Some nurses charge the program has strayed from its original mission
Like many nurses, Alene Nitzky, PhD, RN, went into nursing because she wanted to help people. She had moved through the U.S. healthcare system as both a patient and an advocate, and wanted to draw from her experience to deliver quality, compassionate care to others.
She joined a Magnet hospital in her hometown that was recognized for “nursing excellence” and high-quality patient care.
But the longer she worked there, the more she felt that Magnet status was less about supporting nurses and providing the best care, and more about hospital marketing and profits.
“I felt like all they wanted from me was to hang bags of chemo and keep my mouth shut,” Nitzky told MedPage Today. “I felt I had no future there, that my skills and abilities beyond that were not valued.”
Nitzky acknowledged clashing with management and eventually leaving the hospital, but her concerns about Magnet status were shared by several nurses contacted by MedPage Today. Many similarly acknowledged a lack of autonomy, excessive documentation, and understaffing issues that detracted from the original intentions of Magnet. But some also felt that the program’s value depended on its execution by management — thus varying widely from hospital to hospital.
Principles of Magnetism
Magnet status is awarded to hospitals that meet a set of criteria designed to measure nursing quality by the American Nurses’ Credentialing Center (ANCC), a part of the American Nurses Association (ANA).
It was developed in the early 90s to help hospitals attract and retain nurses during a nursing shortage spurred by poor working conditions, partially due to the introduction of managed care organizations. In response to increasing pressure about the cost of care, hospitals reduced staffing and implemented mandatory overtime. For bedside nurses, this meant an increased workload and less control over scheduling, without a bump in pay.
To combat those challenges and boost the nursing profession’s image, ANCC developed the Magnet designation program, based on a 1983 ANA survey of 163 hospitals, deriving its key principles from the hospitals that had the best nursing performance. The prime intention was to help hospitals and healthcare facilities attract and retain top nursing talent, foster a collaborative culture, and empower nurses to deliver better patient care — ultimately improving clinical outcomes.
Pursuing Magnet status varies from hospital to hospital, but on average it takes a little more than 4 years to achieve, and it needs to be renewed every 4 years.
As of 2016, a total of 445 hospitals had achieved Magnet status, an increase from 387 five years earlier. Notably, U.S. News & World Report‘s top five hospitals of 2017 — the Mayo Clinic, Cleveland Clinic, Massachusetts General Hospital, Johns Hopkins Hospital, and UCLA Medical Center — have all pursued Magnet designation.
Repulsed by Magnet
But several nurses told MedPage Today that the program has strayed from its original mission.
“I think that the original intent of Magnet was good, but that intention is completely lost,” said Sara Koeller, RN, BSN, a California-based nurse who has worked at both Magnet and non-Magnet hospitals. “The overall thing is to get a banner in front of hospital which says we are Magnet status and no one really knows what it means — even the nurses in the hospital.”
Chief among their concerns was that Magnet limited nurses’ independence and flexibility in practice. Nitzky said bedside nurses at Magnet hospitals often don’t have time to think; instead they go through the motions, doing the minimum in hands-on care.
“Nurses do not have autonomy,” she said. “They are railroaded into yes-men and yes-women, ‘Stepford’ nurses who simply function according to the mandates and requirements put on them by the administration.”
Koeller agreed that nurse happiness and critical thinking skills aren’t paramount. She said her hospital often focuses less on patient-centered care and more on technology.
A recent column by MedPage Today contributor Milton Packer, MD, echoed those frustrations with the Magnet system, which Packer experienced first-hand during a relative’s 5-day stay in a Magnet hospital. He said nurses did everything by the book, regardless of whether it made sense.
From taking vital signs to responding to personal needs, he noted that “every movement had been dictated in advance. Every word used in communications had been pre-approved. Forms needed to be checked, whether or not they had relevance. But the really important questions were never asked.”
