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Nursing and Health 1(4): 78-87, 2013 http://www.hrpub.org
DOI: 10.13189/nh.2013.010403
From Magnet-Hospital to the Hospital of the Future
André Heitmann1,*, Rosana Svetić Čišić2, Iris Meyenburg-Altwarg1
1Medical School (MHH), Department of Nursing, Carl-Neuberg-Str.1, 30625 Hannover, Germany
2St Catherine specialist hospital, Bracak 8a, 49210 Zabok, Croatia
*Corresponding Author: andreheitmann78@gmail.com
Copyright © 2013 Horizon Research Publishing All rights reserved.
Abstract In the United States the Magnet Recognition
Program® is an established nursing-oriented organizational
model. Accredited Magnet hospitals succeeded in attract and
retention of qualified nurses. This demonstrated the future
potential of this model. However, a direct transfer of the
model to European conditions seemed to be limited. It raised
the question concerning a European model that could give
hints to organize the hospital of the future. This exploratory
and descriptive study attempted to create a European
framework in order to made recommendations for the
hospital of the future. Following recommendations were
made: 1. Designation of nursing as connecting health
profession, 2. In-depth structural integration of nursing into
the hospital organization, 3. Lived professionalism and
quality.
Keywords Magnet Hospital, Exploratory Study,
European Framework, Hospital of the Future, Croatia,
Germany
1. Introduction
During essential changes in the US health care system in
the eighties of the last century [1] some hospitals mastered
this change despite the financial pressure through the
implementation of DRGs [1]. They were successful in
attracting and retaining nurses [2] despite the shifted focus
from a goal-driven concept in direction of a resource-driven
model [1], which affected the resource situation of the
hospitals. Since them the Magnet Model became an
exceptional framework to promote this change to build an
agile and dynamic nursing work force [3]. These
characteristics referred to the fact that the self-image and
image of the US nursing staff differed significantly from
those in Europe. A direct copy of the so-called concept of
success was therefore limited and reasonable. On this
background the Magnet model was the subject of this
explorative study. Questions aroused concerning the
transferability and adaptability of this Model which affected
the efforts of nurse managers to create a Hospital of the
future. This study tried to identify elements of this Model
which were set in relationship to US and European
Conditions.
To achieve this subject a Literature review and analysis of
empirical studies concerning Magnet hospitals were
conducted. In a further literature search the US context
conditions were identified and sketched to an US framework
model. The findings were interpreted with the
extra-organizational US context conditions and combined to
a conceptional framework. It was applied on two European
countries (Croatia, Germany) to create a basis for further
interpretations aiming to create a matched model. Data
concerning the exemplary (extra-organizational) European
health care systems were also collected via literature search
according the US framework. In a next step the results were
matched to form a European conceptional framework
“Characteristics Hospital of the Future”. This framework
was applied on the Hannover Medical School (MHH)
(Germany) and the St Catherine Hospital (Croatia) as
exploratory examples. In conclusion some recommendations
for nurse managers were given.
2. Methods
Following methods were used in this exploratory and
descriptive study: literature research and analysis of relevant
literature, interpretation of the findings and creation of
conceptional models.
1st Step: Literature search, analysis and clustered
categories: A literature search was conducted in several data
bases: PubMed-NCBI, MEDPILOT and Scopus. The search
strategy in PubMed and Scopus included the use of
following combinations of keywords corresponding to
specific search operators: “magnet hospitals” AND USA,
Nursing AND Magnet AND USA, retention AND strategies
AND hospitals AND USA, “Nursing magnet” AND USA,
“nursing staff retention” AND USA, “retentions strategies
hospitals” AND USA, magnet hospitals AND USA,
“retention nursing hospitals” AND USA, nursing AND staff
AND retention AND USA. In MEDPILOT a parallel
unspecific literature search was conducted (keywords:
“Magnetkrankenhaus”, “Magnet-hospitals. Empirical
studies (quantitative and qualitative studies) and
Nursing and Health 1(4): 78-87, 2013 79
retrospective studies as also systematic reviews were
included into the analysis: 12 relevant papers were able to be
used in the literature analysis. Clustered categories were
interpreted on the basis of the findings.
