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Magnet Research Materials and Resources

This reference list includes research studies that have investigated the relationship between Magnet environments and patient, nurse, and/or organizational outcomes.  In general, findings have consistently demonstrated an association between Magnet characteristics and favorable nurse or patient outcomes.  The most common approaches to measuring Magnet characteristics have been to include ANCC Magnet-recognized Organizations in the study sample or to administer a version of the Nursing Work Index survey, which was initially developed to characterize a Magnet environment. 

For two recent literature reviews, see

Chapter 46 (Magnet Environments for Professional Nursing Practice) at www.ahrq.gov/qual/Nurseshdbk/ in AHRQ's publication Patient Safety and Quality:  An Evidence-Based Handbook for Nurses . (Publication No. 08-0043, edited by RG Hughes, Rockville, MD: Agency for HealthCare Research and Quality, April 2008). 

Chapter 10 (Magnet Practice Environments and Outcomes) in Magnet®: The Next Generation—Nurses Making the Difference , edited by K Drenkard, G Wolf, & S Morgan. Silver Spring, MD: American Nurses Credentialing Center, 2011. Available from here.

ANCC cannot provide copies of any articles listed here.

References

Aiken LH, Clarke SP, Sloane DM, Lake ET, Cheney T. Effects of hospital care environment on patient mortality and nurse outcomes. J Nurs Adm. 2008 May; 38(5): 223-9.

Aiken LH, Havens DS, Sloane DM. The Magnet Nursing Services Recognition Program. Am J Nurs. 2000 Mar;100(3):26-35.

Armstrong KJ, Laschinger H. Structural empowerment, Magnet hospital characteristics, and patient safety culture: making the link. J Nurs Care Qual. 2006 Apr-Jun;21(2):124-32.

Armstrong K, Laschinger H, Wong C. Workplace empowerment and Magnet hospital characteristics as predictors of patient safety climate. J Nurs Care Qual. 2009 Jan-Mar;24(1):55-62.

Brady-Schwartz DC. Further evidence on the Magnet Recognition program: implications for nursing leaders. J Nurs Adm. 2005 Sep;35(9):397-403.

Chen YM, & Johantgen ME. Magnet hospital attributes in European hospitals: A multilevel model of job satisfaction. Int J Nurs Stud. 2010. doi:10.1016/j.ijnurstu.2009.12.016

Clarke SP. Hospital work environments, nurse characteristics, and sharps injuries. Am J Infect Control. 2007 Jun;35(5):302-9.

Cummings GG, Midodzi WK, Wong CA, Estabrooks CA. The contribution of hospital nursing leadership styles to 30-day patient mortality. Nurs Res. 2010 Sep/Oct; 5: 331-9.

Dunton N, Gajewski B, Klaus S, Pierson B. The relationship of nursing workforce characteristics to patient outcomes. Online J Issues Nurs . 2007; 12(3). Available www.nursingworld.org/OJIN-NursingWorkforceCharacteristics.aspx.

El-Jardali F, Alameddine M, Dumit N, Dimassi H, Jamal D, & Maalouf S. Nurses' work environment and intent to leave in Lebanese hospitals: Implications for policy and practice. Int J Nurs Stud. 2011; 48: 204-14.

Friese CR, Lake ET, Aiken LH, Silber JH, Sochalski J. Hospital nurse practice environments and outcomes for surgical oncology patients. Health Serv Res. 2008 Aug;43(4):1145-63.

Friese CR. Nurse practice environments and outcomes: implications for oncology nursing. Oncol Nurs Forum. 2005 Jul 1;32(4):765-72.

Gardner JK, Fogg L, Thomas-Hawkins C, Latham CE. The relationships between nurses' perceptions of the hemodialysis unit work environment and nurse turnover, patient satisfaction, and hospitalizations. Nephr Nurs J. 2007 May-Jun;34(3):271-81.

Havens, DS. Comparing nursing infrastructure and outcomes: ANCC Magnet and nonmagnet CNE's report. Nursing Econ. 2001;Nov-Dec;19(6):258-66.

Hess R, Desroches C, Donelan K, Norman L, Buerhaus PI. Perceptions of nurses in magnet® hospitals, non-magnet hospitals, and hospitals pursuing magnet status. J Nurs Adm . 2011 Jul-Aug;41(7-8):315-23.

Hickey P, Gauvreau K, Connor J. The relationship of nurse staffing, skill mix, and Magnet recognition to institutional volume and mortality for congenital heart surgery. J Nurs Admin. 2010 May; 40 (5): 226-32.

Hughes LC, Chang Y, Mark BA. Quality and strength of patient safety climate on medical-surgical units. Health Care Manage Rev. 2009;34(1):19-28.

Jayawardhana J., Welton JM, Lindrooth R. Adoption of national quality forum safe practices by Magnet® hospitals. J Nurs Adm. 2011 Sep;41(9):350-6.

Kelly LA, McHugh MD, Aiken LH. Nurse outcomes in Magnet® and non-magnet hospitals. J Nurs Adm . 2011 Oct;41(10):428-33.