“Instead of spending time with patients, nurses sit in front of computers,” Packer wrote. “Instead of interacting with patients according to their needs, nurses simply ask formulaic questions that are dictated by the Magnet program. The process takes up all of their time. And their compliance with the process is the only thing that matters.”
While Magnet status is supposed to symbolize better working conditions, nurses still work 12-hour shifts and are expected to take on a huge burden of electronic documentation for the program, Nitzky said. And since hospitals frequently understaff their nursing, the extra burden often leads to not having enough time for real lunch breaks or regrouping during hectic rounds, she said.
Gerard Brogan, lead nursing practice representative for National Nurses United (NNU), the nation’s largest union and professional association of registered nurses, called Magnet designation a “commercial product,” and argued that it’s part of a strategic effort to deregulate the profession.
“The ANA has decided to back the healthcare industry over the bedside nurse,” Brogan told MedPage Today, adding that Magnet promotes short-term financial incentives that drive hospitals to cut costs and skimp on nursing requirements.
Many nurses contacted by MedPage Today complained that hospitals viewed Magnet merely as a marketing tool. Though they went through the certification process, they ultimately did little to support a thriving nursing culture.
“They hire a team of people to go through the program and make the changes in the hospital, to check a box and please the Magnet people, but as soon as they get it, the chief nursing officer is fired,” said Sandy Summers, RN, MSN, MPH, founder and executive director of the Truth About Nursing, a nonprofit organization that raises awareness about the role of nurses in modern healthcare.
“All the changes that the hospital went through to increase professionalism, performance, and vision are reduced and it becomes clear that it was all window dressing and they weren’t interested in changes,” she said.
Nitzky said when Magnet inspectors left her hospital, it would go “back to business as usual, finding workarounds for any promises of nurse/patient staffing ratios, gutting committees where direct-care nurses had a voice.”
Hospitals shell out about $2 million for initial Magnet certification, and pay nearly the same amount for re-certification every 4 years — an obvious money-maker for the ANCC and the ANA. The organizations did not respond to a MedPage Today query about total annual revenue from Magnet.
Magnet status is also a good return-on-investment for hospitals. A study by the Robert Wood Johnson Foundation found that achieving Magnet status not only pays for itself, but actually increases hospital revenue down the line. On average, Magnet hospitals received an adjusted net increase in inpatient income of about $104 to $127 per discharge after earning Magnet status, amounting to about $1.2 million in revenue each year.
Jeff Doucette, DNP, RN, vice president of the Magnet Recognition Program at ANCC, spoke with MedPage Today about the Magnet program, but declined to comment about nurses’ aforementioned complaints.
He had previously sent Packer an email in response to his column noting that patients and nurses should “share these concerns directly with executive leaders at the organization and allow them to investigate. Then they will be given the opportunity to make the necessary changes to ensure the service breakdowns can be corrected.”
Still an Attractor
Doucette’s comments parallel the sentiments of other nurses who said the program’s execution varies widely by hospital.
Susan O’Brien, MS, RN, PCCN, has 41 years of hospital experience and has worked at both Magnet and non-Magnet hospitals. One Magnet hospital where she worked was keenly focused on exceptional patient care and had been recognized with national awards.
“The employees and leadership lived the mission,” O’Brien told MedPage Today. “The leadership in the hospital was committed to staffing ratios that allowed the patient to receive the care that the patient should and the [nurse] wanted to deliver.”
Data about quality were prominently displayed in the hospital for all to see, including patients, their families, and staff, O’Brien said. And the hospital was committed to ensuring staff had the education and equipment to do their job well.
Summers agreed that delivering on the mission of Magnet depends on the institution.
“When going through the program with good intentions, it is a way to transform the hospital to one where nurses are stronger and more included in decision making,” she said. “Those nurses are much happier and confident, and the care they deliver is better. When people feel like respected professionals, they act like respected professionals.”
What Do the Data Say?
There’s no consensus in the literature as to whether Magnet status has an impact on nurse retention or on clinical outcomes.
