Mount Sinai leads industry by example following Magnet status designation

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Margarette Almonte has become a rarity in her profession. She's been a nurse for 20 years, and for 16 of them, she's been happy working at the same place.

"Happy nurses make for happy patients," says the cheerful postpartum nurse at Toronto's Mount Sinai Hospital.

Faced with burnout and low job satisfaction, newly graduated registered nurses are only staying in the profession about five years according to some estimates, says Linda Haslam-Stroud, president of the Ontario Nurses' Association union.

Nurses are being squeezed from different directions, she says: Hospitals are cutting registered-nursing jobs to save money (the union has recorded the elimination of some 325 jobs across Ontario between January and March), long-time nurses are retiring and their positions are left unfilled and younger nurses are leaving the profession feeling overworked and disgruntled.

"In years gone by, when you entered nursing, it [became] your profession for life," Haslam-Stroud says. "For someone to go through four years of intense training…you would think that the nurses would want to continue their careers. And they're not continuing their careers because of workloads and the quality of work life."

Mount Sinai is striving to buck that trend. In January, it was named the first hospital in Canada to receive Magnet status, a designation granted by the American Nurses Credentialing Center for excellence in nursing and patient care. The status, which recognizes patient and employee satisfaction, puts Mount Sinai in an exclusive club of international hospitals, most of them in the United States. Only about 7 per cent of U.S. hospitals have received Magnet designation.

The designation may help the hospital attract and retain highly skilled nurses, Haslam-Stroud says. "If you're wanting to work in Toronto and the surrounding area, certainly that's going to give Mount Sinai a one-up."

To receive Magnet status, a hospital is required to demonstrate strong leadership among its nursing staff, excellent inter-professional relationships among members of its health care team and high levels of employee satisfaction, engagement and professional development.

Mount Sinai has shown it has not only met the requirements, but has surpassed other Magnet hospitals in many of these measures. It recorded a turnover rate of 4.7 per cent for its registered nurses, compared with 10.75 per cent at comparative Magnet organizations; its average length of employment for registered nurses is 11.2 years, compared with 10 years at other hospitals; and 66.3 per cent of its nurse leaders have graduate degrees, compared with 59.3 per cent at other Magnet hospitals.

Mary-Agnes Beduz, Mount Sinai's vice-president of professional practice and associate chief nurse executive, says the hospital began the process of pursuing Magnet status in 2010, but its emphasis on supporting nurses goes back much further. "We've had a long history at Mount Sinai of seeking excellence in nursing practice. So I think for us, [applying for Magnet] was less about the designation as about the recognition of the work we have in place here," she says.

To the general public, the Magnet seal of approval may largely go unnoticed. Magnet hospitals are required to show good patient outcomes, such as low fall rates and low pressure-ulcer rates, but it may not be apparent to patients whether a hospital has the status.

"I don't know that from a patient perspective they're going to know necessarily that this is a Magnet-designated hospital," Beduz says. But, she notes, "What we know from our patients is that there's a high level of patient satisfaction with the quality of nursing care that they receive."

Jan Moran, director of Magnet operations at the American Nurses Credentialing Center, explains her organization puts no limits on the number of hospitals that are granted Magnet status. However, she says, many choose not to apply because they're aware they cannot meet its standards. She was not aware of any Canadian hospitals that are following Mount Sinai's lead in seeking Magnet recognition.

(To vie for Magnet status, hospitals are required to pay a series of fees, including an application fee, appraisal fee and documentation-review fees, as well as costs for appraisers and for site visits by appraisers. Mount Sinai says the process cost a total of $41,000.)

Once they receive the designation, Magnet hospitals are required to submit documentation every year to ensure they're upholding the standards and must be redesignated every four years to retain the status.

Moran notes, however, that some hospitals may already be meeting Magnet standards without actually pursuing the designation.

"This is voluntary. So organizations may be Magnet, but they have chosen not to apply," she says. "It's not that they're not Magnet, it's just that they've chosen not to apply."

At Mount Sinai, Jane Merkley, executive vice-president of patient care and chief nurse executive, says the hospital continues to improve the quality of its nursing. "Part of this Magnet designation means we're on a never-ending journey of looking at the excellence and what it means to be the best from a nursing perspective," she says.

In an e-mailed statement, Mount Sinai chief executive Joseph Mapa applauded the hospital's nursing team. "Our outstanding nurses are playing a leadership role in every area of our growth, helping us to redefine the patient experience. I could not be more proud of this Magnet distinction and the work that they do for our patients every single day."