2nd Step: Literature analysis and interpretation with
clustered categories: A second literature search in PubMed,
Scopus, MEDPILOT and the university library of the
Hannover Medical School was conducted to describe
relevant issues of the US health care system. The search
strategy comprised the keywords “health care system
comparison” AND United States and “health care delivery”
AND United States, and “US Health Care” AND system.
The results were set in relationship to the clustered
categories of the first literature analysis. This step aimed to
create comprised characteristics of the US system as a base
for further interpretations.
3rd Step: Literature search and analysis on the base of the
US conceptional framework model: To adapt the US
conceptional framework a third literature search in PubMed,
Scopus, MEDPILOT and local resources was conducted.
The search strategy comprised the keywords “health care
system comparison” AND Croatia (resp. Germany) and
“health care delivery” AND Croatia (resp. Germany), and
“Croatia/ German Health Care” AND system. It aimed to
draw a sketched view on both European health care systems.
4th Step Creation of a matched model called “European
conceptional framework”: In this stepthe results were
matched into a conceptional framework regarding the
European context.
5th Step: In this step the European conceptional framework
was applied in an exploratory manner on two European
hospitals (St Catherine Hospital, Hannover Medical School).
The objective was to prove the applicability of the
framework aspects. Lead by this framework both
organizations were reviewed and set in an interpretative
relationship to the frameworks’ aspects.
6th Step: In this step recommendations concerning the
hospital of the future were formulated.
3. Results
a) Results of the First Literature Analysis
Following pre-categories were identified from the
analyzed literature (see table 1). These pre-categories gave
an impression about the implementation of the Magnetism in
American hospitals. They were compared with the ANCC
Magnet Recognition Program® Model. The results showed
the relativistic character of the Magnet concept:
Progressive structure-supported quality-oriented
financially-backed leadership style: The Magnet
concept had a meaning about leadership and
organization. A progressive leadership style was
strong connected with an organizational structure
committed to transformation. This included
outcome-orientation and an idea of quality, also
continuity on the management level and financial
security.
Relative degree of autonomy and improved
working conditions: The Magnet concept aimed to
ensure structural empowerment framed by
progressive leadership and organized
transformational processes. A relative degree of
autonomy and relative improved working conditions
constituted an objective.
Quality comes first: Quality Improvement was a
very important model component. It needed the
existence of a so called “quality comes first” –
mentality.
Primary focus nursing: Professional practice in
Magnet hospitals was noticeable by a relative degree
of Nurses’ autonomy. The focus lied primary on the
Nursing profession.
Selective quality: The Magnet concept should
ensure overall high quality, but the implementation
resulted in higher quality in selective fields of
nursing practice compared to
Non-Magnet-Hospitals.
Selection bias of Magnet studies: The studies
which examined Magnet and Non-Magnet hospitals
showed selection bias. No possible Magnet effects
on other professions were investigated.
Fragility of Magnet status: Studies results
indicated that the Magnet status was fragile:
Structural inconsistencies which affected working
conditions remained after Magnet recognition.
Tab le 1. Results of the literature analysis
Pre-categories Characteristics Reference
Pre-category I – Facilitators
outcome-orientation, quality comes first, commitment of proactive leadership, structural
support
[4], [5]
Pre-category II – Barriers personnel discontinuity in management, financial restrictions [4]
Pre-category III - Relative
Autonomy
visible organizational structures, self control, qualification levels
[6], [7], [8],
[9]
Pre-category IV - Working
conditions
relative differences with non-magnet hospitals, dependence of working conditions on
composition of qualification
[10], [11]
Pre-category V - Selective high
quality of health care
selective high quality in elements of nursing, intra-professional better communication and
cooperation, probably higher patient safety
[12], [13]
Category VI - Limitations to
Magnet Characteristics
selection bias on magnet studies, fragile state of magnet hospitals, structural differences
within magnet hospitals affect magnet outcomes, Organization produces outcomes
[14], [15]
80 From Magnet-Hospital to the Hospital of the Future
b) Results of the Second Literature Analysis
Following the literature analysis concerning the US
context some categories were able to set out the
extra-organizational conditions which affected hospitals:
variability of the health care system, possibilities for health
care providers, reform in health care systems.
