New study finds American nurses credentialing center-designated magnet hospitals more likely than non-magnet hospitals to adopt national quality forum safe practices

More nurse-hours per patient, larger percentages of RNs on staff, cited as contributing to higher safe practice adoption levels
(PR NewsChannel) / September 29, 2011 / PRINCETON, N.J.  
Robert Wood Johnson Foundation

The Robert Wood Johnson Foundation

Since 1993, the American Nurses Credentialing Center (ANCC) has certified 383 U.S.  “Magnet Hospitals” (MHs) based on the hospitals’ commitment to and success in providing high-quality practice environments for nurses in order to provide high quality patient care. While these hospitals are widely recognized for high retention rates for nurses and positive work environments, to date, little has been known about their adoption of safe practices compared with other hospitals.

A study recently published in the Journal of Nursing Administration finds that MHs are also more likely to have higher rates of adoption of National Quality Forum (NQF) Safe Practices than non-Magnet Hospitals (non-MHs). A private nonprofit organization that develops and implements a national strategy for health care quality measurement and reporting, the NQF has endorsed 30 evidence-based practices that improve patient safety (NQF Safe Practices). The study’s investigators — a nurse-researcher and two health economists — determined that certain characteristics that are more prevalent among MHs, such as higher percentages of RNs and having more nurse-hours per patient, contributed to successful adoption of NQF Safe Practices.

The study, funded by a grant from the Robert Wood Johnson Foundation Interdisciplinary Nursing Quality Research Initiative, was conducted by an interdisciplinary team that includes John Welton, Ph.D., RN, dean of the School of Nursing and Health Sciences at Florida Southern College; Jayani Jayawardhana, Ph.D., assistant professor at the College of Public Health at the University of Georgia; and Richard Lindrooth, Ph.D., associate professor at the Colorado School of Public Health  at the University of Colorado, Anschutz Medical Campus..

The researchers reviewed data from surveys of 140 MHs and 1,320 non-MHs in 34 regions over three years, to ascertain: whether MHs reported higher rates of adopting and implementing NQF Safe Practices; and the characteristics that lead to higher adoption and implementation rates.

They found that MHs tend to be larger (that is, have more beds) than non-MHs, and are also more likely to be nonprofit and have a lower percentage of Medicaid patients.  MHs are also better equipped with advanced clinical technologies and have a higher percentage of RNs and higher nursing hours per patient-day than non-MHs. While size and the number of Medicaid patients did not have an impact on adoption of NQF Safe Practices (smaller hospitals and those with high numbers of Medicaid patients had high adoption levels), higher numbers of nurse hours per patient, larger proportions of RNs and high levels of competition with other hospitals were all correlated with higher levels of NQF Safe Practices adoption.

“Having more RNs and more RNs available to patients may be what allows hospitals to devote the necessary staff to adopting and implementing the NQF Safe Practices,” said Welton. “Carrying out these safe practices does require a certain level of professional activity and without the right levels of staffing, it may be impossible to fully implement many of the practices recommended.”

The study’s authors did note that several non-MHs were also successful in adopting and implementing many or all of the NQF Safe Practices, so the MH credential is not a prerequisite for success in adopting these practices. The study also found that over time, more MHs and non-MHs were adopting more of the practices.

“Our findings suggest that having more nurses than necessary to meet minimum patient needs is key to adopting these practices, which require activities like conducting meetings, collecting and analyzing data, and reviewing the literature on safe practices” said Jayawardhana. “As hospitals continue to search for ways to cut costs in order to survive in the current economy, we are concerned that some cost-cutting measures may have a negative impact on hospitals’ ability to adopt safe practices and provide the highest levels of patient care.”

INQRI supports interdisciplinary teams of nurse scholars and scholars from other disciplines to address gaps in knowledge about the relationship between nursing and health care quality. It is helping to advance the recommendations of the Institute of Medicine’s landmark report, The Future of Nursing: Leading Change, Advancing Health, which include fostering interprofessional collaboration and preparing and enabling nurses to lead change. By requiring research teams to include a nurse scholar and at least one scholar from another health care discipline, INQRI not only fosters interprofessional collaboration, the Initiative also ensures that diverse perspectives are brought to bear in research.

The Interdisciplinary Nursing Quality Research Initiative is funded by the Robert Wood Johnson Foundation. To learn more, visit or follow on Twitter at @INQRIProgram.

About The Robert Wood Johnson Foundation: The Robert Wood Johnson Foundation focuses on the pressing health and health care issues facing our country. As the nation’s largest philanthropy devoted exclusively to health and health care, the Foundation works with a diverse group of organizations and individuals to identify solutions and achieve comprehensive, measurable and timely change. For nearly 40 years the Foundation has brought experience, commitment, and a rigorous, balanced approach to the problems that affect the health and health care of those it serves. When it comes to helping Americans lead healthier lives and get the care they need, the Foundation expects to make a difference in your lifetime. For more information, visit

Gretchen Wright

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SOURCE:  The Robert Wood Johnson Foundation

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