Letter to the Editor
JONA Volume 42, Number 2, pp 65-66 Copyright B 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Comparison of Patient Outcomes in Magnet and Non-Magnet Hospitals A
The article ‘‘Comparison of Patient Outcomes in Magnet and Non-Magnet Hospitals’’ in the December 2011 issue of Journal of Nursing Administration (available at http://journals.lww.com/ jonajournal/Fulltext/2011/12000/ Comparison_of_Patient_Outcomes_ in_Magnet__and.7.aspx) has multiple limitations that complicate interpretation of the results. Although we agree with the authors that the Magnet Recognition Program is worthy of research to understand how outcomes are improved, the study used data from 2005. This is problematic, as the requirements for Magnet at that time were significantly different than they are today. After a major transformation in 2008 focusing on outcomes, Magnet organizations now have requirements for nurse, workforce, patient, and clinical outcomes not required in 2005. The standards require outcomes above the 51st percentile of the benchmarking database for 2 consecutive years. Over the past 6 years, a growing body of research demonstrates that Magnet characteristics do impact patient outcomes (http://www.nursecredentialing.org/ MagnetReferences.aspx). In addition, the sample size was only 19 Magnet hospitals when there are 391 Magnet organizations today. This time lag, the small samA
A
ple size, and the change in the Magnet requirements call into question the relevance of the study. Although the study shows statistically significant differences (P G .05), the clinical significance is limited. As a voluntary credential, many excellent facilities may not seek Magnet designation. This study does not account for non-Magnet hospitals that may be Magnet-like. University HealthSystem Consortium (UHC) hospitals are likely to have implemented evidence-based practices, hallmarks of Magnet, and many were on the journey to Magnet excellence. Evidence of the UHC excellence is that 13 UHC academic medical centers were designated Magnet in 2006-2007, the 2 years following the year in which the study data were sampled. The Commission on Magnet encourages researchers to strengthen their methods, data selection and analysis, and sample size and identify key variables that may better explain findings. Current and rigorous studies are needed to improve our ability to provide positive practice environments that impact excellence in patient care.
Patricia Reid Ponte, DNSc, RN, FAAN
Chair, Commission on Magnet Recognition Washington, DC
Craig Luzinski, MSN, RN, NEA-BC, FACHE
Director, Magnet Recognition Program Washington, DC The authors declare no conflict of interest. DOI: 10.1097/NNA.0b013e318244bdc0
Author Response Thank you for the opportunity to address the concerns raised by the American Nurses Credentialing Center (ANCC) staff; we believe that healthy dialogues facilitate the development of knowledge. Our study found results that we did not expect but were obligated to report. Every study strengthens the knowledge base and adds to the understanding of nursing issues. Our study used data from 54 hospitals that were members and affiliates of the University HealthSystem Consortium (UHC). The UHC has developed excellent databases providing the best measures of nurse staffing available and also the most highly regarded and widely used patient outcome indicators. Although we did not have the identities of the hospitals and could not obtain information
JONA Vol. 42, No. 2 February 2012
Copyright @ 2012 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
65
Letter to the Editor about their Magnet characteristics, we had other characteristics allowing us to include in our analyses the recommended control variables for this kind of research. The primary findings were published early in 2011.1 These data sets allowed a rigorous analysis; however, generalizing the results beyond academic health centers should be done carefully. Ponte and Luzinski raise the issue of clinical significance regarding the statistically significant findings. We agree, and we reported the actual difference in nursing hours. Although we did not report the clinical significance for patient outcomes, the differences were sub-
66
stantial. The observed/expected rates for infections were 12% to 34% lower in the non-Magnet hospitals. Although the findings that Magnet hospitals in this sample had lower nurse staffing levels and more adverse patient outcomes surprised us, the fact that hospitals with lower nurse staffing have poorer outcomes is in keeping with other research. The data used for the study were collected before the inclusion of patient outcomes in the new Magnet model and criteria, and we feel that our findings reinforce the decision of ANCC to include them.
Colleen J. Goode, PhD, RN, FAAN, NEA-BC
Professor, College of Nursing University of Colorado Denver, CO Mary A. Blegen, PhD, RN, FAAN
Professor, College of Nursing University of California San Francisco The authors declare no conflict of interest. DOI: 10.1097/01.NNA.0000410619.02894.3d
REFERENCE 1. Blegen MA, Goode C, Spetz J, Vaughn T, Park SH. Nurse staffing effects on patient outcomes: safety-net and non-safety-net hospitals. Med Care. 2011;409:406-414.
