 100 15
OP 119 4 Type of institution
Pediatrics 1,470 44
Other, IP 114 3 Rural 189 6 2
Home health 13 1 Suburban 592 18 3
Mental health 29 1 Urban 1,097 33 3
QI, QA, UR, research, 8 G1 Academic medical 51 1 1
school nurse, hospice center
Missing 66 2 Pediatrics 1,408 42 6
Sex Total 3,337 100 15
Male 160 5 Bed size
Female 3,103 93 G200 beds 271 8 3
Missing 74 2
200Y299 beds 919 27 5
ICU indicates intensive care unit; ED, emergency department; 300Y399 beds 324 10 3
PRN, pro re nata meaning ‘‘when necessary’’ OB-MB, 400Y499 beds 868 26 2
obstetrical-mother baby; OB-L/D, obstetrical-labor and deliver; 9500 beds 955 29 2
OP, outpatient; IP, inpatient; QI, Quality Improvement; Total 3,337 100 15
QA, Quality Assurance; UR, Utilization Review.

202 JONA  Vol. 37, No. 4  April 2007

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 Table 5. IWPS Workload Subscales by Magnet Status (ANOVA Results, Means, and SDs)
Subscale Magnet Magnet Aspiring Non-Magnet P Value

Manager support 3.60 (0.034) 3.48 (0.016) 3.39 (0.043) .000

Peer support 4.08 (0.026) 3.98 (0.013) 3.66 (0.036) .000
Unit support 3.88 (0.027) 3.76 (0.012) 3.53 (0.031) .000
Workload 3.86 (0.028) 3.56 (0.015) 3.42 (0.034) .000
Intent to stay 3.92 (0.039) 3.72 (0.019) 3.64 (0.052) .000
Nurse satisfaction 3.86 (0.024) 3.69 (0.012) 3.52 (0.028) .000

ANOVA indicates analysis of variance.

Criterion of rejection set at .05. Values are given as mean (SD).

manager support (.152) and intent to stay (.261) Conclusion

between Magnet-aspiring and non-Magnet hospi-
tals did not remain statistically significant in post The findings indicate that the Magnet Recognition
hoc testing. All 6 of the subscales remained Program has been successful in achieving its goal of
significant at the .000 level between the Magnet improving the work environment for nursing pro-
and non-Magnet sites. fessionals. The IWPS, designed with the staff
To determine if the large percentage of pedi- nurse’s perception of critical support elements of
atric nurses biased the results, these scores were the organization, their satisfaction, and their intent
omitted and the data set was reanalyzed. All to stay, may be a sensitive instrument for organiza-
findings remained consistent without the influence tional assessment both before an organization
of the pediatric nurses’ scores. commits the resources toward the Magnet distinc-
tion and afterward as an organizational surveil-
lance tool to ensure that a strong professional
Limitations practice environment is maintained over time.
The authors caution that because the original sam- Deficits identified with the IWPS may help the
ple of registered nurses was a convenience sample, institution conserve resources to address the great-
there are limitations to the generalizability of these est needs of staff nurses, rather than using a more
findings. However, the diversity of regions, sizes, broad brush approach that may or may not achieve
and types of institutions included in this sample their intended objective.
suggests that the findings are a legitimate first step The descending mean scores from Magnet to
in understanding the impact of the Magnet status non-Magnet participants reflect the sensitivity of
on nursing personnel’s perceptions of their organi- the IWPS and also the organizational traits that re-
zational environment and in introducing the IWPS flect the Magnet culture. When a hospital achieves
as a survey tool that holds promise for organiza- Magnet status, support features are in place and
tional assessments for nursing leaders. nurses are more satisfied and intend to stay with
the organization. Even when comparing Magnet-
aspiring to non-Magnet facilities, the mean scores
were consistently more positive for the Magnet-
Table 6. Planned Comparisons of aspiring sites, indicating that even for those facili-
Significant ANOVAs (Tukey post hoc ties that have made the formal commitment to this
results) pursuit, there is a perception by the staff nurses
Magnet to Magnet that their organization supports them, which leads
Magnet Magnet to Aspiring to to their satisfaction and commitment over institu-
Subscale Aspiring Non-Magnet Non-Magnet
tions where no such commitment has been made.
Manager support .003 .000 .152 Of particular note is the finding that manager
Peer support .003 .000 .000 support had the lowest mean scores in all 3 hos-
Unit support .000 .000 .000
Workload .000 .000 .002
pital types. One explanation is that nurse managers
Intent to stay .000 .000 .261 continue to be stretched thin. Increases in span of
Nurse satisfaction .000 .000 .000 control and numbers of direct reports continue
ANOVA indicates analysis of variance.
in hospital settings even though this management
Criterion of rejection level set at .05. structure is not supported in the literature. Having
rapid access to a nurse manager has been found to

JONA  Vol. 37, No. 4  April 2007 203

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be a critical component of satisfaction15 in that
nurses need to know that when they have issues of
concern during their shift, they have an advocate to
contact for advice and support.
These findings are congruent with the work
conducted by Aiken and colleagues using the
Nursing Work Index-Revised and Kramer and
Schmalenberg Essentials of Magnetism. Regardless
of the level of assessment, more tangible nurse
support, such as help with staffing issues, versus
more professional practice framework, such as a
clinical ladder, supporting the work of nurses yields
a greater level of satisfaction and is likely to
decrease turnover of staff.15,16 The largest percent-
age of institutions in this sample, 67% (n = 10),
were Magnet-aspiring organizations, which account
for 74% of the staff nurses in this sample. This fact
highlights the large number of institutions consider-
ing recognition through the Magnet Recognition
Program, a positive phenomenon for staff nurses
in the United States.
The results of this study indicate that the
Magnet Recognition Program has been instrumen-
tal in fostering more positive perceptions of basic
needs for frontline nurses. It also remains clear that
nurses who work in Magnet facilities and those in
the process of obtaining Magnet status perceive
that support systems are significantly better than
do nurses who work in non-Magnet facilities. The
assessment of these nurses’ institutions with the
IWPS is a reliable way for institutions to quantify
nurses’ perceptions of the presence or absence of
basic workplace requirements. Once Magnet rec-
ognition is obtained, however, continued due
diligence is recommended to ensure that the nurs-
ing work environment continues to be positive and
that the overall goals of the Magnet program
specific to nursing support are maintained for the
long term. To illustrate, many institutions continue
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to use the IWPS for their annual appraisal of nurse
satisfaction, mandated by the Magnet Recognition
Program.
At a time of unprecedented challenges in
healthcare, especially fiscal limitations, it is incum-
bent on nurse executives to be a voice for dedicat-
ing appropriate, targeted resources to support
nursing practices. There is now a plethora of data
to indicate that more nurses and more highly
educated nurses equate to safe care and better
patient outcomes; therefore, retention is critical.17
In addition, Needleman and colleagues18 provided
a detailed analysis describing why adequate nurse
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trary numbers to manipulate when an organization
is under fiscal constraints. Indeed, adequate and
appropriate staffing levels make good business
sense and should be vigorously attended by the
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As the push continues for stronger nursing
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pursue the seal of excellence that Magnet desig-
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assess the organization’s support for professional
nursing practice as this process begins in earnest.
The IWPS can provide this assessment in a valid
and reliable way for organizations across the
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for professional nursing practice that translates to
better patient outcomes for the clients they serve.
Acknowledgment
The authors thank the staff nurses, site coordinators,
and nurse executives who participated in this project.
In addition, the support of the CHCA in the recruit-
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