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Essentials of Magnetism II

Instrument Author:

Kramer, Marlene. Schmalenberg, Claudia.

Source title:

Essentials of a productive nurse work environment


Schmalenberg, C., & Kramer, M. (2008). Essentials of a productive nurse work environment. [Multicenter Study]. Nursing Research, 57(1), 2-13.

Source Author:

Schmalenberg, C., Kramer, M.

Journal Name:

Nursing Research










BACKGROUND: Staff nurse work environments must be improved. To do so, their quality must be measured. The Essential of Magnetism (EOM) tool measures eight characteristics of a productive and satisfying work environment identified by staff nurses in magnet hospitals as essential to quality patient care. The EOM items are based on grounded theory and are used to measure attributes of the work environment as functional processes. The EOMII is a revision of two of the subscales of the EOM. OBJECTIVES: To test the hypotheses that staff nurses in hospitals designated as having excellent work environments (Magnet) will score significantly higher on the EOMII and on two outcome indicators than will their counterparts in Comparison hospitals. Additional aims include establishing the psychometric properties of the EOMII; updating the National Magnet Hospital Profile; ascertaining relationships between nurse attribute, work, and contextual variables and the characteristics of a productive work environment; and investigating the relationship between the magnet structure, care processes and relationships and two single-item indicators, overall job satisfaction, and nurse-assessed quality of patient care. METHODS: This was a secondary analysis of aggregated data from 10,514 staff nurses in 34 hospitals who completed the EOMII and the two outcome indicators. RESULTS: The EOMII is a valid and reliable measure of the quality of work environment from a staff nurse perspective. The hypotheses were confirmed. There are differences in essentials and outcome variables by (a) context-nurses in magnet hospitals report the most productive work environment; (b) education-master's prepared nurses report the most favorable environments; (c) experience-the most inexperienced and the most experienced report the most satisfying, productive environments; and (d) clinical unit-medical and surgical specialty and outpatient units report the healthiest work environments. DISCUSSION: The primacy of magnet designation as a contextual variable indicating a quality work environment was affirmed. A larger percentage of magnet hospitals meet the magnet profile now than in 2003. Item analysis of the EOMII subscales provides guidance on how to improve the unit work environment. Suggestions are made for additional study and research.


Attitude of Health Personnel

Data Collection/mt [Methods]


Job Satisfaction

Nursing Staff, Hospital/px [Psychology]

Patient-Centered Care/og [Organization & Administration]


Quality of Health Care

Number of questions:

58 items, 8 subscales: (1)cultural values, (2)nurse manager support, (3)control of nursing practice, (4)clinical autonomy, (5)perceived adequacy of staffing, (6)RN/MD relationships, (7)clinically competent peers, (8)support for education

Response Options:

10 point single item indicator.


Criterion validity previously tested for the 2003 psychometric testing of the EOM


Internal consistency reliability ranged from .83 to .97.  Test-retest reliability also tested.  .



Sample Descriptors:



Sample Items:

“Considering all aspects of your job as well as your own values, ideals and goals, how satisfied are you with your current nursing job? (Circle any number on the scale).’’

Measure Descriptors:

