Introduction

Background
It is the responsibility of both institutions and health professionals to identify, on the

one hand, the characteristics of the work environment in which they develop, and on the

other, to ensure more favorable practice models for the quality of patient care. and contribute

to positive outcomes for staff and the organization. The review of studies reported in the

literature showing satisfactory repercussions for the patient and the institution that are based

on excellence in care of nursing which are called “magnet or magnetic hospitals.”

(Rodríguez-García et al., 2020)

A magnetic hospital is identified by its ability to hire and retain qualified nurses,

however, because of studies that have been conducted for more than a decade, it has been

shown that they also have characteristics and benefits for patients, the nursing staff and for

the institution as a whole. (Beal & Riley, 2019)

There is currently an accreditation and recognition program to identify magnetic

hospitals in the United States, which is based on quality indicators and standards for nursing

practice. It is necessary to know these models of nursing practice in our country, to see the

impact that the structure and context of organizations have when strategies are formed based

on these models that guarantee the quality of care for patients and it is revealed the

importance of the role of the nursing professional. (Stone et al., 2019)

Historical Development

The concept of magnetic hospital was introduced for the first time in 1983, it derives

from a policy defined by the American Academy of Nursing (AAN) in 1981, due to the

serious phenomenon of shortage of nursing personnel in the United States, for which it was

characteristics of the organization that were capable of retaining and attracting qualified

nursing personnel and seeking the best conditions for professional practice. As a result of this

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study, it was determined that the best contribution would be to carry out research on the

different factors that intervened in the creation of hospitals that attracted and retained nursing

professionals and to share the results with other hospitals, so that they would implement

actions to in order to implement in other institutions the values of excellence promoted by the

magnetic hospital model. And items identified as hospital essentials magnetic. (El-khateeb, El

Dahshan, & Shokry, 2022)

In 1988 Kramer and Schmalenberg published the results of magnetic hospitals, linked

to institutions of excellence, and the concept was established in the literature that includes the

most crucial element that has been identified in these institutions, job satisfaction. and its

impact on the quality of care. (Schmalenberg & Kramer, 2009)

After this first review, the convenience of implementing a recognition program for

these centers called so in 1994 the magnetic hospital recognition program was established

known as accreditation center United States of America Nurses Association (ANN), which

evaluates 14 fundamental and essential elements to provide excellent care (Halverso

& Scott Tilley, 2022):

1. Quality of leadership Nursing.

This indicator is explored at all levels of the organization, institutional support for staff

and patients is transmitted and perceived.

2. Organizational structure dynamic and sensitive to changes.

The organization has a productive system, and its operation includes shared decision-

making.

3. Management Style.

The Leaders create an environment that supports participation. Nurses serving in

leadership positions have visibility and communicate effectively with staff.

4. Programs and policies of staff.

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 Salaries and benefits of the organization are competitive. There is staffing that favors a

healthy and safe work environment for both the patient and the nurses.

5. Models of professional attention.

Nurses are responsible and have autonomy for their own practices as well as care

coordination.

6. Quality of care.

Nurse leaders are responsible for providing an environment that positively influences

outcomes of the quality of care the patients.

7. Quality improvement.

The organization has structures and processes for quality measurement and care and

service improvement programs within the organization.

8. Resources.

The organization provides adequate hospital care, provided with resources, support and

opportunities, in addition to promoting the participation of nurses in professional

organizations.

9. Nursing autonomy.

Nursing has the ability to evaluate and implement independent actions as appropriate, for

patient care based on competence, professional experience, and knowledge.

10. The Community and the health organization.

The institution establishes relationships between different hospital organizations and

community organizations, to develop strong partnerships that support the improvement of

health outcomes for patients’ patients.

11. Nurses as teaching staff.

Nursing Professionals participate in educational activities within the organization and

the community.

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12. Image of the infirmary.

The services provided by nurses are characterized as essential by other members of

the health care team. The nurse effectively influences

all care processes.

13. Interdisciplinary relationships.

This indicator explores working relationships with different disciplines, mutual respect is

based on the premise that all members of the health care team are essential and contribute

significantly to the achievement of patient results.

14. Professional development.

The hospital organization supports professional growth and development, promotes

programs for formal education and professional certification.