Variability of the health care system [16], [17], [18]:
There was only a partial coherent public health care
system, which was primarily focused on special population
groups. The public influence on the design of supply and
financing of health care settings differed significant between
the states. There were also differences in the amount of pay
depended on the financiers (e.g. Health Maintenance
Organizations, Medicaid program). Employers acted partly
as self-insurer of their employees. Also insurances (e.g.
Health Maintenance Organizations) were a social benefit
from the employers.
Possibilities for health care providers [19], [20]:
The health care providers had many ways to create their
offer on the U.S. health care market. This included the
connection with the gatekeeper by purchasing general
practitioner practices or the provision of hospital equipment
for them in the hospitals’ owned health care centers. They
reduced costs by creation of new professional groups as
substitutes for established professions (e.g. license
Anesthesia Assistants vs. Anesthesia Nurses). In individual
segments there was a high attractiveness for students in
established professional groups.
Reform in health care system [20], [21]:
The shortcomings of the system were modified by the
reforms in context of "Obama Care." This included the
elimination of maladministration that a large number of the
US-citizens have no health insurance coverage. By the
reforms supply gaps should be filled, spending on
government programs should be reduced and the quality of
care should be improved. For the health care providers the
reforms caused a requirement for action.
c) Creation and Interpretation of a Conceptual
Framework USA
The used framework (see fig. 1) divided the conditions in
conditions outside the hospital organization (=
extra-organizational conditions) and within the organization
(= hospital). The extra-organizational conditions were the
categories identified in the second literature analysis.. In this
model they produced an innovative pressure, caused by the
variability of the health system. This VARIABILITY
initiated an increased need for reform(s) in order to cancel
problems caused by this VARIABILITY. The variability
was related to the allocation of monetary resources to the
hospitals. Especially against the background of different
accounting systems to allocate resources the VARIABILITY
triggered in this way the innovative pressure. Also
POSSIBILITIES which were affected by the condition
REFORM contributed the innovative pressure.
POSSIBILITIES existed for hospitals, e.g. in the
construction or expansion of hospital buildings or in buying
facilities downtown commercial areas. In the same direction
POSSIBILITIES potentially exacerbated the
VARIABILITY in this model.
The organization HOSPITAL had to make a respond on
this innovative pressure. A HOSPITAL could focus on the
nursing profession (i.e. mono-disciplinary focus) or it could
focus the entire organization (i.e. multidisciplinary focus).
The results of the literature review indicated that either little
difference between the magnet- and non-hospitals exist (see
[3], [10]) or accredited magnet hospitals had also internal
organizational differences that affected the magnet status. It
could therefore assume that there are existing different
manifestations of the response to the innovative pressure
with respect to the chosen focus. This fact was illustrated by
the reciprocal overlap of the two foci. Reciprocally because
structural changes in a department affected other
organizational structures. A reciprocal interface in this case
related to be a mixed response to the innovative pressure.
The reflection on the basis of the clustered categories and
the comparison with the Magnet Recognition Program®
Model illustrated the dependence on structural (legal, policy
and intra-organizational) aspects. With this viewpoint a
framework model was designed as an exploratory approach.
It visualized on the one side extra-organizational conditions
and on the other side the intra-organizational foci. The first
one comprised the terms “Variability”, “Possibilities” and
“Reform”; the last one was designed according the
components of the Magnet Recognition Program® Model.
This exploratory framework was used in further reflections
as an interpretation basis on the Croatian and German
framework conditions. The results of these interpretations
were part of the matching of the country-specific
frameworks.
d) Results of the Matching of the Conceptual Framework
US A on European Examples
Matching of extra-organizational conditions (see table 2)
The frameworks in both European countries showed a
distinctive consistency. This consistency was in straight
opposition to the variability of the US-Health care system.
