Professor and Chairman, Joseph Barnhart Department of Orthopedic Surgery, Baylor College of Medicine

Dissertation Title

A longitudinal study relating patient care outcomes to nurse magnet designation in United States academic medical centers.

Dissertation Abstract

The purpose of this investigation is to determine whether the addition of the structural and process elements necessary for an academic medical center to garner its initial Magnet designation is associated with improved patient care. Donabedian's linear structure-process-outcome theory serves as the framework to empirically assess the relationship between Magnet status and patient care outcomes. The influence of such organizational factors as hospital size, clinical activity, and complexity of care is investigated. Secondary data from the American Nurse Credentialing Center (ANCC) and the University HealthSystem Consortium (UHC) is used as the basis of this empirical study.

This investigation identified two specific nursing-sensitive outcome measures that statistically improved following initial Magnet certification: the rate of pressure ulcers, and the rate of physiologic or metabolic derangements following elective surgical procedures.

In the adjusted models, the significant improvement in the rate of pressure ulcers was modified by case mix index. A time-dependent improvement in five additional outcome measures was also revealed: infection resulting from medical care, post-operative deep vein thrombosis or pulmonary embolus, post-operative respiratory failure, failure to rescue, and hospital re-admission.

In the adjusted models the significant time-dependent improvement for failure to rescue was modified by organizational characteristics representing clinical activity and complexity of care. Similarly, the level of care complexity modified the significant improvement observed for hospital re-admission rate.

Time-dependent improvements in rates of infection resulting from medical care and post-operative respiratory failure either held constant or improved with the inclusion of covariates. The rate of post-operative deep vein thrombosis or pulmonary embolus slightly increased in the adjusted model. In-hospital mortality rates resulting from acute myocardial infarction or congestive heart failure, and the rate of post-operative sepsis were not correlated with either time or initial Magnet designation.

Though the initial Magnet designation did result in patient care outcome improvements, the frequency of in-hospital complications of care and adverse events was decreased primarily as a function of time. It is possible that these time-dependent improvements stemmed from a shared predisposition by the hospitals studied to consider nursing a critical component of quality improvement.