magnet vs. non-magnet
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Magnet vs. Non-Magnet:What is the Performance Difference?
First Annual NDNQI® ConferenceJanuary 30, 2007Las Vegas, NVNancy Dunton, PhD
Byron Gajewski, PhDSusan Klaus, PhD, RNBelinda Pierson, MA
University of Kansas, School of NursingKansas City, KS
4 Themes in ResearchLiterature on Magnet Hospitals
• Professional practice– RN autonomy, control over practice and RN-
MD relationships• RN job satisfaction, retention and
turnover• Outcomes
– Perceived quality of care and patient mortality• Effect of nursing administration on the
practice environment
Copyright American Nurses Association 2007 All rights reserved.
2
Focus of Current StudyMagnet/non-Magnet differences:
• Nursing workforce characteristics
• Trends in characteristics
• Factors associated with improving the nursing workforce
Presentation Aims
1. Discuss characteristics of nursing workforce
2. Describe NDNQI® database and study design
3. Describe trends in the nursing workforce
• Magnets vs. Non-Magnet Hospitals
4. Identify hospital characteristics associated with improvement in workforce characteristics
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3
The Nursing Workforce
Nursing Processes
• Assessment• Surveillance• Intervention• Patient/Family
Education
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4
Nursing Workforce Characteristics
Concepts
• Surveillance
• Skill—assessment, treatment
• Knowledge
• Expertise
Measures
• Nursing hours per patient day
• Skill Mix• Use of Agency staff• RN Education• RN Certification• Experience
Nursing Workforce Indicators• Total Nursing Hours
per Patient Day– “Patient/Nurse Ratio”
• RN Hours per Patient Day
• Skill Mix– %RN– %LPN/LVN– %UAP
• % Nursing Hours Supplied by Agency Staff
• % RNs with BSN, MSN, or PhD
• % RNs with National Certification
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5
Longitudinal Study Design
Research Questions1. How do hospitals approaching Magnet
recognition change their nursing workforce?
2. Do hospitals with Magnet recognition maintain the characteristics of their nursing workforce after recognition?
3. Do trends in Magnet hospitals simply mirror trends in non-Magnet hospitals?
4. What types of hospitals maintain or improve the characteristics of their nursing workforce?
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Sample
Quarterly Database Design• Data collected at Unit
level (8 types)– Critical Care– Step Down– Medical– Surgical– Medical-Surgical– Other
• Rehab• Pediatric• Psychiatric
• Longitudinal– Quarterly data
• 29 Quarters
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7
NDNQI Facilities• Over 1,000 Hospitals participate in
NDNQI
• Participation in a nursing outcomes database, like NDNQI, required for Magnet recognition– 93% of Magnet facilities participate in
NDNQI
• 20% of NDNQI Facilities are Magnets
Sample• Magnet facilities, designated between
3rd Quarter 2003 and 2nd Quarter 2004– 41 hospitals– 484 units
• Non-Magnet facilities (never designated or an applicant)– 175 hospitals– 1,295 units
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8
Sample Structure
1Q06
4Q05
3Q05
2Q05
1Q05
4Q04
3Q04
2Q04
1Q04
4Q03
3Q03
2Q03
1Q03
4Q02
3Q02
2Q02
1Q02
4Q01
Non-Magnets
Cohort 4
Cohort 3
Cohort 2
Cohort 1
Magnet
Limitations• Limited information on which
hospitals are Magnet applicants or preparing to apply
– May decrease ability to detect differences
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Measures
Hospital Characteristics• Staffed Bed Size
– Groups of 100s, from <100 to 500+
• Teaching Status– Academic Medical Center– Other Teaching– Non-Teaching
• Ownership– For Profit– Not for Profit & Government
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Magnet Hospitals DifferentThan Non-Magnet Hospitals
• Larger
• Higher percentage of academic medical centers
• A lower percentage of medical/surgical units
Staffed Bed Size
5
15 15
24
5
37
18
34
21
15
7 5
50
23
12
73
5
0
10
20
30
40
50
60
< 100 100-199 200-299 300-399 400-499 >= 500
Perc
ent Magnet
Non-MagnetAll (AHA)
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Teaching Status
29 3239
15
26
59
5
14
81
0
10
20
30
40
50
60
70
80
90
Academic MedicalCenter
Teaching Hospital Non-TeachingHospital
Perc
ent Magnet
Non-MagnetAll (AHA)
Ownership
2
98
5
95
20
80
0
20
40
60
80
100
120
For Profit Not For Profit
Perc
ent Magnet
Non-MagnetAll (AHA)
Government hospitals included in Not for Profit category.
