Date of Conferral





Public Policy and Administration


Melanie Smith


Many U.S. hospitals have historically failed to recognize nursing as essential to quality of care. Given the relationship between the patients' experiences, measured by the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), and government reimbursement, stakeholders now value the role of nurses in the care experience. Some hospitals have pursued Magnet designation, which is a rigorous and costly process, in order to promote patient satisfaction through nurse autonomy and retention. The purpose of this study was to understand whether non-Magnet hospitals received similar HCAHPS scores. Expectancy disconfirmation theory provides a framework to understand the components of patient satisfaction within the context of organizational structures and norms addressed by the Bourdieu theory of cultural health capital. A quantitative study was conducted using secondary data from a stratified random sample of 317 non-Magnet hospitals and a purposive sample of 317 Magnet hospitals. Chi-square tests of independence were performed; Magnet designation was significantly related to nurse communication, pain management, timely responsiveness of care, explanation of medication, and willingness to recommend. Magnet designation consistently had a higher proportion of 3-star and 4-star ratings compared to the tendency of non-Magnet hospitals to be more normally distributed across all five ratings. Study results, combined with the climate of patient consumerism, provide the social impetus for healthcare improvement specialists to promote social change through Magnet-like culture and protocols using an evidence-based practice outcome approach to champion better care experiences through empowerment of both patients and nurses to match expected care with delivered care.