JONA Vol. 42, No. 2 February 2012
Copyright @ 2012 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
JONA Volume 42, Number 2, pp 65-66 Copyright B 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Comparison of Patient Outcomes in Magnet and Non-Magnet Hospitals A
The article ‘‘Comparison of Patient Outcomes in Magnet and Non-Magnet Hospitals’’ in the December 2011 issue of Journal of Nursing Administration (available at http://journals.lww.com/ jonajournal/Fulltext/2011/12000/ Comparison_of_Patient_Outcomes_ in_Magnet__and.7.aspx) has multiple limitations that complicate interpretation of the results. Although we agree with the authors that the Magnet Recognition Program is worthy of research to understand how outcomes are improved, the study used data from 2005. This is problematic, as the requirements for Magnet at that time were significantly different than they are today. After a major transformation in 2008 focusing on outcomes, Magnet organizations now have requirements for nurse, workforce, patient, and clinical outcomes not required in 2005. The standards require outcomes above the 51st percentile of the benchmarking database for 2 consecutive years. Over the past 6 years, a growing body of research demonstrates that Magnet characteristics do impact patient outcomes (http://www.nursecredentialing.org/ MagnetReferences.aspx). In addition, the sample size was only 19 Magnet hospitals when there are 391 Magnet organizations today. This time lag, the small samA
A
ple size, and the change in the Magnet requirements call into question the relevance of the study. Although the study shows statistically significant differences (P G .05), the clinical significance is limited. As a voluntary credential, many excellent facilities may not seek Magnet designation. This study does not account for non-Magnet hospitals that may be Magnet-like. University HealthSystem Consortium (UHC) hospitals are likely to have implemented evidence-based practices, hallmarks of Magnet, and many were on the journey to Magnet excellence. Evidence of the UHC excellence is that 13 UHC academic medical centers were designated Magnet in 2006-2007, the 2 years following the year in which the study data were sampled. The Commission on Magnet encourages researchers to strengthen their methods, data selection and analysis, and sample size and identify key variables that may better explain findings. Current and rigorous studies are needed to improve our ability to provide positive practice environments that impact excellence in patient care.
Patricia Reid Ponte, DNSc, RN, FAAN
Chair, Commission on Magnet Recognition Washington, DC
Craig Luzinski, MSN, RN, NEA-BC, FACHE
Director, Magnet Recognition Program Washington, DC The authors declare no conflict of interest. DOI: 10.1097/NNA.0b013e318244bdc0
Author Response Thank you for the opportunity to address the concerns raised by the American Nurses Credentialing Center (ANCC) staff; we believe that healthy dialogues facilitate the development of knowledge. Our study found results that we did not expect but were obligated to report. Every study strengthens the knowledge base and adds to the understanding of nursing issues. Our study used data from 54 hospitals that were members and affiliates of the University HealthSystem Consortium (UHC). The UHC has developed excellent databases providing the best measures of nurse staffing available and also the most highly regarded and widely used patient outcome indicators. Although we did not have the identities of the hospitals and could not obtain information
JONA Vol. 42, No. 2 February 2012
Copyright @ 2012 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
65
Letter to the Editor about their Magnet characteristics, we had other characteristics allowing us to include in our analyses the recommended control variables for this kind of research. The primary findings were published early in 2011.1 These data sets allowed a rigorous analysis; however, generalizing the results beyond academic health centers should be done carefully. Ponte and Luzinski raise the issue of clinical significance regarding the statistically significant findings. We agree, and we reported the actual difference in nursing hours. Although we did not report the clinical significance for patient outcomes, the differences were sub-
66
stantial. The observed/expected rates for infections were 12% to 34% lower in the non-Magnet hospitals. Although the findings that Magnet hospitals in this sample had lower nurse staffing levels and more adverse patient outcomes surprised us, the fact that hospitals with lower nurse staffing have poorer outcomes is in keeping with other research. The data used for the study were collected before the inclusion of patient outcomes in the new Magnet model and criteria, and we feel that our findings reinforce the decision of ANCC to include them.
Colleen J. Goode, PhD, RN, FAAN, NEA-BC
Professor, College of Nursing University of Colorado Denver, CO Mary A. Blegen, PhD, RN, FAAN
Professor, College of Nursing University of California San Francisco The authors declare no conflict of interest. DOI: 10.1097/01.NNA.0000410619.02894.3d
REFERENCE 1. Blegen MA, Goode C, Spetz J, Vaughn T, Park SH. Nurse staffing effects on patient outcomes: safety-net and non-safety-net hospitals. Med Care. 2011;409:406-414.
JONA Vol. 42, No. 2 February 2012
Copyright @ 2012 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