Certainly the conditions in the European Union would also
lead to the impression of a great range of variability
concerning each health care system of the member states,
because of country specific driving forces [44]. But all
systems shared similarities like the universal or
near-universal coverage of health care costs e.g. for hospital
care [45]. For the European matching model we could
assume that the term “Consistency” visualized a very
important condition which influenced the nursing service in
hospitals. Seen through the lens of this framework all
hospitals including the nursing profession had to face the
same innovative pressure. This pressure emerged from the
“trinity” “Consistency, Reform and Possibilities”.
Consistency was the key element regarding the regulation of
resources on the basis of the health care insurance system. It
influenced the term “reform” which included the actions to
accommodate the “consistency” to the respective
circumstances.
Nursing and Health 1(4): 78-87, 2013 81
Figure 1. Conceptual Framework USA
Tab le 2. Matching of extra-organizational conditions
“Reform” became a common condition as a result of the
analysis of the circumstances of the three exemplary
countries. In opposition to the US reform which focused on
the elimination of the maladministration in form of an
expansion of the population coverage [46], Europe’s
direction focused on cost reduction, cost containment and
improvement of quality and efficiency. Hospitals in Europe
dealt with a need for investments in their provision of health
care services (quality + efficiency) and paradoxically to cut
their costs.
Concerning the condition “Possibilities” to match the
innovative pressure and focusing on European conditions
Hospitals had to invest in job opportunities due to the
shortage of Health professionals (especially nurses)
connected with the fulfillment of high professional standards
and the enhancement of clinic facilities. These actions
should be done instead of the above mentioned paradoxical
direction of the innovative pressure.
The dominance of the medical profession in Germany was
not part of the matched model because the independence of
82 From Magnet-Hospital to the Hospital of the Future
the medical profession as a requirement for this dominance
eroded gradually [36].
Matching of intra organizational conditions (see table 3)
Many sub segments of the intra-organizational conditions
which effects nursing were related to the Magnet model
concept. In the matched model “Mutual Respect” was a
component of the magnetic force “Management Style” and
the Model component “Transformational Leadership” which
was represented by the term “Nursing centered
Management”. This could be justified because mutual
respect should be set as an organizational norm to provide
structure and direction in patient care as also in
organizational functions [47]. The Magnet model component
“Structural Empowerment” was related via the magnetic
force “Personnel policies and programs” with efforts for
“Increasing the number of nurses”, the “Involvement in
organizational changes” and the “Provision of
work-home-balance”. These sub segments importance was
justifiable because some studies (although some limited on
the German context) gave hints: As an example the
introduction of the DRG in Germany possible worsened
adequate staffing and supportive management [48]. As well
Management should address the work-home interface which
influences leaving intentions [49]. Also the magnetic force
“Professional Development” was similarly to the sub
segment “Research and professional development”. In
conclusion the best term to summarize this sub segments was
“Nursing integrating structure” which included Personnel
Policies and Programs with emphasis on increasing the
Number of Nurses, competence development, research as
also significant involvement in organizational changes and
provision of Work-home Balance. Quality improvement as a
magnetic force was interpreted as a result of the other sub
segments which also characterized the European matched
model. But to take emphasize into the nursing focus it should
be noted as “Improvement of Quality in Nursing”. An
approach could be the enhancement of working conditions
which maintains the work force, able to ensure a high level of
quality [49]. The Magnet model component “Exemplary
Professional Practice” contained the magnetic force
“Professional Models of Care” which was related to the
(European) sub segment “Fulfillment of professional
standards and Quality of Care”. This point had for example
in Germany a great Importance corresponding to the
increased valuation of the evidence based nursing principle
through the jurisprudence [50]. Especially service provider
should integrate professional standards in their processes to
prevent liability cases [51]. Also the magnetic force
“Interdisciplinary Relationships” was related to “Mutual
respect”. Concerning “Mutual respect” a longstanding
emotion work should be addressed to enable nurses for
collaboration with other professionals [52], although of the
existence of a fragmented and transient collaboration in
practice [53]. In the matched model the term “Lived
professional practice” denoted both sub segments in the best
manner. The magnetic force “Quality of Care” respectively
the Magnet model component “Empirical Quality Results”
were also related with the “Fulfillment of professional
standards”. This relationship was justified because “lived”
professional standards ensured empirical quality results. In
consequence this aspect was integrated into the segment
“Lived Professional Standards”
Tab le 3. Matching of intra-organizational conditions
.