Last month, a study of a single hospital found that nurses who worked there 2 years after it lost its Magnet designation reported significantly lower work engagement than those who worked there under Magnet status. Similarly, a 6-year-old study found that Magnet hospitals provide better work environments and a more highly educated nursing workforce than non-Magnet hospitals.
A 2010 study, however, found no significant difference in working conditions between Magnet and non-Magnet hospitals.
The clinical outcomes literature is similarly equivocal: one study from 2013 found that Magnet hospitals have 14% lower mortality and 12% lower failure-to-rescue rates than non-Magnet hospitals. But a 2011 study showed that non-Magnet hospitals generally had better patient outcomes than Magnet hospitals.
Regardless of whether they work at a Magnet hospital or not, nurses are likely to face continued pressure as hospital administrators focus on keeping costs down, Summers said.
But Nitzky still channeled the blame on Magnet: “What we really need is a massive sit-down strike of all physicians and nurses who work under these oppressive conditions to band together and say, enough. This is not healthcare. This is a profit-generating scheme that preys on direct caregivers and the uninformed public.”
This story was originally posted on MedPage Today.
In honor of Certified Nurses Day, we reached out to nurses who have earned certification to find out why they love being certified.
As you’ll see their answers are varied: some are glad to have the additional knowledge, some are proud of the accomplishment, and some like being able to have varied skills to help support patients and the nursing field as a whole.
What follow are just some of the quotes that we received. Some were edited, but only for length and/or clarity—we didn’t change the ideas expressed.
“Being certified in rehabilitation nursing benefits our patients and families with a documented level of knowledge and shows our commitment to patient care. It also benefits our coworkers as they have a mentor who can advise and support them with their patients and families.”
—Barbara Hennigan, BSN, RN, CRRN; Nurse Manager, Comprehensive Medical Rehabilitation Unit; University of Maryland Rehabilitation & Orthopaedic Institute
“Certification opened doors for me by allowing my supervisors to trust me enough to teach competencies and mentor new nurses. My supervisors trusted my nursing and clinical judgment enough for me to become a valued resource on our cardiac unit. Certification allowed me the opportunity to climb our clinical nurse ladder, which also provided an additional monetary component.”
—Kendra Armstrong, MSN, RN, ACNPC-AG, PCCN; acute care nurse practitioner; Phoebe Putney Memorial Hospital; Albany, Georgia (Provided by AACN.)
“Nursing certification helps me provide the highest level of care to patients during some of the most vulnerable moments of their lives. Knowing that my certification provided me the skill set and knowledge to have meaningful effects on people’s lives is both rewarding and humbling.”
—Shentelle Parker, RN, BSN, TNCC; ICU Nurse; Southeast Louisiana Veterans Care System
“Certification offers me a sense of personal accomplishment and validates my knowledge, skills, and clinical judgment in my specialty area.”
—Robin Colchagoff, MSN, RNC-OB, C-EFM; Director, Clinical Nursing Practice; University of Maryland Capital Region Health
“Becoming a certified nurse affirmed my nursing knowledge within my specialty of practice, Critical Care. Since becoming certified, I have joined my professional organization and have an easier time staying up to date with new evidenced-based practices by reading publications distributed by AACN. I have also encouraged many of my peers to pursue certifications in their specialties, too. I proudly wear my “Nationally Certified RN” badge as a reminder of my dedication to provide the best possible care I can to Every Patient, Every Encounter, Every day!”
—Tracy Kline, MSN, RN, PCCN; Direct Care Nurse, Intermediate Care Unit; University of Maryland Upper Chesapeake Health
“Being certified is a validation of my commitment, experience, and clinical expertise. I am proud to work along with my fellow certified nurses every day. It is a constant reminder and reassurance to our patients and family members that they are receiving the highest quality care. Certified nurses are determined professionals who invest in their professional and personal growth – they inspire me to be the best.”