To link these fundamental elements of magnetic hospitals with the ability to provide high-

quality patient care, Kramer and Schmalenberg in 2001 conducted a study With 279 nurses

who worked in magnetic hospitals, this survey made it possible to identify the 8 essential

elements to provide quality care, directly related to health satisfaction at work (which were

called essential factors of magnetism). (Schmalenberg & Kramer, 2009)

It has also been identified that magnetic hospitals are characterized by having a

horizontal structure, with few supervisory personnel, giving nursing professionals greater

responsibility and autonomy, control over practice, and job satisfaction. (Choi & Kim, 2019)

The recognition program for magnetic hospitals developed by the Nursing

Accreditation Center has allowed researchers to carry out studies within the institutions

recognized as magnetic, based on the characteristics of the work environments

(characteristics organization), that is, the institutions that are under this model, provide the

means and support of a leading head to the nurses to use their experience and knowledge in a

way that favors the conditions to provide excellent care to the patient , which increases

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satisfaction and therefore greater retention and less intention to leave the workplace. (El-

khateeb, El Dahshan, & Shokry, 2022)

Factors related to magnetic hospitals.

Patients who are cared for in hospitals characterized by having sufficient nursing

staff, administrative support for nursing care, good relations between nurses and doctors are

satisfied with the care they receive, and nurses report lower levels of care. emotional

exhaustion. Related studies have reported that the identification of factors that contribute to

creating conditions to attract and retain qualified nurses should be put in place by nursing

directors and human resource administrators so that work can be redesigned in practice of

nursing professionals, contributing to the improvement of the quality of care for patients, the

satisfaction of nurses in

their jobs, as well as positive results for the organization. (Choi et al., 2021)

These results are related to the decrease in patient mortality, mainly when there are

factors in the institutions that have already been identified in the magisterial hospitals, such

as having nurses with a higher level of academic training, as well as adequate. (Park, 2022)

staffing.

Other related studies have identified the presence of burnout syndrome and turnover

of nursing employees in an important way in nursing personnel, particularly in the United

States as well as in the KSA, where it has been found that there is a 40-45% level of burnout

associated with job dissatisfaction of nurses also identified that work overload related to the

number of patients assigned per nurse increases mortality. (Alrashedi, 2021; Shah et al.,

2021)

Achieve Magnet Status

It’s not a simple task to become a Magnet hospital, meaning some hospitals who

apply for this designation do not receive a certification. The application and review process

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can be a long one, and require strong record-keeping, data analysis and solid organizational

practices. Magnet status requirements include educational standards for nurse leaders and

nurse managers, ensuring a facility's top staff hold at least a nursing bachelor's degree,

according to the ANCC.

Magnet hospitals must also submit an application and undergo a site visit to review

their excellence in the "forces of magnetism" first identified by the Magnet hospital study in

the 1980s. Today, the ANCC categorizes those organizational features into

Five primary components of a Magnet hospital.

1. Transformational Leadership

The field of nursing and health care is undergoing tremendous change, as technology

advances, patient management becomes more data-driven and new medications and therapies

become available. According to the ANCC, "the intent of this Model Component is no longer

just to solve problems, fix broken systems, and empower staff, but to actually transform the

organizations to meet the future. Magnet-recognized organizations today strive for

stabilization; however, healthcare reformation calls for a type of controlled destabilization

that births new ideas and innovations."

The Magnet Recognition Program examines the quality of nursing leadership and the

management style of hospital leaders. Magnet hospital leaders must have vision, influence,

clinical knowledge and a strong expertise in nursing practice, according to the ANCC. This

type of nursing leadership style is key, Urban said, because the field of nursing is changing so

rapidly. How we practice today can change tomorrow with the discovery of a new treatment

or technology tool that can improve patient outcomes. The fluid nature of our work requires

nurses to be skilled leaders with vision, influence, and high levels of clinical knowledge to

manage turbulent times and move innovative approaches to care forward to meet future

needs.

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2. Structural Empowerment

Having strong leadership is not enough for an institution to be classified as a Magnet

hospital. The organizational structure of a hospital must also empower its nursing staff to

innovate and put the hospital’s mission, vision and values into daily practice, according to the

ANCC. The Structural Empowerment component of Magnet designation reviews an

organization’s personnel policies and practices, its professional development programs and

its collaboration among the medical team and with community organizations.

