Magazine article American Nurse Today

How Magnet[R] Designation Affects Nurse Retention: An Evidence-Based Research Project: A Positive Work Environment and Nurse Satisfaction Can Improve Nurse Retention

Magazine article American Nurse Today

How Magnet[R] Designation Affects Nurse Retention: An Evidence-Based Research Project: A Positive Work Environment and Nurse Satisfaction Can Improve Nurse Retention

Article excerpt

As the nursing shortage continues, the need for acute-care facilities to retain registered nurses (RNs) has become overwhelming. Sufficient staffing correlates directly to safer care and better patient outcomes. To increase nurse satisfaction and retention--and rise above the nursing shortage--hospitals should promote a positive work environment and retention. Hospitals that have achieved Magnet Recognition[R] are known to foster positive work environments.

For the evidence-based project described in this article, the authors reviewed the scholarly literature to determine if a relationship exists between Magnet[R] designation and nurse retention. We formulated the following PICO question (patient/ problem, intervention, comparison, outcome):

How does nurse retention in acute-care hospitals with Magnet designation compare to nurse retention in non-Magnet hospitals?

Search and analysis methods

The search method for this critical literature review included a comprehensive search of the Cumulative Index to Nursing and Allied Health Literature (CINAHL-Plus with Full Text) and Medical Literature On-Line (MEDLINE) databases, plus a hand search of the American Nurses Credentialing Center (ANCC) Magnet Research References.

Limiters used in the search included peer reviewed, written in the English language, published between 2003 and 2013, written and published in the United States, and research-based. Database exclusions included articles not pertaining to nurse retention and articles whose title or abstract doesn't pertain to the PICO question. Exclusion criteria for the hand search included articles older than 2007, title of article and/or abstract lacks relevance to the PICO question, and international studies. On critical appraisal of the resulting seven articles, five were deemed pertinent to the PICO question.


Critical analysis of the literature confirmed that Magnet designation correlates to positive work environments and nurse satisfaction, both of which may influence nurse retention. Our analysis found:

* a positive work environment that meets the RN's basic needs can influence nurse satisfaction, which relates to nurse retention

* support and reimbursement of continuing education and career development decrease a nurse's intent to leave her or his current position

* Magnet designation isn't a requirement for positive effects on an organization's work environment and nurse satisfaction

* Magnet facilities can't afford to become complacent about maintaining a positive work environment and nurse satisfaction.

Environmental factors that contribute to a positive work environment and increased nurse satisfaction included:

* safe, effective patient care

* good relationships with coworkers and patients

* opportunity for professional growth

* overall support for nurses

* nurse recognition programs

* strong leadership

* effective collaboration between nurses and physicians

* nurse autonomy.

A common feature among Magnet organizations is promotion of employee education, including career-development programs and payment for employees' continuing education. Organizations with these programs were found to have higher nurse satisfaction rates and less intent to leave.

Also, an organization doesn't necessarily need Magnet designation to achieve a positive work environment and nurse satisfaction. By incorporating Magnet characteristics, organizations can increase the quality of the workplace environment.

In addition, facilities can't afford to grow complacent after obtaining Magnet status. Instead, they should continuously improve the work environment and maintain the overall goals of the Magnet program to ensure the nursing work environment continues to be positive.

Application of findings

Hospitals can form nursing taskforces to explore positive work environments. Topics of focus may include factors contributing to nurse burnout and turnover, collaboration among healthcare team members, and ways to implement Magnet-like characteristics even if the organization doesn't have Magnet designation.

Nurse leaders are instrumental in creating healthy work environments and thereby can influence nurse satisfaction. To help retain nurses, leaders should take measures to ensure nurse autonomy, decrease nurse constraints, practice good communication skills, and collaborate as healthcare team members--and encourage staff nurses to do the same. To increase nurses' intent to stay with an organization, leaders should create recognition programs and support employee education.