Nursing and Health 1(4): 78-87, 2013 83
e) European Conceptual Framework Characteristics
“Hospital of the Future”
At first this conceptional framework focused on
intra-organizational aspects. This approach could be
reasonable because extra-organizational conditions could not
be influenced by a single hospital. Regarding this aspect the
extra-organizational conditions were concluded into the
keyword of “Innovative Pressure” which visualized the
influence of these conditions without dominating the
framework: consistency (= all hospitals have
country-specific same starting positions), reform (=
rationalization as target) and possibilities (= requirement for
self-investment). These facts needed innovative measures to
cope it and to gave the nursing profession a responsible role
as a “Connecting Health Profession” including effective
self-competences. That was the reason why this framework
should be an integrative part of the Nursing management as
also on the general hospital management level. It gave an
impression concerning quality in nursing in the hospital of
the future – derived from current understandings and
requirements. Nursing should be part of a holistic strategy
referring to the multi-professional character of hospitals.
They should emphasize improved nursing quality in the
context of a multi-professional institution. From our view
this approach was justified referring to the “interface
character” of nursing. Nursing should be considered as a
“connecting health profession” because Nurses act on a field
with many reciprocal interfaces (e.g. Nurses and Physicians
or Nurses and Physiotherapists). The accentuation of Quality
improvement in Nursing seemed to be a promising approach
to address the innovative pressure and to correspond with the
sub segments in relation to the magnetic forces. As a
consequence investments in Nursing could support to meet
other demands and pressures in the future.
This framework was constructed by these aspects: Nursing
centered management, nursing integrating structure, lived
professional standards and lived quality. Aspect 1 “Nursing
Centered Management” meant a culture of mutual respect
between the nursing management level and nurse
professionals at the bedside. Also it meant a culture of
mutual respect on the management level of the different
professions which affected the cooperation between health
professionals on the lower hierarchical levels [6], [7]. From
our view this was a very essential issue, because it gave nurse
managers a wide radius of action to establish and maintain
the following aspects of the conceptual framework. Another
essential reason was that institutional mutual respect support
high quality patient care [54]. From our view mission
statements indicated the scope and profoundness of mutual
respect.
Aspect 2 “Nursing Integrating Structure” meant a strong
institutional emphasis on efforts for increasing personnel
resources. In this direction professional competences should
be developed to gain benefits from a sound and empowered
staff. The provision of competences with a sound staffing
made it easier to conduct organizational changes in a
multi-professional expert organization [55]. As a possible
result e.g. business processes could be defined from a
bedside perspective. Another issue of this structure was a
main focus on staff retention – the provision of
work-home-balance. It reflected the coming requirements
concerning the demographic change which could affect the
workforce structure [56], [57], [58].
Aspect 3 “Lived Professional Standards and Quality of
Care” could be defined as a commitment for fulfillment of
the own professional standards and quality of care. This
meant e.g. a stronger appreciation of the specific role
accountability as a nurse [59]. Also a professional model
could affect the patient safety more favorable than a
functional model [60]. The professional model was
characterized by managers who recognized nursing as a
profession exercised by skilled professionals [60]. A
functional model which regarded nursing as a broad resp.
unspecific set of tasks [60] should be removed by nurse
managers. In case of this aspect respectful interdisciplinary
relationships would be essential [44]. Also this aspect
focused on the operational level regarding working groups,
structures and proceedings.