—Sherley John, MSN, RN, CCRN; Clinical Nurse, Neurosurgical ICU; North Shore University Hospital, Manhasset, New York (Provided by AACN.)
“Having a certification, NE-BC, has given me confidence in my role and supported growth in my career! I would encourage everyone to consider certification in their specialty areas.”
—Danielle M. Wilson MSN, RN, NE-BC; Director Nursing Innovation and Evidence Based Practice; University of Maryland Capital Region Health
“As a certified nurse, I have even more confidence when conferring with my clinical colleagues, because they understand that I have specialized knowledge about my field of nursing. Because of this, I can advocate even more strongly for my patients, consistently improving the standard of care—and the reputation of our nursing staff and hospital. My certification shows that I am a mentor, a leader in my field, committed to growth, accountability, and superior care.”
—Kristen Wolfe, RN, RNC-MNN; Nurse Manager, Mother-Baby Unit; University of Maryland St Joseph Medical Center
“Becoming a certified nurse validates competence and knowledge within a specialty area, and it could increase job opportunities and potentially an increase in earnings. Some areas, such as case management, nursing administration, or being promoted within levels of practice for staff nurses, require certification.”
—Marilyn Wideman, RN, DNP, FAAN, Academic Dean and Vice President; the School of Nursing at Purdue University Global
“I am very proud to have been a certified rehabilitation nurse since 2007. This certification elevates our expertise in the way that we understand and take care of our rehabilitation patients after a disabling event or chronic illness. Maintaining the certification keeps me current with evidence-based practice specific to the needs of our rehab patients.”
—Holny Santana, BSN, RN, CRRN; Nurse Manager, Spinal Cord Unit; University of Maryland Rehabilitation & Orthopaedic Institute
“What I value most about my certification is the opportunities it’s opened up for me – the respect that I receive from my nursing and non-nursing peers, and the changes I’ve been able to make to the nursing practice at my current and previous organizations. I am a better practitioner because of my certifications.”
—Sam Merchant, MBA, BSN, RN, CCRN, PCCN, NE-BC, RN-BC; Progressive Care Unit; University Health System, San Antonio, Texas (Provided by AACN.)
“Earning my Medical Surgical Board Certification provided more professional credibility as a nurse. It helped me with my professional growth as well because it made me more confident in providing quality care to my patients. Patients I have taken care of expressed ‘feeling safe under my care’ just by them knowing that I have an RN-BC title in my badge.”
—Lina DeCastro, MAN, RN-BC; Clinical Nurse 4; Post-Surgical and Orthopedic Unit; University of Maryland Charles Regional Medical Center
“Besides personal satisfaction and a sense of accomplishment, certification validated all of the knowledge and experience I’ve gained working in the ICU for almost 10 years. My certification has made me a more confident nurse, knowing what I’ve been doing for my patients is aligned with national guidelines and standards for excellence in patient care.”
—Erica McCartney, BSN, RN, CCRN-CMC, ICU/IMCU; resource RN; Swedish Medical Center, Edmonds, Washington (Provided by AACN.)
“It is important for myself and my colleagues to become certified because it demonstrates that nurses have the knowledge, skills, and passion to provide high quality care to patients and their families. Certification shows that you are a lifelong learner who cares about the quality of care you deliver based on the most up-to-date evidence. Certified nurses are role models for other nurses and other health care professionals. It enhances their credibility among colleagues, patients and other members of the health care team. Certification shows that nursing is a profession that cares about safety, quality, and excellence.”
—Kathy M Reisig, RN-BC, BSN; Nurse Manager, NICU, Pediatric Unit, and Pediatrics After Hours; University of Maryland St Joseph Medical Center
“Certification provides validation and it indicates pride, dedication, self-direction and professional development for nurses. It also provides assurance to patients and families for quality patient care. I am proud to hold two certifications!”