Magnet-status hospitals involve nurses as key players in developing and updating

institutional policies to improve practice and the patient experience and outcomes. This

practice not only benefits the hospital and its patients, but it can also lead to more

engagement and job satisfaction among nurses. Collaborative decision-making improves

work satisfaction and acknowledges the value and expertise of nurses.

3. Exemplary Professional Practice

An organization’s professional nursing practice is truly the foundation for its

certification as a Magnet hospital. Nursing staff at Magnet hospitals must demonstrate a clear

understanding of the role of nursing and how it applies to working with patients, families,

communities and an interdisciplinary teams, according to the ANCC. Magnet hospitals are

assessed not only on the quality of nursing in the institution but on what that professional

practice can achieve. Magnet certification reviews a number of professional practice

measures, including the autonomy of its nursing staff and the relationships between its nurses

and other medical teams.

Magnet hospitals put a strong focus on communication among nursing units, hospital

departments and all levels of medical staff, from surgeons and physicians to pharmacists and

lab workers. Before the Magnet movement, nursing units were more compartmentalized and

there wasn't as much communication across units and teams. Evidence confirms that the

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practice shift to cross-team and interprofessional collaboration has lead to improved patient

outcomes.

4. New Knowledge, Innovations and Improvements

Magnet hospitals should also display a commitment to evolving the future of patient

care and nursing practice, using existing evidence, new research and innovative contributions

to advance the science of nursing, according to the ANCC. The Magnet hospital program

encourages institutions to base best practices and institutional advancements on hard

evidence, and not just change for the sake of change.

We make changes because there is some evidence that this change will improve the

patient outcome. The Magnet program is really asking us to look for new knowledge,

research and innovations so that we can improve the outcomes of our patients.Nurses really

lead that charge.

5. Empirical Quality Results

While many of the components of a Magnet-designated hospital focus on an

institution's structure and practices, the foundation of the Magnet Recognition Program is the

impact these practices have on the hospital, its staff, its patients and its community, according

to the ANCC. Studies have shown that Magnet hospitals often have better patient outcomes

and a higher standard of patient care, according to the ANCC.

These improved patient outcomes can be attributed to many features of a Magnet

hospital, including improved nurse engagement, collaboration across medical teams and a

focus on regularly reviewing patient data. Nurses really step up in this area, they are change

agents. They look for something that needs improvement, look at the processes in place and

the policies in place and really are the leaders of saying, We need to adjust what we're

currently doing because we're not getting the outcomes we desire for our patients.

The Benefits of Being a Magnet Hospital

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  In today’s changing healthcare landscape, patients have more choices than ever before

when it comes to their medical care.

 From urgent care offices and pharmacies providing vaccines and simple medical tests

to a spike in the number of independent labs and even at-home testing for blood work

and allergies, medical institutions need to do what they can to stand out.

 Earning a Magnet Recognition Program certification is a strong indicator to patients

that an organization is committed to innovation, excellence in nursing and high-

quality patient care.

 Studies have shown there are also significant benefits to becoming a Magnet hospital

for the institution and its nursing staff.

Benefits to the Hospitals

 According to an article from American Nurse Today, studies have shown that

Magnet-designated hospitals report better economic performance than non-Magnet

hospitals.

 One key to this performance is improved attraction and retention of its nursing staff,

saving hospitals money in recruitment efforts and registered nurse (RN) employment

agency costs.

 The cost of recruiting and orienting a new RN can cost a hospital close to a year's

nursing salary, Urban said, so reducing nurse turnover can be a big cost savings.

 Magnet hospitals can also save money by producing better patient outcomes and

discharging patients in a timely manner – ensuring proper reimbursement by

insurance companies – and by reducing patient falls and other injuries, Urban said.

 Hospitals can also see improved financial performance thanks to an improved

marketing position with the Magnet designation.

 According to American Nurse Today, Magnet-recognized hospitals regularly appear

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 at the top of the list of the nation’s most prestigious hospital rankings and can more

easily raise awareness of their efforts within their community, opening the door to

increased philanthropic gifts and valuable community partnerships.

Benefits to Patients

 Some of the biggest benefits of Magnet designation for hospitals may be the benefits

to patients.

