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Magnet hospitals: what makes them places where nurses want to work?

Why UK hospitals are trialling the US model and what it means for staff and patients

Why UK hospitals are trialling the US model and what its staff well-being and autonomy goals mean for nurses and patients

  • Organisations participating in the four-year Magnet4Europe study will be twinned with a Magnet-accredited US hospital
  • How the Magnet principles and and priorities can help organisations address the challenges presented by COVID-19
  • The workplace environment review process designed to give front-line nurses a voice in everything from shift patterns and patient care to canteen layouts

As the UK emerges from the COVID-19 second wave, hospitals in England are among those taking part in a Europe-wide project to improve nurses working environments and reduce their stress.

Trusts participating in

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Why UK hospitals are trialling the US model and what its staff well-being and autonomy goals mean for nurses and patients

  • Organisations participating in the four-year Magnet4Europe study will be twinned with a Magnet-accredited US hospital
  • How the Magnet principles and and priorities can help organisations address the challenges presented by COVID-19
  • The workplace environment review process designed to give front-line nurses a voice in everything from shift patterns and patient care to canteen layouts
Illustration showing nurses and other staff walking towards a 'Magnet' hospital
Picture: Annette Taylor-Anderson

As the UK emerges from the COVID-19 second wave, hospitals in England are among those taking part in a Europe-wide project to improve nurses’ working environments and reduce their stress.

Trusts participating in the four-year Magnet4Europe study will implement the principles of the Magnet programme, a US accreditation scheme that recognises excellence in nursing care.

How Magnet status affects staff and patient experiences

Research shows organisations that gain Magnet status have lower levels of staff burnout and provide safer patient care.

University of Southampton professor of nursing workforce policy Jane Ball, principal investigator for Magnet4Europe in the UK, explains: ‘In a nutshell, it’s about creating places where nurses want to work.’

As the study began in January 2020, researchers were concerned trusts’ interest in taking part may have faded, in light of the immense challenges posed by the pandemic. In fact the opposite was true, with organisations keen to explore new ways to support staff.

‘We’ve been blown away by trusts’ enthusiasm and interest,’ says Professor Ball. ‘Many say they wanted to take part because of COVID-19.’

Fourteen hospitals are involved in the UK arm of the study, all in England. They will all be twinned with a hospital in the US and work closely with their partner to develop plans and implement changes in the way they work. This includes carrying out a detailed ‘gap analysis’ to identify strengths and areas for improvement.

Collaboration with a ‘twin’ hospital in the US

Participating hospitals get a Magnet handbook and other resources and take part in so-called ‘learning collaboratives’ that bring together the UK hospitals, their US partners and the project’s researchers to share ideas and inspiration.

The hospitals have been randomly assigned to two different groups. One will embark on the Magnet-based intervention first, using its support and resources, while the second group will join in later – acting as a control group.

One of the key ways the project research team will measure the impact of any changes made is through surveys of front-line nursing and medical staff, repeated at different points during the study.

‘We know Magnet status is associated with lots of good things, but we don’t know much about what that journey might look and feel like in the NHS’

Jane Ball, professor of nursing workforce policy and principal investigator for Magnet4Europe in the UK

‘This allows us to look at change over time and potentially look at the early intervention group compared with the “not yet” control group,’ says Professor Ball. ‘The survey will cover things like the practice environment, visibility of nursing leaders, involvement of nurses in hospital affairs and staffing levels.’

The research team will also look at trust data such as sickness absence levels, staff turnover and vacancy rates and undertake interviews and focus groups with staff.

The Magnet project at a glance

What is Magnet4Europe?

A ground-breaking project that aims to redesign hospital workplaces to boost the mental health and well-being of nurses and doctors and improve patient care.

How is it funded?

Via a €4 million grant from the EU’s Horizon 2020 research and innovation programme.

Who is in charge?

Two highly respected figures in healthcare – world-renowned nursing professor Linda Aiken from the University of Pennsylvania School of Nursing, and Walter Sermeus, professor of healthcare at Katholieke Universiteit Leuven in Belgium.

The Magnet4Europe programme involves hospitals in six different countries
Picture: iStock

Who is taking part?