—Katie Boston-Leary, PhD(c) MBA MHA BSN CNOR NEA-BC; Chief Nursing Officer; University of Maryland Prince George’s Hospital Center
Take a moment to celebrate Certified Nurses Day and tell us what you love about being certified in the comments below.
Radiology nursing primarily involves diagnosis through imaging. It is one of the most heavily used departments in nursing. Nonetheless, many nurses are unfamiliar with what a radiology nurse is or does. Schools don’t have courses dedicated to radiology and clinicals tend to focus on inpatient units. Furthermore, most new graduate nurses want to be in the ICU, PCU, ED, or another inpatient unit. Unfortunately, these sought-after positions can be hard to find for new graduates because of demand, and many hospitals won’t hire new grads to some of these units.
Radiology nursing provides an alternative career path that most new graduate nurses and more experienced nurse are not familiar with.
Radiology: The Unsung Hero of the Hospital
Often radiology goes unnoticed, but every department uses it in some way. Whether you are in the emergency room evaluating for a bleed in a recent trauma patient, having a drain placed due to a fluid collection, or staging a newly found mass, you will need the radiology department. CT scans, ultrasounds, and MRIs are all covered by radiology. They can perform something as simple as a chest x-ray or as advanced as 3-D anatomic modeling to assist physicians in surgical planning.
In some hospitals, over 75% of patients have a scan or procedure in radiology during their stay. Thus, at the bedside, chances are you have interacted with a radiology nurse, even if you didn’t know it.
So What is Radiology Nursing?
Radiology nurses ensure patient safety by making detailed assessments, providing moderate sedation to patients, assisting in the recovery of patients post-procedure, injecting contrast, and assessing patients during procedures, amongst other responsibilities. This makes the radiology nurse an integral part of the care team that helps ensure safe and efficient care to all patients.
Radiology nurses can expect to work with physicians, patient care assistants, technologists, and sonographers, as well as other RN staff from different units. They care for adult and pediatric patients and generally hold advanced certifications such as ACLS (Advanced Cardiac Life Support) and PALS (Pediatric Advanced Life Support).
Whether you are a new graduate looking for a strategic job opportunity or an experienced nurse looking to diversify your experience, radiology nursing could be a fantastic opportunity for you.
Earning certifications of any kind can definitely help your nursing career. If you work with adults in gerontology, you have a couple of choices. So, how do you choose the one that would work best for your particular situation?
Robin Dennison, DNP, APRN, CCNS, NEA-BC, Director of Nursing Programs at the University of Saint Augustine for Health Sciences, answered some basic questions about the differences between the two for Nurse Practitioners (NP).
Regarding gerontology certifications—specifically the ACNPC-AG and the AGPCNP-BC—what are the similarities between the two certifications? What are the major differences?
The ACNPC-AG (Acute Care Nurse Practitioner Certified in Adult-Gerontology) is offered by the American Association of Critical-Care Nurses (AACN) via the AACN Certification Corporation. The AGPCNP-BC (Adult-Gerontology Primary Care Nurse Practitioner certification) is offered by the American Nurses Credentialing Center (ANCC)
Both certifications require a passing score on an examination after verification of eligibility. Eligibility for both certifications require a current, active RN license in a state or territory of the United States or the equivalent in another country. Eligibility for both certifications require the applicant to be a graduate of an adult-gerontology acute care nurse practitioner program accredited by either CCNE or ACEN. The program must have three separate graduate-level courses in advanced physiology/pathophysiology, advanced health assessment, and advanced pharmacology. They both require a minimum of 500 faculty-supervised practicum hours in the program. Eligibility for both requires submission of an official transcript.
While the fees are comparable, current memberships result in significant discounts. Membership in AACN or ANA results in a discount on the respective certification.
The test blueprints are similar, but the AACN certification has a greater percentage of the exam questions focused on clinical practice. The ANCC certification test blueprint has the majority of questions focused on clinical practice, but it has a greater percentage of questions focused on role-professional responsibilities and health care systems than the AACN examination.
How can nurses determine which one would be the better for them to pursue?