Kim H, Capezuti E, Boltz, & Fairchild S. The Nursing Practice Environment and nurse-perceived quality of geriatric care in hospitals. West J Nurs Res. 2009. Online Mar 11, 2009.

Kutney-Lee A, McHugh MD, Sloane DM, Cimiotti JP, Flynn L, Neff DF, & Aiken LH. Nursing: A key to patient satisfaction. Hlth Affrs. 2009 Jun; 28(4): 669-77.

Kwak C, Chung BY, Xu Y, & Eun-Jung C. Relationship of job satisfaction with perceived organizational support and quality of care among South Korean nurses: A questionnaire survey. Int J Nurs Stud. 2010; 47: 1292-8.

Lacey SR, Cox KS, Lorfing KC, Teasley SL, Carroll CA, Sexton K. Nursing support, workload, and intent to stay in Magnet, Magnet-aspiring, and non-Magnet hospitals. J Nurs Adm. 2007 Apr;37(4):199-205.

Lake ET, Shang J, Klaus S, Dunton NE. Patient falls: Association with hospital Magnet status and nursing unit staffing. Res Nurs Health . 2010 Oct;33(5):413-25.

Laschinger HKS. Effect of empowerment on professional practice environments, work satisfaction, and patient care quality: further testing the Nursing Worklife Model. J Nurs Care Qual. 2008 Oct-Dec:23(4):322-30.

Laschinger HK, Almost J, Tuer-Hodes D. Workplace empowerment and magnet hospital characteristics: making the link. J Nurs Adm. 2003 Jul-Aug;33(7-8):410-22.

Laschinger HKS, Leiter MP. The impact of nursing work environments on patient safety outcomes: the mediating role of burnout/engagement. J Nurs Adm. 2006 May;36(5):259-67.

Laschinger HKS, Finegan JE, Shamian J, Wilk P. A longitudinal analysis of the impact of workplace empowerment on work satisfaction. J Org Behav 2004 Jun;25(4):527-45.

Laschinger HKS, Shamian J, Thomson D. Impact of Magnet hospital characteristics on nurses' perceptions of trust, burnout, quality of care, and work satisfaction. Nurs Econ 2001 Sep- Oct;19(5):209-219.

Manojlovich M. Linking the practice environment to nurses' job satisfaction through nurse-physician communication. J Nurs Scholarsh. 2005;37(4):367-73.

Manojlovich M, Antonakos CL, Ronis DL. Intensive care units, communication between nurses and physicians, and patients' outcomes. Am J Crit Care. 2009; 18(1): 21-30.

Manojlovich M, DeCicco B. Healthy work environments, nurse-physician communication, and patients' outcomes. Am J Crit Care. 2007 Nov;16(6):536-43.

Manojlovich M, Laschinger H. The nursing worklife model: extending and refining a new theory. J Nurs Manag. 2007 Apr;15(3):256-63.

Mark BA, Lindley L, Jones CB. Nurse working conditions and nursing unit costs. Policy Polit Nurs Pract. 2009 May; 10 (2): 120-8.

McHugh MD, Kutney-Lee A, Cimiotti JP, Sloane DM, & Aiken LH. Nurses' widespread job dissatisfaction, burnout, and frustration with health benefits signal problems for patient care. Health Affairs. 2011; 30 (2): 202-10.

Rheaume A, Clement L, & LeBel N. Understanding intention to leave amongst new graduate Canadian nurses: A repeated cross sectional survey. Int J Nurs Stud. 2011; 48: 490-500.

Ridley J, Wilson B, Harwood L, Laschinger HK. Work environment, health outcomes and magnet hospital traits in the Canadian nephrology nursing scene. CANNT Journal. 2009 Jan-Mar; 19(1): 28-35.

Rondeau KV, Wagar TH. Nurse and resident satisfaction in magnet long-term care organizations: do high involvement approaches matter? J Nurs Manag. 2006 Apr;14(3):244-50.

Schmalenberg C, Kramer M. Essentials of a productive nurse work environment. Nurs Res. 2008 Jan-Feb; 57(1):2-13.

Seago JA. Unit characteristics and patient satisfaction. Policy Polit Nurs Pract. 2008 Nov; 9(4):230-40.

Siu H, Laschinger HKS, Finegan J. Nursing professional practice environments: setting the stage for constructive conflict resolution and work effectiveness. J Nurs Adm. 2008 May;38(5):250-7.

Smith H, Tallman R, Kelly K. Magnet hospital characteristics and northern Canadian nurses' job satisfaction. Nurs Leadersh (Tor Ont) [Can J Nurs Leadersh]. 2006 Sep;19(3):73-86.

Stone PW, Gershon RR. Nurse work environments and occupational safety in intensive care units. Policy Polit Nurs Prac. 2006 Nov;7(4):240-7.

Stone PW, Larson EL, Mooney-Kane C, Smolowitz J, Lin SX, Dick AW. Organizational climate and intensive care unit nurses' intention to leave. Crit Care Med. 2006:Jul;34(7):1907-12.