About 60 hospitals in six different countries – the UK, Ireland, Belgium, Germany, Sweden and Norway.

What is the big idea?

The study will look at whether redesigning hospital work environments based on Magnet principles, supported by an experienced Magnet partner, works in Europe and whether or not this improves workforce well-being, including job satisfaction, burnout, sickness absence and retention.

The findings will inform policy recommendations that could help transform the way the NHS supports nurses and other staff.

Can a US model work in UK hospitals?

A key question for the project team is whether a model developed in the US can work in the NHS, where care is organised, managed and funded differently.

‘We know Magnet status is associated with lots of good things, but we don’t know much about what that journey is like and, in particular, what that journey might look and feel like in the NHS,’ says Professor Ball.

The model focuses strongly on ensuring front-line nurses have a say in decision-making and are at the forefront of innovation and research. It also aims to foster exemplary professional practice and strong working relationships between nurses and doctors in multidisciplinary teams.

Increasing nurse involvement in research is among the Magnet project goals
Increasing nurse involvement in research is among the Magnet project goals
Picture: iStock

Greater professional autonomy for nurses

University Hospitals of Morecambe Bay NHS Foundation Trust associate chief nurse Laura Neal is passionate about the project’s potential to recognise the contribution of nurses and help them recover from recent experiences.

‘Their focus has been on saving lives so – as we move out of the pandemic – our focus is on helping colleagues heal and replenish,’ she says.

The trust, which is twinned with Summa Health in north east Ohio, has completed its gap analysis and has just put together a strategic delivery plan setting out goals and action points.

‘The really important thing is that staff councils are not led by hospital leaders but by people who hold the patient’s hand at the bedside’

Laura Neal, associate chief nurse, University Hospitals of Morecambe Bay NHS Foundation Trust

A key ambition is to develop shared governance ‘so staff are heard’, says Ms Neal.

One option the trust is keen to explore is the creation of staff councils to enable front-line nurses to play a greater role in decision-making, with a higher level of professional autonomy.

Ward-level councils will be developed, as well as those for different specialties or aspects of practice, such as quality, professional development and research.

‘The really important thing is they are not led by hospital leaders but by people who hold the patient’s hand at the bedside,’ says Ms Neal.

Another ambition is to significantly boost the amount of nurse-led research. Trust goals include increasing the number of of nationally recognised studies and tripling the number led by nurses, midwives or allied health professionals by 2022.

The benefits of empowering staff in their jobs

For Ms Neal, the benefits for nurses from the trust’s participation in the Magnet4Europe project are clear.

‘It’s really simple – it empowers them and there is nothing better than empowering staff to do their job.’

Ultimately, she believes this will lead to better patient care and better value for money for the NHS.

‘Where people have autonomy on the front line and are able to advocate for patients, you get a reduced length of stay and reduced harms such as falls and pressure ulcers,’ she says. ‘That then leads to a better return on investment for hospitals.’

Surveys and staff councils are used to elicit front-line nurses’ views on staffing, patient care and policy
Surveys and staff councils are used to elicit front-line nurses’ views on staffing, patient care and policy Picture: iStock

US nurses are also enthused about taking part in the study and sharing lessons they have learned.

Nurse Heather Warlan is assistant director of Magnet and nursing quality at UC San Diego Health in California, which is partnering with South Tees Hospital NHS Foundation Trust in North East England.

UC San Diego is currently applying for Magnet status for the third time – accreditation lasts for four years after which time the award must be renewed or it will lapse.

Sharing what staff in the US have learned

‘We wanted to share what we’ve learned over the years to help support nurses at other organisations just starting their own journey,’ says Dr Warlan.

She says the reason the scheme works is because it inspires nurses to strive for excellence.

Nurse Maureen Altieri, director of service excellence and Magnet at Mather Hospital in Port Jefferson, New York, agrees.

‘It enables organisations to create a culture of excellence where nurses at all levels have autonomy, participate in shared decision-making and implement innovative practice,’ she says.

Mather Hospital, which is part of Northwell Health and working towards its third Magnet accreditation, is twinned with Bradford Teaching Hospitals NHS Foundation Trust.

Together they will look at ways to tackle ‘present and future challenges’ and bring about ‘transformational change’, says Ms Altieri.