 Studies have shown that patients at Magnet facilities have lower mortality rates and

better health outcomes thanks to higher nurse engagement and high-quality standards

of care.

 A 2015 study of surgical patient outcomes at Magnet and non-Magnet hospitals found

that patients treated at Magnet hospitals were 7.7% less likely to die within 30 days of

their procedure, and 8.6% less likely to die after a postoperative complication.

 Improved patient outcomes have also been linked to higher rates of nurse

engagement, a key component of a hospital’s certification as a Magnet facility.

 A 2016 study of nurse engagement at hospitals around the United States compared

engagement levels to patients’ likelihood to recommend the facility to friends and

family. The study found that the percentage of patients reporting they would

definitely recommend the hospital was more than 14 points higher in hospitals with

the most engaged nursing staff.

Benefits to Nurses

 For nursing professionals, working in a Magnet hospital can bring many benefits,

including a workplace that encourages innovation and values high-quality,

professional nursing care.

 According to American Nurse Today, a Gallup survey found that Magnet hospital

nurses were more engaged with their work, correlating with better patient outcomes.

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  The same study also estimated that the average Magnet facility experiences fewer

safety-related incidents, fewer workplace injuries and lower rates of blood and body

fluid exposure.

 The survey also found that nurses in Magnet hospitals have higher rates of job

satisfaction and more desire to stay in their positions, with a 1.7% lower turnover rate

than the industry average for nursing.

 While there are no specific educational requirements for non-leadership nursing staff

that impact a Magnet designation, there are some things you can do to set yourself

apart when applying to a Magnet hospital job.

Getting a Job at a Magnet Hospital

 With higher rates of job satisfaction and lower nursing turnover, a Magnet hospital

can be a great place to look for work for nursing school graduates.

 To help your resume stand out, look for opportunities to advance your education, said

Urban.

 While you can get nursing jobs at Magnet hospitals with an associate degree in

nursing, earning your Bachelor of Science in Nursing (BSN) or Master of Science in

Nursing (MSN) can advance your knowledge and help you stand out among other

applicants.

 Accelerated RN to MSN programs can help you advance your education faster.

 Magnet hospitals value nurses who advance their degrees and really encourage.

 The thinking is that the higher the degree, the more knowledgeable you are, and the

more you can share that knowledge with the people you work with and improve

practice.

 Magnet-designated institutions are not alone in looking for nurses with advanced

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 degrees. A 2020 survey from the American Association of Colleges of Nursing

(AACN) found that 41% of hospitals and other healthcare facilities are requiring new

hires to have a bachelor’s degree, while 82% of health care employers expressed a

strong preference for BSN program graduates.

 If you do not have a BSN, some employers will expect you to achieve your BSN

within a specific time frame such as 3-5 years after hire date and may also offer

tuition reimbursement or assistance.

 Some employers may expect that the BSN is achieved with a specific time frame, and

may offer tuition reimbursement or assistance.

 The Veteran's Administration, for example, requires a BSN for promotion beyond

entry-level positions, and the employer allocated $50 million to help RNs advance

their education, according to the AACN.

 No matter where your nursing degree takes you, whether to a Magnet hospital, small

community hospital or another medical facility, continuing your nursing education

will always be an important part of advancing your health care career.

 Nursing, as a discipline, will continue to evolve as society and healthcare evolve, so

career long learning will continue to be an essential part of the nursing profession.

 Nurses need to embrace career-long learning to ensure professional growth, practice

competency and the advancement of the profession.

 The ANCC holds a celebration each year for Magnet designed hospitals and those on

the journey to Magnet at an annual conference.

 This conference has been attended by over 10,000 nurses from all over the world and

offers inspiring keynote speakers, presentations by nurse leaders, poster presentations

and a large exhibit hall.

Conclusions

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 The previous review allows us to identify lines of research that nurse administrators

must attend to in our country in order to identify the phenomenon related to job satisfaction

based on the identification of factors that can affect quality and staff satisfaction of nursing,

in a way that allows proposing strategies to generate healthy environments and environments

for nursing work and deal with the impact on the shortage, absenteeism and turnover of

nurses, particularly in the quality of care of the patients. patients and their families, which

will translate into benefits for the institutions of the health system in our country.

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