Recommendation 4-3. HCOs should employ management structures and processes throughout the organization that:

  • Provide ongoing vigilance in balancing efficiency and safety.

  • Demonstrate trust in workers and promote trust by workers.

  • Actively manage the process of change.

  • Engage workers in nonhierarchical decision making and in the design of work processes and work flow.

  • Establish the organization as a “learning organization.”

These recommendations are feasible. Indeed, they are currently practiced in a number of nursing work environments described in the next section.


The five evidence-based management practices described above have been employed successfully in a number of nurse work environments by HCOs acting alone or in collaboration with one another. Examples include magnet hospitals, the Pittsburgh Regional Healthcare Initiative, and the Wellspring model of long-term care.

Magnet Hospitals

In the early 1980s, during one of the cyclical nursing shortages, a task force of the American Academy of Nursing undertook a study to identify those hospitals—labeled “magnet hospitals” that had no difficulty in attracting and retaining nurses during such shortages (McClure et al., 1983). Through two decades of research, the characteristics of these magnet hospitals have been articulated and their relationship to nurse and patient outcomes studied.

In the original magnet hospital study, 165 organizations were identified across the country that fit three criteria: (1) nurses saw the hospital as a good place to work; (2) the hospital was able to recruit and retain nurses (as measured by a lower-than-usual turnover rate during a nursing shortage situation); and (3) the hospital was located in a market area that included other hospitals competing for its nurses. Based on a review of the hospitals’ recruitment and retention records as well as other material, 41 organizations were selected as magnet hospitals (McClure et al., 2002). Systematic interviews with the CNE and a selected staff nurse from each organization provided the data for an analysis of the characteristics that attracted and retained nurses in these hospitals. Magnet characteristics were identified in the areas of administration, professional practice, and

The National Academies | 500 Fifth St. N.W. | Washington, D.C. 20001
Copyright © National Academy of Sciences. All rights reserved.
Terms of Use and Privacy Statement