Magnet vs. Non-Magnet - Confex

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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.

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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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The Nursing Workforce

Nursing Processes

• Assessment• Surveillance• Intervention• Patient/Family

Education


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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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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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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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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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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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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

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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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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.


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.



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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.


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.



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% 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.


% 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.



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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.


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


• 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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• 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


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Questions and Comments

Nancy Dunton, PhDSchool of NursingUniversity of Kansas Medical Center3901 Rainbow Blvd.Mail Stop 4043Kansas City, KS 66160(913) [email protected]


Magnet vs. Non-Magnet - Confex

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