ABSTRACT
Those familiar with the inner workings of hospitals will not be surprised that there is a relationship between the practice of nursing and the mortality experience of hospital patients (Sunshine and Wright 1988; Koska 1989; Findlay et al. 1990). The connection between nursing and mortality rates dates as far back as the reforms in British hospitals made under Florence Nightingale during the Crimean War (Cohen 1984). Nurses are the only professional caregivers in hospitals who are at the bedside of hospital patients
around the clock. What nurses do or do not do (or in some circumstances are not allowed to do) is directly related to a variety of patient outcomes, including in-hospital deaths (Benner 1984). Nurses often must act in the absence of the physician when timely intervention is required (Mechanic and Aiken 1982; Stein et al. 1990)
Six American Academy of Nursing (AAN) hospital nursing experts in each of eight regions of the country were selected to nominate 6-10 hospitals that met the following three criteria: 1) nurses consider the hospital a good place to practise nursing; 2) the hospital has the ability to recruit and retain professional nurses, as evidenced by a relatively low turnover rate; and 3) the hospital is located in an area where it will have competition for staff from other institutions and agencies. A total of 165 hospitals was nominated; 155 agreed to participate. Each participating hospital provided information on a range of nursing-related issues including nurse vacancy, turnover and absentee rates; the ratio of inexperienced to experienced nurses; use of supplemental staffing agencies; nursing staffing policies; educational preparation of nurses in leadership positions; and the predominant mode of nurse organisation on the units (i.e. primary, team, functional or other). Hospitals were then ranked according to evidence of being able to attract and retain professional nurses and to create an environment conducive to nursing care. The top-ranked 41 institutions were subjected to a subsequent round of data collection interviews with staff nurses and directors of nursing. These were the hospitals that ultimately came to be designated ‘magnet’ hospitals.
