Employment in Magnet-Oriented Hospitals and Socialization of Students in Clinical Nurse Specialist Programs

Saturday, 7 November 2015: 3:35 PM

Terri L. Ares, PhD, MSN, RN, CNS-BC
School of Nursing, California State University - Dominguez Hills, Carson, CA, USA

Background and Purpose: 

Regional transformation of health care is possible with a more educated nursing workforce and the advancement of health care organizations to support professional nursing excellence. The clinical nurse specialist, a graduate-prepared advanced practice registered nurse, has been identified as a role that is important to the success of organizations seeking Magnet recognition, a credential awarded for nursing excellence, quality, and innovation in practice.

In the effort to prepare more nurses for the clinical nurse specialist (CNS) role, graduate nursing programs are responsible for the socialization of students to assume the role. There is also a preparatory phase or anticipatory socialization of the individual that takes place prior to entry into the academic program. 

A prior study of the professional socialization of graduating and newly graduated CNS students found that 47.1% had been employed in a Magnet-designated hospital or one on the Magnet journey prior to entering their graduate programs. In 2011, the American Nurses Association reported that only 7% of hospitals in the U.S. had achieved Magnet recognition.  It was postulated that working in a Magnet-oriented hospital could have a socializing impact on students as a result of Magnet program values for nursing professionalism and educational advancement.  The purpose of this study was to determine if CNS students differed on measures of socialization based on their exposure to Magnet-oriented hospital employment.


A secondary analysis of data from a study of the professional socialization of a national sample of graduating and newly graduated CNS students (N = 225, representing 73 CNS programs) in the United States was conducted. Data for that study were collected from 2012-2013 via an online survey. Researcher designed items and the Nurses Self-Description Form subscales of Professionalism, Work Ethic, and Empathy were analyzed for this study.  Comparisons of the students who worked in Magnet-oriented hospitals prior to enrolling in their academic program with students who did not work in such settings was examined. Data were subjected to descriptive, t-test, two-way ANOVA, and chi-squared analyses. 


Students that were employed in a Magnet-oriented hospital prior to enrolling in their CNS program were significantly more likely to be exposed to the CNS role by working with or observing a CNS in the workplace (chi-square [1] = 14.59, p = .000). The variance in perceived preparedness for CNS practice was not dependent on exposure to the role in a Magnet-oriented hospital.  No significant differences in the years of leadership experience, rate of nursing specialty certification, having a mentor-protégé relationship with a CNS, or preconceived impression of the CNS role on the perceived preparedness for practice as a CNS were found when employment status was compared.

There was a significant difference in the interaction effects between Magnet employment and workplace exposure to the CNS role on the professionalism self-concept scores (F [1, 221] = 5.035, p = .026). There was a negative effect of exposure to the CNS role for students employed in non-Magnet hospitals, while there was a positive effect of role exposure for those with Magnet-oriented hospital employment on professionalism self-concept.

Exposure to the CNS role in the workplace was helpful to the development of an accurate preconceived impression of the role for students employed in non-Magnet environments at a level approaching significance, but there was no effect for students employed in Magnet-oriented hospitals (F [1, 218] = 3.582, p = 0.60).  


Few differences in socialization based on student employment in a Magnet-oriented hospital prior to enrollment in CNS graduate program were identified. Students with Magnet-oriented hospital employment had greater workplace exposure to the CNS role which may help explain why they chose the role for their graduate education focus and why such a large percentage of students in the national sample had a history of exposure to Magnet-oriented workplaces. However, since the current ratio of Magnet to non-Magnet hospitals is quite small, it is reassuring that the measures of socialization in CNS students were largely not dependent on employment in a Magnet-oriented hospital. The graduate program is likely the primary socializing agent for CNS students. In consideration of the effort to diffuse the Magnet recognition program internationally, it is not known if the experiences within Magnet-oriented hospitals that were found in this study to foster nurse socialization to an advanced nursing role would apply in the context of other countries’ educational and health care contexts.