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12
Unit Types
22
18
24
15
18
3
24
15 1514
28
4
0
5
10
15
20
25
30
AdultCritical
Care
Adult StepDown
AdultMedical
AdultSurgical
AdultMed/Surg
AdultRehab
Perc
ent
MagnetNon-Magnet
Longitudinal Results
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13
Trajectory Analysis• For each staffing indicator, we fit a curve
to the trends over a 15 quarter period– 7 quarters pre- and post-recognition for
Magnet facilities– 15 quarters, centered on 4th Quarter 2003 for
non-Magnet facilities• Model
– Random effects model, with each unit receiving its own intercept and slope
– Assumption—data missing at random
Total Nursing Hours Per Patient Day
7 Quarters Pre- and Post-Recognition
8
8.5
9
9.5
10
10.5
11
-10 -5 0 5 10
MagnetNon-Magnet
Magnet trend, not significant.2nd period, Magnet & non-Magnet trends significantly different.On average, Magnet significantly higher than non-Magnets
0 is Quarterof Recognition
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14
RN Hours Per Patient Day7 Quarters Pre- and Post-Recognition
5
5.5
6
6.5
7
7.5
8
8.5
-10 -5 0 5 10
MagnetNon-Magnet
Neither Magnet nor non-Magnet trend significant.On average, Magnets significantly higher than non-Magnets.
0 is Quarterof Recognition
Skill Mix: % RN Hours7 Quarters Pre- and Post-Recognition
65
66
67
68
69
70
71
72
-10 -5 0 5 10
MagnetNon-Magnet
Both Magnets and non-Magnets increase %RN in 2nd
period. However, Magnet increase is significantly greater than non-Magnet. Equal averages.
0 is Quarterof Recognition
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15
Skill Mix:% LPN/LVNHours7 Quarters Pre- and Post-Recognition
0123456789
-10 -5 0 5 10
MagnetNon-Magnet
Magnets had significant decrease in 2nd period. Relative to Magnets, non-Magnets experienced higher decreases throughout the period. Non-Magnets significantly higher than Magnets.
0 is Quarterof Recognition
Skill Mix: % UAP Hours7 Quarters Pre- and Post-Recognition
0
5
10
15
20
25
30
-10 -5 0 5 10
MagnetNon-Magnet
Magnets had a significant decrease in the 2nd period.Relative to Magnets, non-Magnets significantly increased %UAP in both periods. Magnets significantly higher than non-Magnets.
0 is Quarterof Recognition
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16
% Agency Hours7 Quarters Pre- and Post-Recognition
0
1
2
3
4
5
6
-10 -5 0 5 10
MagnetNon-Magnet
Magnets had a significant decrease in both periods.Trend for non-Magnets not significantly different than trend for Magnets.
0 is Quarterof Recognition
% BSN+7 Quarters Pre- and Post-Recognition
02468
10121416
-10 -5 0 5 10
MagnetNon-Magnet
Magnet trend stable.Non-Magnets had significant decrease in 2nd period.Magnets significantly higher than non-Magnets.
0 is Quarterof Recognition
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% Certified7 Quarters Pre- and Post-Recognition
05
101520253035404550
-10 -5 0 5 10
MagnetNon-Magnet
Significant increase in 1st period for both Magnets and theMagnet trend was greater than the non-Magnet trend.Magnets significantly higher than non-Magnets.
0 is Quarterof Recognition
Answers to First 2 Research Questions
• Hospitals approaching Magnet recognition:– Decreased the use of agency staff – Increased the use of BSNs
• After recognition, Magnet hospitals:– Continued to decrease the use of agency staff– Increased the % RN hours– Decreased the % LPNs/LVN and UAP hours
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Answers to3rd Research Question
• There were some general trends in nurse staffing. Both Magnet and Non-Magnet facilities:– Decreased the hours supplied by:
• Agency staff• LPNs/LVNs
Answers to3rd Research Question
• Some Magnet and Non-Magnet trends differed in the 2nd period :– Magnets held total nursing hours steady,
while non-Magnets increased total hours– While both groups increased %RN hours,
Magnets’ increase was significantly higher than non-Magnets
– Magnets decreased the %UAP hours, while non-Magnets increased %UAP
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Answers to3rd Research Question
• Magnet facilities increased the use of certified RNs, or held a steady percentage, while non-Magnet facilities decreased the use of certified RNs
4th Research Question:Factors Associated with
Improvement In Nursing Workforce
• Academic Medical Centers• Larger Facilities• Medical/Surgical Units
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No Evidence of MajorPre-Magnet Ramp Up
• No significant increase in TNHPPD or %RN
• Magnets increased the % of RNs who were certified and decreased the % Agency hours.
Magnets Continuedto Improve
• Magnet facilities maintained nursing workforce characteristics– Increased %RN
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Discussion• Magnets are a select group of
hospitals. They differ from non-Magnets in – Facility characteristics– Nurse staffing characteristics– Many nursing workforce trends
Discussion• Appropriate analysis of Magnet
“effect” on patient outcomes should take those differences into account
• NDNQI data can be used conduct such analyses
Copyright American Nurses Association 2007 All rights reserved.
22
Questions and Comments
Nancy Dunton, PhDSchool of NursingUniversity of Kansas Medical Center3901 Rainbow Blvd.Mail Stop 4043Kansas City, KS 66160(913) 588-1456ndunton@kumc.edu
Copyright American Nurses Association 2007 All rights reserved.
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