AACN, with its focus on critical care, would likely be the preference for a nurse who was previously a critical care nurse and held the CCRN credential. If the nurse did not have that previous affiliation with AACN, then they may select ANCC. It may even come down to the nurse’s memberships: AACN or ANA and the discounts that are given for the membership.
How could these certifications help them in their careers? Could having one of these help them get better paying jobs? Move up? Be experts in their field?
National certification in one of the advanced practice roles (i.e., nurse practitioner, clinical nurse specialist, nurse anesthetist, nurse midwife) is required for an eligibility for licensure as an advanced practice registered nurse in most states. The board of nursing in the state of residence will specify requirements for APRN licensure as well as standards of practice for the advanced practice role. Advanced practice licensure allows greater autonomy, authority, and generally higher salaries.
It may seem like it would take a superhero to balance full-time nursing work with continuing education and perhaps even a personal life, but take heart. It is possible, even without sacrifice. Continuing nursing education, whether for an advanced degree, studying for specialty certification, or keeping current on evidence-based practice, is a matter of discipline. That life is about quality rather than quantity is also true in the balancing act of being a working student.
The first step in nursing education is organizing the details: What would a full-time course load look like? Will it require cooperation from your employer, and if so, how willing are they to accommodate you? Will your employer help you pay tuition and what are the limits of that? What are your other commitments and how flexible are they?
One suggestion for making it work is to look at a typical week of your life and block out times that you are unavailable. This includes times that you spend with your family, running errands, and yes, even playing and relaxing. Make your class schedule around that, while at the same time remembering that there will be homework.
When you apply to school, start the process early and give yourself the luxury of time in the application process; it is easier done in small nibbles than large bites. Your application can be painlessly completed one transcript, personal statement paragraph, and reference request at a time.
Once enrolled, having the discipline to give your schoolwork quality attention will allow you to feel fulfilled and purposeful rather than deprived. When you study, turn your phone and TV off, ask for privacy, set a timer, and focus. And when you’re done, be done. Don’t give up anything important to you. Continue exercising, knitting, playing music, or whatever gives you pleasure and reprieve.
The last thing your patient or your family needs is an angry, tired nurse. Even if it’s one class at a time, you’re doing it. So…do it, but do it as you continue high-quality patient care and high-quality self-care.
About 650,000 Americans are currently affected by End Stage Renal Disease (ESRD), and this number is increasing by 5% annually. The primary causes of kidney failure leading to ESRD are poorly managed diabetes and high blood pressure, the treatment options for which are limited to kidney transplant and dialysis. Unfortunately, there are currently more than 93,000 potential recipients on the kidney transplant waiting list and 80% of those individuals are on kidney dialysis while they wait.
Demand for Nurses is Growing
The specialty of nephrology and dialysis nursing continues to grow with these rising ESRD numbers. In fact, nephrology nursing is expected to grow over 25% within the next 10 years. These nurses can expect an attractive salary and a diverse working environment. Nephrology nurses might work on a typical hospital unit, but those who perform dialysis also work in dialysis centers, nursing homes, inpatient hospice centers, and even in-home health.
Nurses Develop Deeper Relationships with Patients
Renal failure is a chronic condition, so those who suffer from it must access care frequently. This means nephrology nurses will see their patients regularly. Dialysis nurses often have the ability to work with patients one on one, providing an opportunity to give care in a much more personal, attentive way. They also care for their patients through the continuum of the disease progression, so they get to know their patients quite well.
Certification and Advanced Education for Leadership
A nephrology nurse may elect to pursue certification or even further education and their Nephrology Nurse Practitioner certification. These nurses take their practice deeper, providing primary care for their patients who battle ESRD during dialysis and even after transplant—if and when that becomes possible.
There are plenty of worthwhile opportunities for nurses to make a difference in the lives of renal patients whose prognosis can be dire. Examples of such opportunities and further information on dialysis nursing can be found here.