Stone PW, Mooney-Kane C, Larson EL, Pastor DK, Zwanziger J, Dick AW. Nurse working conditions, organizational climate, and intent to leave in ICUs: an instrumental variable approach. Health Serv Res 2007 Jun;42(3 Pt 1):1085-104.

Stone PW, Mooney-Kane C, Larson EL, Horan T, Glance LG, Zwanziger J, Dick AW. Nurse working conditions and patient safety outcomes. Med Care 2007 Jun;45(6):571-8.

Thomas-Hawkins C, Denno M, Currier H, Wick G. Staff nurses' perceptions of the work environment in freestanding hemodialysis facilities. Nephrol Nurs J. 2003 Aug;30(4):377-86. [Previously published Apr:30(2):169-78.]

Tigert JA, Laschinger HK. Critical care nurses' perceptions of workplace empowerment, magnet hospital traits and mental health. Dynamics. 2004 Winter;15(4):19-23.

Tourangeau AE, Doran DM, Hall, LM, Pallas LO, Pringle D, Tu JV, Cranley LA. Impact of hospital nursing care on 30-day mortality for acute medical patients. J Adv Nurs. 2006;57(1):32-44.

Ulrich BT, Buerhaus PI, Donelan K, Norman L, Dittus R. Magnet status and registered nurse views of the work environment and nursing as a career. J Nurs Adm. 2007 May;37(5):212-20.

Ulrich BT, Woods D, Hart KA, Lavandero R, Leggett J, Taylor D. Critical care nurses' work environments: value of excellence in Beacon units and Magnet organizations. Crit Care Nurse 2007 Jun;27(3):68-77.

Wade GH, Osgood B, Avino K, Bucher G, Bucher L, Foraker T, French D, Sirkowski C. Influence of organizational characteristics and caring attributes of managers on nurses' job enjoyment. J Adv Nurs. 2008 Nov; 64(4):344-53.

Magnet Recognition Program® Designation Criteria

Magnet Recognition Program® Designation Criteria

Appraisal by Peers
One of the strengths of the Magnet Recognition Program® is the contemporary peer review of the nursing practices of the applicant organization. A team of graduate degree prepared RNs experienced in the concepts and operational expectations of the Magnet environment reviews the organization for Magnet designation. These appraisers often work in healthcare facilities.

Qualitative and Quantitative Review
Both qualitative and quantitative approaches are used in the review process. The applicant organization submits documentation to demonstrate the presence of the Forces of Magnetism in their work environment. The appraisal team reviews the documents and scores the sources of evidence in relation to the degree of development.
If warranted, the same appraisal team that reviewed the documents conducts a site visit of the organization. The information contained in the documents is verified, clarified, and amplified in the setting in which nursing is practiced is appraised. The appraisal team reports its findings to the Commission on Magnet.

Designation as Magnet
The decision to award Magnet recognition status is made by the Commission on Magnet. Designation is made for a 4-year period.

Biennial Monitoring
For Magnet recognition to retain its significance, the program must be constantly vigilant that the Magnet environment is sustained throughout the period of designation. Some Magnet designated organizations have faltered during the period of designation. This may result in a repeat site visit to assess the environment for the Forces of Magnetism.

Re-Designation
At the end of the 4-year designation period, the organization applies for re-designation. All Magnet organizations that apply for re-designation are not universally successful.

National Magnet Research Agenda

To establish a national research agenda for the growing Magnet community and keep the agenda current in the future, ANCC plans to conduct periodic surveys of nurse researchers and executive personnel in Magnet healthcare facilities about what they believe to be the most important research priorities for healthcare organizations.

The first National Magnet Research Agenda Study was carried out between October 2005 and February 2006. Of the 162 organizations invited to participate (those holding Magnet recognition as of July 2005), 79 (48.8%) participated in the nurse researchers survey and 104 (64.2%) in the executives' survey. A total of 348 nursing research committee members and 232 executives returned survey responses.

The survey presented a list of 61 topics that were generated by literature searches, reviewed by an expert panel, and organized into five categories. The 26 research topics shown below were judged of highest priority by both respondent groups. As reported in the July-September 2007 issue of Journal of Nursing Care Quality, a striking finding of the initial Magnet National Research Agenda Study was the high degree of consensus expressed about research priorities between the nurse and nonnurse respondents.

National Magnet Research Priorities

Clinical Outcomes

  • quality of care
  • errors
  • adverse events
  • injuries
  • functional outcomes

Satisfaction (Patient, Nurse)

  • patient satisfaction with overall nursing care
  • patient satisfaction with pain management
  • RN satisfaction with current job
  • RN satisfaction with physician-nurse relationships
  • RN satisfaction with management/administration

Organizational/Practice Environment

  • evidence-based practice
  • effective leaders
  • quality improvement processes
  • staff relationships
  • failure to rescue

Human Resources

  • adequacy of nurse staffing
  • RN retention
  • RN education levels
  • advanced practice nurses as knowledge resources
  • RN vacancy rates
  • RN certification levels
  • support service staff

Financial and Material Resources

  • cost savings due to improved patient safety
  • cost savings due to RN retention
  • professional development opportunities
  • funds for professional development
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