‘Nurses who have a voice and can make decisions are happier’

For Frimley Health NHS Foundation Trust Magnet4Europe programme lead and head of quality Beth Bal, the study is an opportunity to bring something ‘really optimistic’ into the workplace.

‘Particularly with everything we have gone through with COVID-19, it felt like a light at the end of the tunnel,’ she says.

Her trust is twinned with the world-renowned Cleveland Clinic in Ohio and has embarked on its gap analysis and staff survey.

‘The idea is we really listen to staff at the bedside so they can shape how they deliver care. Some nurses say the survey made them feel quite emotional because they’ve had to stop and think about how they really feel.’

Meanwhile the gap analysis not only identified areas that need work but also highlighted where the trust is already doing well, such as its preceptorship, postregistration professional development and international nurse programmes.

‘That’s been a really great exercise,’ says Ms Bal. ‘We identified areas we need to strengthen but it also allowed us to think about pockets of excellence in the organisation.’

Staff will help redefine our nursing strategy

One of the first steps at Frimley Health will be to launch a new nursing strategy ‘in a slightly different way’.

‘Historically, senior nurses shaped the development of nursing strategy,’ explains Ms Bal. ‘This time, we’re going to hear from our bedside nurses as to how they want to shape the strategy and what they think is important.’

The strategy – set to be introduced by September – is likely to include goals to increase the proportion of nurses with higher level qualifications, such as master’s degrees.

‘Creating a really professional and skilled workforce attracts nurses to the organisation and also helps with retention,’ says Ms Bal. ‘So we want to set ambitions around what proportion of our workforce we want at certain levels.

‘If, as a nurse, I come to work and I’ve got a voice, feel respected by my colleagues, and have the skills and autonomy to make decisions about patient care, then I feel happier. And that is how I want our nurses to feel.’

Magnet programme’s role in nurse retention

For senior nurses at East and North Hertfordshire NHS Trust, the study fits in perfectly with ongoing trust-wide efforts to create a positive working environment where nurses are at the heart of developing and improving practice.

The trust is also one of 14 being supported by NHS England and chief nursing officer Ruth May to take part in the Pathway to Excellence programme – another accreditation scheme, run by the American Nurses Credentialing Center.

The two schemes ‘complement each other beautifully’, according to the trust’s chief nurse Rachael Corser.

Ms Corser believes the Magnet project will help the organisation move on from the pandemic and hold on to talented nurses.

A nurse presenting to a group of colleagues
Picture: iStock

‘We’ve invested a lot of time and energy in recruiting some outstanding nurses, so it’s about how we retain those high-calibre students, nurses from overseas and practitioners coming into the profession who had never considered nursing before COVID-19.’

Following the successful introduction of professional midwifery advocates, the trust is planning to introduce professional nurse advocates.

‘A lot of our work is focused on making people feel nurtured in a career as well as being able to practise safely,’ says Ms Corser.

‘Your twin pushes you to explore all aspects of your organisation and think about what you can do to enhance the well-being and working lives of staff’

Natalie Pattison, Magnet4Europe local lead and clinical professor of nursing, East and North Hertfordshire NHS Trust

Building research capacity is integral to both the trust’s nursing strategy and the Magnet model.

The trust will be appointing two chief nurse research fellows and has funding via the East and North Hertfordshire Hospitals’ Charity to support two nurses or allied health professionals a year to undertake PhD research.

Exploring your organisation with a twin

While the Magnet4Europe study focuses on front-line nurses and doctors in acute care, East and North Herts lead research nurse Carina Cruz believes it will affect all staff.

The trust is in the second cohort of the study, so is yet to find out with which US organisation it will be twinned.

It is already sharing ideas with other trusts in the group and looking ahead to its gap analysis.

The trust’s Magnet4Europe local lead and clinical professor of nursing Natalie Pattison says the chance to work with an experienced partner is a significant advantage.

‘Your twin pushes you to explore all aspects of your organisation and think about what you can do to enhance the well-being and working lives of staff,’ she says.

‘For me, that’s going to be a really exciting piece of work, looking at everything from shift patterns to the layout of canteens. We want this to be an amazing, fun place to work.’


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