Work environment


  1. Aiken, L. H., Clarke, S. P., Cheung, R. B., Sloane, D. M., & Silber, J. H. (2003). Educational levels of hospital nurses and surgical patient mortality. JAMA, 290(12), 1617-1623.
  2. Aiken, L. H., Clarke, S. P., & Sloane, D. M. (2002). Hospital staffing, organization, and quality of care: Cross-national findings. Nursing Outlook, 50(5), 187-194.
  3. American Hospital Association. (2002). In our hands: How hospital leaders can build a thriving workforce. Chicago: Author.
  4. American Nurses’ Association. (2007). National Database of Nursing Quality Indicators. Retrieved April 3, 2007, from http//
  5. American Organization of Nurse Executives. (2006). Principles and elements of a healthful practice/work environment. Retrieved February 11, 2007, from
  6. Baggs, J.G., Schmitt M.H., Mushlim A.I., Mitchell, P.H., Eldrige, D.H., Osler, D., et al. (1999). Association between nurse-physician collaboration and patient outcomes in three intensive care units. Critical Care Medicine, 27(9), 1991-1998.
  7. Cummings, G. G., Hayduk, L., & Estabrooks, C. A. (2006). Is the Nursing Work Index measuring up? Nursing Research, 55(2), 82-93.
  8. Donabedian, A. (1980). Explorations in quality assessment and monitoring: Volume 1. The definition of quality and approaches to its assessment. Ann Arbor, MI: Health Administration Press.
  9. Goode, C. J., Pinkerton, S., McCausland, M. P., Southard, P., Graham, R., & Krsek, C. (2001). Documenting chief nursing officers’ preference for BSN-prepared nurses. Journal of Nursing Administration, 31(2), 55-59.
  10. Hall, L. M. (2005). Indicators of nurse staffing and quality nursing work environments. In L. M. Hall (Ed.), Quality work environments for nurse and patient safety (pp. 1Y7). Sudbury, MA: Jones and Bartlett.
  11. Institute of Medicine. (2004). Keeping patients safe: Transforming the work environment of nurses. Washington, DC: The National Academies Press.
  12. Irvine, D., Sidani, S., & McGillis-Hall, L. (1998). Finding value in nursing care: A framework for quality improvement and clinical evaluation. Nursing Economics, 6(3), 110-131.
  13. Kim, J., & Mueller, C. Q. (1978). Factor analysis, statistical methods, and practical issues. Beverly Hills, CA: Sage.
  14. Kramer, M., & Hafner, L. P. (1989). Shared values: Impact on staff nurse job satisfaction and perceived productivity. Nursing Research, 38(3), 172-177.
  15. Kramer, M., Maguire, P., & Schmalenberg, C. (2006). Excellence through evidence: The what, when, and where of clinical autonomy. Journal of Nursing Administration, 36(10), 479-491.
  16. Kramer, M., Maguire, P., Schmalenberg, C., Andrews, B., Burke, R., Chmielewski, L., et al. (2007a). Excellence through evidence: Structures enabling clinical autonomy. Journal of Nursing Administration, 37(1), 41-52.
  17. Kramer, M., & Schmalenberg, C. (2002). Staff nurses identify essentials of magnetism. In M. McClure, & A. S. Hinshaw (Eds.), Magnet hospitals revisited: Attraction and retention of professional nurses (pp. 25-59). Kansas City, MO: Academy of Nursing.
  18. Kramer, M., & Schmalenberg, C. (2004). Development and evaluation of essentials of magnetism tool. Journal of Nursing Administration, 34(7/8), 1-14.
  19. Kramer, M., & Schmalenberg, C. (2005). Revising the essentials of magnetism tool. Journal of Nursing Administration, 35(4), 187-197.
  20. Kramer, M., Schmalenberg, C., & Hafner, L. P. (1989). What causes job satisfaction and productivity of quality nursing care? In T. Moore, & M. Mundinger (Eds.), Managing the nursing shortage: A guide to recruitment and retention (pp. 13-32). Rockville, MD: Aspen.
  21. Kramer, M., Schmalenberg, C., & Maguire, P. (2004). Essentials of a magnetic work environment: Culture, the unifying essential of magnetism, part 4. Nursing 2004, 34(9), 44-48.
  22. Kramer, M., Schmalenberg, C., Maguire, P., Brewer, B., Burke, R., Chmielewski, L., et al. (2007b). Nurse manager support: What is it and structures and practices that promote it. Chapter? In Thriving in a Political World. Nursing Administration Quarterly. 32(4), 22.
  23. Lacey, S., Cox, K., Lorfing, K., Teasley, S., Carroll, C., & Sexton, K. (2006). Nursing support, workload and intent to stay in magnet, magnet aspiring and non-magnet hospitals. Journal of Nursing Administration, 37(4),199-205.
  24. McClure, M., Poulin, M., Sovie, M., & Wandelt, M. (1983). Magnet hospitals: Attraction and retention of professional nurses. American Academy of Nursing Task Force on Nursing Practice in Hospitals. Kansas City, MO: American Nurses Association.
  25. Schmalenberg, C., Kramer, M., King, C., Krugman, M., Lund, C., Poduska, D., et al. (2005a). Excellence through evidence: securing collegial/collaborative nurseYphysician relationships, part 1. Journal of Nursing Administration, 35(10), 450-458.
  26. Schmalenberg, C., Kramer, M., King, C., Krugman, M., Lund, C., Poduska, D., et al. (2005b). Excellence through evidence: Securing collegial/collaborative nurseYphysician relationships, part 2. Journal of Nursing Administration, 35(11), 507-514.
  27. Smith, H. L., Hood, J. N., Waldman, J. D., & Smith, V. L. (2005). Creating a favorable practice environment for nurses. Journal of Nursing Administration, 35(12), 525-531.
  28. Spratley, E., Johnson, A., Sochalski, J., Fritz, M., & Spencer, W. (2000). The registered nurse population: Findings from the national sample survey of registered nurses. Rockville, MD: United States Department of Health and Human Services.
  29. Ulrich, B. T., Lavandero, R., Hart, K., Woods, D., Leggett, J., & Taylor, D. (2006). Critical care nurses’ work environments: A baseline status report. Critical Care Nurse, 26(5), 46-57.
  30. Ulrich, B. T., Woods, D., Hart, K., Lavandero, R., Leggett, J., & Taylor, D. (2007). Critical care nurses’ work environments: Value of excellence in beacon units and magnet organizations. Critical Care Nurse, 27(3), 68-77.
  31. Verran, J. A., Gerber, R. M., & Milton, D. A. (1995). Data aggregation: Criteria for psychometric evaluation. Research in Nursing & Health, 18(1), 77-80.
  32. Washington, B. T. (2007). Up from Slavery: An Autobiography. New York: Doubleday, Page 1901;, 2000. Retrieved July 29, 2007, from
  33. Youngblut, J.M., & Casper, G.R. (1993) Focus on Psychometrics SingleYItem Indicators in Nursing Research. Research in Nursing & Health, 16(10), 459-465.

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