Nurse attrition can cause large monetary losses for an organization; replacing a nurse who has left can cost about $64,000. Attrition also leads to loss of nursing mentors and may compromise patient care. Once an organization achieves Magnet designation, it must maintain Magnet principles to ensure nurses stay in their current positions and don't leave to pursue other employment. Hard work by leaders and nurses to ensure Magnet principles remain in place can save the organization money.

A chief limitation for this evidence-based project was lack of research articles specific to the PICO question: How does nurse retention in acute-care hospitals with Magnet designation compare to nurse retention in non-Magnet hospitals? So the most apparent need for future nursing research in this area is to investigate the influence of an acute-care hospital's Magnet or non-Magnet designation on nurse retention. Research also is needed to explore how hospitals without Magnet designation can achieve and maintain Magnet-like characteristics. Finally, research should be done to examine how high nurse retention on particular units can be replicated hospital-wide.

Although nurse retention can be attributed to Magnet-like characteristics, organizations that find the cost of obtaining Magnet designation prohibitive can still achieve Magnet-like characteristics. They should focus on promoting a positive work environment and ensuring nurse satisfaction to retain nursing staff.


1920 Atherholt Rd., Lynchburg, VA 24501

Centra is a nationally recognized award winning nonprofit healthcare system serving central and southside Virginia with more than 6,000 healthcare professionals, three hospitals, numerous specialty centers and programs and a network of over 150 primary care physicians and medical and surgical specialists. Two of Centra's hospitals, Lynchburg General and Virginia Baptist, achieved Magnet[TM] designation 2005 and were re-designated in 2010.

Children's Mercy Hospitals and Clinics

2401 Gillham Road, Kansas City, MO 64108

1-800-698-4790 *

390 Beds

Children's Mercy Hospitals and Clinics offers expertise and innovative research in nearly every pediatric subspecialty and surgical area, and has been ranked by U.S. News and World Report in all 10 specialties measured.

Children's National Health System

111 Michigan Ave, NW, Washington, DC 20010


Sharon Livingston, MA, BSN, RN *

283 Beds

Level IIIC NICU; Level I pediatric trauma center; Critical Care Transport Teams; We are a Magnet recognized facility; Our NICU, CICU and PICU received the Beacon Award for Critical Care Excellence; Regional referral center for cancer, cardiac, orthopaedic surgery, neurology, and neurosurgery patients.

Children's National Health System, located in Washington, D.C., is a proven leader in the development of innovative new treatments for childhood illness and injury. Consistently ranked among the top pediatric hospitals in America, Children's physicians and nurses have been serving the nation's children for more than 140 years. For more information about Children's National Health System, visit

VCU Health System

1250 E. Marshall St.

Richmond, VA 23298

804-628-0918 *

Gale Rose *

865 Beds

Level 1 Trauma Center; nearly 200 Specialty areas, to include Hume-Lee Transplant Center, Stroke Center, Massey Cancer Center, Harold F. Young Neurosurgical Center, Evans-Haynes Burn Center, Pauley Heart Center and the Children's Hospital of Richmond at VCU.

VCU Medical Center is an internationally-recognized, Magnet[R]-designated regional referral center on the forefront of health care, providing the most progressive treatments and medical technology available. In 2012 and 2013, we were recognized by U.S.News & World Report[R] as a #1 Hospital in Virginia. And in 2013, named Virginia's first, and only, Level 1 Pediatric Trauma Center by the American College of Surgeons.

Visit for a list of selected references.

By Mellisa Renter, MSN, RN; Anna Allen, MSN, RN; Anne Thallas, BSN, RN; and Linda Foley, MSN, RN, PhD

Mellisa Renter is a nurse educator at Kaplan University in Omaha, Nebraska. Anna Allen is a staff nurse in the emergency department at Rapid City Regional Hospital in Rapid City, South Dakota. Anne Thallas is nurse supervisor of the pulmonary service line at Children's Hospital & Medical Center in Omaha, Nebraska. Linda Foley is director of the MSN Program at Nebraska Methodist College in Omaha. (The evidence-based project described in this article was completed as a capstone project in the college's MSN program.)

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