Magnet hospital certification has a reputation for being one solution to nurse recruitment and retention. It is a matter of priority for hospitals to identify and enhance the basic organizational social structures which promote the development and maintenance of magnetism. A total of 436 valid self-administered questionnaires were collected from nurses. Paired sample t-tests, importance-performance gap analysis andANO-VAwere applied. The aims of this study were to investigate the key factors in and the gaps between nurses’ perceptions and hospital performance in areas contributing to magnetism. The results showed that Salary structure, welfare, and manpower deployment were the key forces of magnetism influencing nursing practice. Public and private hospitals showed significant differences in manpower deployment and nurse-patient relationships. Nurses who rotated shifts were more dissatisfied with their hospital scheduling system. Therefore, personnel policies and program are the primary forces in the development of a magnet hospital. Considering the demand for flexible scheduling of nurses, providing a supportive work environment, and keeping pace with today’s changing health care environment could achieve better outcomes for nurses, patients, and hospitals. These findings provide a reference to help set priorities for the implementation and development of effective strategies with limited resources. Public hospitals should take the lead in promoting magnet hospitals and set up reasonable salary systems, nursing workforce standards, and administrative support in order to attract and effectively retain nurses.
Worldwide, the developing of magnet hospitals has become the trend for solving the nursing shortage, and it has been viewed as the gold standard for nursing excellence [
According to the American Nurses Credentialing Center (ANCC), magnet recognition refers to meeting certain criteria by which a hospital is able to withstand nursing shortages, and attract and retain nurses [
To date, the number of hospitals that have achieved magnet recognition is not as good as expected; not only in the United States but even Canada, England, Scotland, and Germany still face the challenge of nursing shortages [
Magnet hospitals can create a magnetic working environment that encourages professional nursing and provides excellent nursing practices which serve as the hallmark of high performance institutions [
The participants were nurses who had at least 1 years experience in a hospital located in the same administrative district covered by national health insurance in Taiwan. Each of 9 district teaching hospitals recruited 50 eligible nurses during August 2012. A total of 450 selfadministered questionnaires were collected, and, of these, 436 were valid.
In order to investigate the key magnetic factors influencing nursing practice and identify the gaps between nurses’ perception and hospital performance, this study was carried out with a questionnaire using the 14 forces of magnetism drafted by the ANCC [
Nurse characteristics included gender, age, education, salary, marital status, experience, work setting, clinical ladder, and work shift. Hospital attributes were public or private.
Descriptive statistics, such as mean, standard deviation, frequency and rank order, were used to investigate the key magnetic factors which influenced nursing practice.
Paired sample t-tests were used to analyze the gaps between nurses’ perceptions and hospital performance. Factors with statistical significance (P < 0.05) were defined as performance gaps.
Independent samples t-tests and ANOVA were used to examine the relationships among nurses’ characteristics, hospital attributes and performance gaps.
The IPGA matrix was used to develop strategic management for magnet hospitals. The IPGA tool is a simple graphic that enables a comparison of perceived importance against performance, and is expected to help make service decisions through a simple strategic matrix. It also includes a gap theory to identify hospital failures based on nurse’s expectations vs. their perception of hospital services. Understanding nurse’s demands should help hospital managers to provide effective leadership.
The IPGA model includes the following six steps:
Step 1: Collect nurses’ perceptions of importance and hospital performance for all 18 forces of magnetism.
Step 2: Calculate the average value of importance of each item (), the average value of performance of each item (), the average value of importance of all items (), and the average value of performance of all items ().
Step 3: Use paired sample t-tests to determine whether the gap between perception and performance for each item of the 18 forces of magnetism was a positive gap (performance > importance), negative gap (performance < importance) or no gap (performance = importance).
Step 4: Compute the relative importance (RI) and relative performance (RP), RI =. Determine if
and the t-test was significant, RP(j) =., if and the t-test was significant, RP(j) =, or if or and the t-test was non-significant, RP(j) = 0.
Step 5: Draw the IPGA strategic matrix (
tion is fixed at (0,1). The IPGA grid represents the different strategies for resource allocation and management, as illustrated below:
1) Quadrant I is composed of high relative performance and high relative importance items and corresponds to “Keep up the good work”’.
2) Quadrant II is composed of low relative performance and high relative importance items, and corresponds to “Concentrate here”. A point farther away from coordinate (0,1) indicates a greater need for improvement.
3) Quadrant III is composed of low relative performance and low relative importance items, and corresponds to “Low priority”.
4) Quadrant IV is composed of high relative performance and low relative importance items, and corresponds to “Possible overkill”. A point farther away from co-ordinate (0,1) indicates a greater need to re-allocate resources; and Step 6: Determine the priorities for resource allocation for the items in Quadrant II.
The distance D(j) indicates the degree of priority for improvement:
Among the 436 participants, 45.2% worked in a public hospital and 54.8% in a private hospital; 98.8% were women. Those aged 25 - 34 accounted for 60.7%. Being single accounted for 51.8% and being married for 48.2%; 50.2% had Bachelor’s degrees. Salaries of 40,001 - 50,000 NTD were the majority (45%), followed by 30,001 - 40,000 NTD (40.7%). Twelve or more years of experience accounted for 30.9%, and 66.5% worked on internal and surgical wards. A rotating shift was the majority (57.3%) type of work. Clinical ladders N1 and N2 accounted for 28.5% and 38.7% respectively (
For the18 forces of magnetism perceived as important and hospital performance as seen by nurses, Cronbach’s α were all >0.9. The rankings are shown in
The 18 forces of magnetism had a statistically significant (P < 0.05) gap (
n
%
n
%
n
%
Hospital
Education
Clinical ladder
Public
197
45.2
216
49.8
N
51
11.8
Private
239
54.8
≥Bachelor
218
50.2
N1
123
28.5
Gender
Salary(NT)
N2
167
38.7
Female
431
98.9
30,001 - 40,000
174
40.7
≥N3
91
21.1
Male
5
1.1
40,001 - 50,000
192
45
Work setting
Age
50,001 - 60,000
47
11
Emergency
54
12.4
≤24
48
11.4
≥60,001
14
3.3
ICU
92
21.1
25 - 29
121
28.7
Experience
Internal Medicine
163
37.5
30 - 34
135
32
≤3
82
18.9
Surgery
126
29
35 - 39
74
17.5
4 - 6
79
18.2
Work shift
≥40
44
10.4
7 - 9
70
16.1
rotating shift
239
57.3
Marital
10 - 12
68
15.7
Evening/ night shift
78
18.7
Single
216
51.8
≥13
134
30.9
day shift
100
24
Married
203
48.2