Magnet designation identifies high-performing work environments and has also been linked to high-quality patient care. Some research suggests that RN staffing levels are part of the causal chain linking Magnet status to improved patient care quality. But it is important to differentiate staffing at the unit level from hospital-wide staffing levels. When reviewing staffing, nurse leaders should also consider nurse education level, certifications, skill competency, and the experience level of their nurses.
An article in the Journal of Nursing Care Quality1 examines the relationship between staffing by nursing specialty at New Jersey Magnet facilities compared with staffing levels at non-Magnet healthcare centers. The authors speculate that using unit-level RN staffing information may help identify the extent to which RN staffing levels contributes to Magnet status.
Defining nurse staffing levels
For the purposes of the study, nurse staffing was derived as a patient-per-nurse ratio (PRN). This figure was calculated from monthly hospital reports which contained the number of RNs and patients present during each shift on specific hospital units.
Additionally, 12 separate nursing units were recognized in the course of the work, each falling under one of five broad categories:
- Critical care
- Intermediate care
- Acute care
- Psychiatric care
- Emergency care
Magnet recognition linked to better ratios
From 2008 to 2015, the researchers found that staffing was comparable in nine out of the 12 nursing units between Magnet and non-Magnet hospitals. However, there was a 6.9% increase in staffing ratios in Magnet hospitals compared to only 4.7% in non-Magnet facilities. Both Magnet and non-Magnet hospitals had similar PNRs, but there were slightly lower PNRs in Magnet hospitals for six of the nursing units studied (adult and neonatal critical care, adult intermediate care, med/surg acute care, open psychiatric, and closed psychiatric units).
Typically, nurses cared for one to two patients each shift in critical care units, and the lowest PNRs occurred in pediatric critical care units. Additionally, the variation in RN staffing between Magnet and non-Magnet hospitals was small.
Each shift, the average RN cared for four patients in adult intermediate care and, on average, two babies per shift in both Magnet and non-Magnet hospitals. The largest decline in PNR occurred in neonatal intermediate care units, and the variation in RN staffing between Magnet and non-Magnet hospitals was moderate.
RNs cared for, on average, five patients per shift on med/surg units, four patients per shift in postpartum, three patients per shift in pediatrics, and four babies per shift in the newborn nursery in both classifications of hospitals. A 13.8% reduction in PNR occurred among pediatric units in Magnet hospitals.
RNs typically cared for five to six patients each shift depending on whether the unit was open or closed. The variation in RN staffing between Magnet and non-Magnet facilities was moderate.
In both Magnet and non-Magnet hospitals, each nurse cared for eight to 11 patients per shift. While the variation in staffing levels was large, PRNs decreased by 7% in Magnet hospitals over the study period.
According to the data, as patient acuity increased, the number of patients assigned to each RN decreased over time. This confirmed the importance of unit-level data when studying staffing and its impact on healthcare organizations and patient outcomes. Additionally, Magnet hospitals showed a greater increase in RN staffing for nine of the 12 specialties.
For nurse leaders looking to achieve Magnet status, the ANCC does not specify specific staffing levels to obtain Magnet recognition. Additionally, there was no meaningful difference in staffing levels in Magnet and non-Magnet facilities. The authors recommend that nurse leaders continue to invest in RN staffing to help promote a healthy work environment and ensure high-quality patient care.