Four years. A four-day site visit. One hundred four questions.
That’s the minimum it takes for a hospital to even be considered for Magnet designation.
And those questions aren’t multiple choice. All 104 require essays, including documentation and outcomes behind the stories of nursing excellence.
Just 9% of U.S. hospitals have received this honor from the American Nurses Credentialing Center (ANCC).
Less than 1% of them have earned the prestigious Magnet designation six times. Among them, only two pediatric hospitals: Ann & Robert H. Lurie Children’s Hospital of Chicago and Children’s Mercy Kansas City.
Everyday excellence
Nursing leaders responsible for the hefty applications say they’ve been successful because recognition follows the work at their hospitals, rather than driving it.
“We don’t do things for Magnet. We achieve Magnet because of the things we do, which actually makes my job a lot easier,” said Paula Blizzard, RN, Children’s Mercy’s senior director of nursing excellence. “Instead of saying ‘oh, we have a gap in the application here; we’ve got to throw a project together,’ we’re able to look and see what great things our nurses are already doing at the bedside every day. And then I get to tell those stories to the appraisers.”
Brian Stahulak, DNP, RN, echoed that, saying “it’s not about preparing for the next survey” at Lurie Children’s either.
“We are looking for ways to continually improve and provide higher-quality care because it’s part of our patient-first culture versus ‘we have to do this for Magnet’,” said the hospital’s chief nursing officer, chief clinical officer, and senior vice president. “It goes beyond what Magnet tells us to do. This has become the standard of how we operate.”
Always advancing
Both Stahulak and Blizzard have been part of every one of their hospitals’ Magnet application processes spanning more than two decades.
Each time, ANCC enhances the rigor of its evaluation, seeking to recognize organizations worldwide that sustain strong nursing governance, a commitment to innovation and research, interprofessional collaboration, and engaged and empowered nurses.
"We don’t do things for Magnet. We achieve Magnet because of the things we do."
So, reaching the milestone six consecutive times is far from rinse and repeat.
“You can’t do for the sixth round what you did for the fifth and expect it count. Each round becomes progressively more difficult because you’re continuing to raise the level of excellence you’re providing,” said Stephanie Meyer, RN, chief nursing executive and chief operating officer of acute care at Children’s Mercy. “We’re showing that we have a strong foundation that continues to build on itself and accelerate nursing forward.”
Capturing excellence
It’s easy for small — and even big — moments of collaboration and innovation to go unnoticed in busy pediatric care settings. Improvements adopted by happenstance can become routine without fanfare or documentation.
That’s why both hospitals have invested in positions focused on the Magnet Recognition Program and work strategically to gather success stories.
The Magnet application isn’t just about outcomes. Appraisers want details on how an idea originated, was implemented, is interprofessional, and then, made an impact.
Blizzard said sometimes that’s challenging because even a life-saving project can be sparked by a quick chat between a new nurse and the CNO in a hallway.
So the Magnet program lead at each hospital works closely with about 75 cross-departmental frontline nurses they refer to as Magnet ambassadors or champions, who help spot ideas and innovation that may capture the attention of Magnet appraisers.
Children’s Mercy also made it easy for all staff to share potential “Magnet moments” by creating a portal on their internal site for any employee to enter just the basics about projects that may align with one of the credentialling requirements. And Lurie Children’s keeps the application front of mind by spotlighting some of the success stories on their nursing Instagram, during team and all-staff meetings, and on Magnet Mondays.
Proof in practice
After ANCC appraisers review the lengthy applications, they visit qualifying hospitals to see the efforts they’ve read about in action. Over several days, they get a feel for the culture, meeting with employees at all levels and across departments as well as community partners and patient families.
“The families speak, better than anyone, to the transformative impact our nurses have on the children we serve,” Stahulak said. “And I love seeing the pride in our nurses when they hear them tell their stories.”
"We are looking for ways to continually improve and provide higher-quality care. This has become the standard of how we operate."
He says the Magnet process reminds busy nurses how much the care they put into even everyday tasks matters and how invaluable their voices are in planning and decision-making.
“In nursing, we don’t tell our stories enough, and there aren’t many accolades out there that are just nursing-specific and that speak to the impact nurses have on quality outcomes, patient safety, and nurse engagement,” Stahulak said.
While the designation is for nursing excellence, the nurse leaders emphasize it belongs to the entire workforce at their pediatric hospitals.
A third of the questions ask for examples of collaboration with other disciplines, often physicians and researchers.
“One of the biggest differences I notice in a Magnet hospital is that the partnerships are more intentional,” Meyer said. “The nursing care is better, outcomes are better, information sharing is better, and the teams work together in a much more seamless way.”
And she says health care professionals have come to expect it.
“It’s a recruitment tool not only for nursing but for the broader workforce. It signals we have a collaborative environment rather than a hierarchical one,” Meyer added. “I’ve had physicians tell me that while they’ve worked with strong nurses in other settings, the nurses here are a different caliber compared to non-Magnet hospitals. We uphold a different expectation of excellence, and it’s closely tied to our purpose.”
Lasting impact
Studies have shown work-life balance and retention are also better at hospitals with the designation. And when retention improves, patient satisfaction and outcomes do too.
“We want to celebrate their relentless determination to support our patients and families,” Stahulak said. “And we want to continue to elevate the kind of nursing practice, education, and research that makes us a place pediatric nurses want to come and want to stay.”
His goal is for Lurie Children’s to achieve Magnet with Distinction, which ANCC says it gives to “only a few top-tier organizations around the world that have achieved the highest level of nursing excellence while addressing emerging challenges and changes in health care moving forward.”
“I think our commitment to excellence and the support we provide our nurses is what helps us continue to achieve the designation and will get us there. But that’s not why we do it,” Stahulak said. “We do it because we want to continue to elevate nursing practice and make sure we are leaders in that.”
The way the Magnet program is designed means even the day after a hospital submits their application, they are working on the next one due in four years.
“The only way to reach the sixth, seventh, eighth is to have that excellence be who you are,” Meyer said. “It can’t be something you do for the sign on the wall; it has to be ingrained in your culture. It is who we are, and I’m immensely proud of that.”
Magnet with Distinction
The following children’s hospitals have achieved Magnet with Distinction, given to less than 1% of all hospitals since it was created in 2023. According to ANCC, these hospitals not only met but far exceeded Magnet scoring thresholds and are “global role models for nursing quality.
- Advocate Children’s Hospital
- Children’s Nebraska Cook
- Children’s Medical Center
- Golisano Children’s Hospital of Southwest Florida
- Nemours Children’s Hospital, Florida
- St. Jude Children’s Research Hospital
- St. Louis Children’s Hospital