Tab le 4. Efforts in direction of the Conceptional Framework Europe – Characteristics “Hospital of the Future”
Medical School Hannover (MHH) St Caterine Hospital
Nursing Centered Management:
Mission Statements (= Mutual Respect)
Nursing Centered Management:
Mission Statement (= Mutual Respect)
Nursing Integrating Structure:
Re-entry and trainee programs (= Increasing Number of Nurses)
Advanced Professional Training/ Future Oriented Development
Program ZEP (= Development of Nursing Competencies)
Research Office (= Investment in Nursing Research)
Participation in Corporate Development Programs (= Significant
Involvement in Organizational Changes)
Service Agreements/ Reconciliation Family/Work (= Provision of
Work-Home-Balance)
Nursing Integrating Structure:
Coping of Nursing Shortage (= Increasing Number of Nurses)
Education measures in a new established institution (=
Development of Nursing Competencies)
Publications on nursing management research (= Investment in
Nursing Research)
Planning and organization of equipment and services (=
Significant Involvement in Organizational Changes)
Lived Professional Standards and Quality of Care:
Commitment in Mission Statements/ Quality Management
System/ Working Group on Nursing Standards
Lived Professional Standards and Quality of Care:
Commitment in Mission Statements/ Certification ISO
9001:2008/ Working Group on Nursing Standards
84 From Magnet-Hospital to the Hospital of the Future
Figure 2. Conceptional Framework Europe – Characteristics “Hospital of the Future”
f) Application of the European Conceptional Framework
Hannover Medial School (GER) Sveta Katarina
(HR)
In this chapter the European conceptional framework was
applied in an exploratory manner. The objective was to prove
the applicability of the framework aspects. Lead by this
framework both organizations were reviewed and set in an
interpretative relationship to the frameworks’ aspects.
Regarding the MHH the application of the matched model
led so some suggestions about the congruence of institutional
efforts with the matched model: Concerning the sub-segment
“Mutual respect” this sub-segment was stated as a core value
of all nursing relevant mission statements. The “Nursing
Integrating Structure” comprised the sub-segment
“Increasing number of Nurses” which was embodied by the
re-entry and trainee programs. Especially the re-entry
program was an effort to increase nursing staff with a strong
reference to the gender topic, because it was targeted on the
empowerment of women to enhance their career chances.
Concerning the next sub-segment “Development of nursing
competence” the MHH applied a micro- and macro-level
approach. Possibilities for advanced professional training
focused on the point of care on the micro-level; the future
oriented development program (ZEP) faced the macro-level
to enable coming nurse managers. The sub-segment
“Investment in nursing research” was embodied by the
institution of a research office of the nursing department.
This indicated efforts to establish and maintain applied
nursing research activities. “Significant involvement in
organizational changes” was represented by the participation
of the nursing department in corporate development projects.
Referring the sub-segment “Provision of work-home balance”
the context of the MHH as a governmental institution was
evident, because efforts for reconciling family and work and
the service agreement were fostered by this institutional
status. The sub-segment “Fulfillment of professional
standards” in the segment “Lived Professional Standards and
Quality of Care” and “Mutual respect” were embodied by the
mission statements. It was also (focused on quality of care)
embodied by the certified quality management system and
the working group on nursing standards wherein nurses
combined evidence based knowledge with practice
requirements. This indicated that the fulfillment of
professional standards in the nursing department was a key
objective which was pursued by the management. All these
efforts indicated a growing consciousness about the
importance and responsibility of nursing in a maximum care
setting. This could reflect the future requirements concerning
hospitals to integrate nursing into a general management
strategy.
The Croatian example showed that the establishment of a
new hospital enabled the nursing profession to make
significant contributions in direction of institutional
structuring and development. Compared with the MHH St
Catherine Hospital was a small hospital in a specific
therapeutic field. But it was interesting that this “small”
institution reflected many aspects of the theoretical
framework like the MHH as a “bigger” institution. In the first
segment “Nursing Centered Management” Mutual Respect
was also addressed in the mission statement. The “Nursing
Integrating Structure” comprised the sub-segments
“Increasing number of nurses” and the “Development of
nursing competences” as imperative conditions of a new
hospital within a countrywide shortage of skilled health
professionals. Noticeable were the efforts in the sub-segment
“Investment in nursing research”. Similar to the MHH the St
Nursing and Health 1(4): 78-87, 2013 85
Catherine Hospital invested in research activities which
resulted in two papers. From our view the involvement in
the institutional building as part of the establishment process
was strong connected with the “Significant involvement in
organizational changes”. The sub-segment “Provision of
Work-home-Balance” was not addressed. We found possible
reasons were in the situation of a newly established hospital
and in the employment law, which did reflect the shortage of
skilled health professionals. The segments “Lived
Professional Standards and Quality of Care” were also
addressed by the St Catherine Hospital in the same manner
like the MHH.
