The Magnet Hospital

Magnet hospitals act as a magnet for nurses. These are hospitals that can easily recruit and retain nurses. Magnet hospitals are also characterized by high job satisfaction. The Magnet concept originally comes from the United States, but Dutch hospitals are now also experimenting with it, with the main aim of finding a solution to the structural shortage of nurses.

What is a Magnet Hospital?

The core of the meaning of Magnet Hospitals is that nurses are given more autonomy and are involved in decisions regarding patient care and a lot is invested in their education and training. In addition, there is open communication between nurses and other members of a healthcare team, creating an appropriate mix of staffing, ensuring good clinical outcomes and employee satisfaction. Ultimately, the Magnet Concept affects not only the nurses but the entire hospital and the relationships between, for example, doctors and nurses. Self-scheduling, for example, is part of greater responsibility for nurses. This social innovation comes from Sweden and is now also being experimented with in the Netherlands. The advantages of self-scheduling are, for example, that the employee’s social life gets a boost. It also results in less absenteeism and staff turnover for the employer. “Nurses are proud of their profession and radiate that. They have autonomy, make their own decisions and are an equal partner of doctors”

14 Magnetic forces

Research has shown that Magnet Hospitals are characterized by the following Magnet forces:

  1. Quality of nursing leadership: Competent, strong and risk-taking nurse leaders follow a well-formulated strategy
  2. Organizational structure: the organizational structure is often flat and decisions are made decentrally
  3. Management style Participation and giving feedback are encouraged and ingrained in the organization
  4. Personal Policies and Programs: Salaries and bonuses are good and competitive. Career opportunities are offered and there is a good balance between work and private life: in short, the healthcare institution is a good employer
  5. Professional care models: Based on various models, the nurse has responsibility for and authority over direct patient care. The models are based on the unique needs of the patient and promote skilled nurses to achieve desired clinical outcomes.
  6. Quality of care: Everyone is driven by the desire to deliver high quality of care. Managers are responsible for continuing this ‘working climate’.
  7. Quality improvement: The organization is structured in such a way that quality projects and processes are continuously worked on
  8. Consultation and resources: The organization provides adequate resources, resources and opportunities for deploying experts. The organization promotes involvement of nurses in professional organizations and working groups in society
  9. Autonomy: Autonomous nursing care is the competence, professional expertise and knowledge-based ability of a nurse to determine and implement the appropriate nursing actions for patient care. The nurse is expected to work autonomously, in accordance with professional standards and to make independent decisions within the framework of interdisciplinary and multidisciplinary about patient care
  10. Society and the healthcare institution: Contacts are maintained within and with all kinds of healthcare organizations and other organizations in society with the aim of collaboration to improve healthcare outcomes and public health.
  11. Nurses as trainers: Professional nurses are involved in training activities within the organization and in society. Students are welcome and encouraged within the organization. There are plenty of opportunities for both students and nurses to follow training courses. There is a patient education program that caters to the needs of patients in the various departments.
  12. The image of nursing: The input and influence of nurses is essential in the care provided by the multidisciplinary team and this is how it is handled.
  13. Interdisciplinary relationships: There is mutual respect between and within disciplines and multidisciplinary teams and a willingness to learn from each other.
  14. Professional development: The organization creates conditions for this.

The origins of Magnet Hospitals

The concept of so-called Magnet Hospitals originated in the 1980s when there was a major shortage of nurses in the United States. However, some hospitals were successful in attracting and retaining nurses. These hospitals seemed to be a magnet for nurses. This was the reason why the American Academy of Nursing started a study in 1984 to see how these 41 hospitals distinguished themselves from other hospitals. This research resulted in the 14 characteristics that were described in the then Magnet Hospitals report. The report showed, among other things, that nurses in those hospitals had control over their work, had a good relationship with their colleagues and there were enough employees to provide good care. A second study followed in 1989, which showed that the Magnet Hospitals also had higher job satisfaction and that staff went on holiday less often. This confirmed the fourteen magnetic forces. The real development of the Magnet Hospital concept only came about when the first report demonstrated magnetic forces. Since then, in the 1980s, further research has been done into magnetic forces. In the 1990s, the American Nurses Credentialing Center (ANCC) developed a formal program to officially recognize magnet hospitals. This involves approximately 170 requirements. For example, nurses must be represented up to the Board of Directors.

Implementation Magnet Concept

From the formal recognition of the Magnet Concept, hospitals could also officially start applying the fourteen specific magnetic forces. This application of the features of the Magnet Hospital is different in every hospital. To explain the process, the case of Georgetown University Hospital (GUH) in Washington is used. The GUH was number 98 to receive recognition as a Magnet Hospital after a three-year implementation process. To make the introduction of the Magnet Concept a success, an attempt was first made to gain commitment in the hospital organization, from the shop floor to the board, so that everyone understood the value of the Magnet Concept. A strategic plan was then drawn up, a change team and a steering group were established and magnet champions were appointed. The latter group consisted of enthusiastic nurses who planned fun monthly meetings with knowledge building as the main goal. The implementation process that started in 2000 consisted of (re)planning, data collection and preparation for the ANCC deadline. After the necessary documentation had been submitted to the ANCC, the hospital was visited by auditors in 2003 to determine whether Magnet status would be obtained. The adjustment of the Magnet Concept took place mainly on the basis of knowledge building. A lot of scientific research has been and is being done into, for example, job satisfaction in the context of the Magnet Concept. This ensures knowledge accumulation and best practices that can be learned from. The Magnet concept itself has not seen any major changes over the years. However, there remains work to be done after its implementation. This is caused by the purpose of the magnet state; The goal is not the certificate but improving the quality of care and that requires continuous change.

Magnet Hospital Certificate

The first magnet hospitals were already magnet hospitals without knowing it. After all, it had not yet been investigated and recognized at the time. Since the 1990s, a certificate can be obtained for magnet hospitals. This certification is an innovation in itself and provokes the response that hospitals want to achieve magnet status. This is therefore a form of reciprocity in which elements of practices are used for other new things. There are currently approximately 290 magnet hospitals certified by the American Nurses Credentialing Center (ACCN) in the United States. Novel combinations in which practices are applied in many applications can be found in other countries, for example. In 2003, the first non-American hospital was given Magnet status.


The Magnet Concept is characterized by fourteen features that make working at such a Magnet organization attractive and that make nurses want to (continue to) work at such a hospital. The process by which innovations have come about in America is mainly the result of a drive for improvement. The implementation phases are characterized by a process for which an approach must be chosen that suits the hospital. It is mainly about cultural change that creates a different way of thinking.