g).Recommendations for the Hospital of the Future
This exploratory study showed the meaning of structural
aspects which determined the efforts of nurse managers to
keep and attract nurses (in the sense of Magnet Hospitals) as
also the efforts to address a paradoxical systemic pressure on
hospitals.
From this view we could formulate three
recommendations which should be considered as key points
for the hospital of the future by nurse managers and the
hospitals’ executive committees:
Designation of nursing as connecting health
profession
In-depth structural integration of nursing into the
hospital organization
Lived professionalism and quality
Designation of nursing as connecting health profession:
Nurses and their profession should be designated as
connectors in the multidisciplinary hospital setting. The term
connecting health profession implied that the focus should be
placed on the interfaces between other health professions.
Nurse Managers should advocate and promote mission
statements which take emphasis on mutual respect as a
pre-requisite to act in interface areas. This could create a
climate which attract and retain nurse employees. We think
that a lot of innovation impeding gaps could be filled with
the engagement by these interface professionals.
In-depth structural integration of nursing into the
hospital organization:
From our view in-depth structural integration was an
aspect which will gain more and more importance for the
nursing profession. This finding meant that in term of a
nursing integrating structure and with consideration of the
site-specific situation nurse managers should amplify
conditions for a sound staffing situation. This could include
measures which deal with the staffing shortage in the best
way. In either situation some points could be the
development of nursing competences (e.g. strengthening the
core and interface competences) and the investment in
research actions on practical issues (e.g. quality research).
Significant involvement in organizational changes should be
advocated by nursing managers but needed a broad
institutional commitment of each hospital’s executive
committee. Measures to provide a work-home balance
should be installed in accordance with the hospitals’
economic situation. As a possible consequence nurses could
act as active colleagues with their counterpart from other
professions.
Lived Professionalism and Quality:
To foster a nurse attracting and retaining hospital structure
a culture of lived professionalism and quality should be
promoted by nurse managers. The third segment of the
European framework (“Lived Professional Standards and
Quality of Care) addressed this issue: Standards were an
embodiment of professionalism. They based on developed
competences and results of research projects from an
integrated nursing profession. This also included the
reference on mutual respect, because it was not sufficient
that nurses believed in their own professionalism alone.
Nurse professionalism needed to be acknowledged by other
professions (e.g. physicians). Also the fulfillment of
standards indicated Quality of Care.
This exceeded the level of professional standards in
direction of a general thinking about quality in the hospital.
A concrete measure to promote both aspects could be the
generation of experience- and research-based nursing
databases. Other measures could be sharing and spreading of
professional knowledge (visualized by professional
standards) with other institutions.
4. Limitations
This study did not claim completeness on the topics
magnetism and future requirements for hospitals. As an
exploratory study it aimed to sketch and visualize possible
aspects with meaning for the future which should be
considered by nursing managers. Also the framework was
sketched in a comprised way. The application of the
framework could include some bias because the authors
explored their own institutions. As a consequence further
empirical research could be needed to fill this framework
with evidence for refinement of its’ theoretical approach.
From the authors view this framework should be a basis for
further discussions concerning the hospital of the future.
5. Discussion
Both examples show that nurse managers undertook
activities according the European framework for hospitals of
the future. In opposition to the Magnet Recognition
Program® Model as a nursing centered staff attracting and
retaining approach, this concept focused on the coping of the
external innovative pressure which needed a more integrated
nursing profession into the hospitals’ structures. As a
possible by-product the implementation of this framework
could attract and retain nurses because their meaning as
interface-experts resp. connectors in high-complex settings
86 From Magnet-Hospital to the Hospital of the Future
increased.
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