The change won't come from anything as simple as $20,000 sign-on bonuses.

Five Las Vegas hospitals hope to be recognized as magnet hospitals, a designation that attracts top-notch nurses and signifies superior nursing care.

The elite Magnet Recognition program through the American Nurses Credentialing Center takes several years - and in Nevada it has prompted hospitals to hire extra staff or start an endowment to pursue the designation.

The rewards will be especially sweet in a state with the second-worst nursing shortage, according to a 2004 report by the U.S. Health Resources and Services Administration.

"For many people, the first thing they do in a community is look for a magnet hospital because it's the best place to work," said Ann Wagner, who is coordinating the Magnet Recognition effort for St. Rose Dominican Hospitals.

St. Rose estimates the process will take at least two years and probably less than five years. The application takes the form of documentation - not to exceed 15 inches thick - and a site visit by an evaluation team.

Approved hospitals put the Magnet emblem all over, from billboards and recruiting materials in nursing magazines.

"What I've been comparing it to is magnet schools: You can go to get the best education in the community where you live," Wagner said. "Here, you can get the best nursing care."

UMC nurse Lorraine Noonan, left, and Magnet coordinator Linda Yi are shown during a shared governance meeting at the University of Nevada School of Medicine Building. The hospital is currently trying to earn Magnet status. Photo by Richard Brian

The ANCC has been granting magnet recognition to hospitals since 1994, and only 4 percent of hospitals in the country have achieved magnet status. In 2001 the level of interest among hospitals started to rise. The organization recognized 22 hospitals in 2001, compared to 67 in 2006.

Growth has been attributed to a nationwide nursing shortage, word-of-mouth among nurse leaders in professional organizations and through labor union contracts (like at St. Rose).

The Magnet program dates back to 1983, when the American Academy of Nursing surveyed 163 hospitals to find strategies that helped retain nurses. The report identified the guidelines by which hospitals now strive to achieve: The so-called 14 Forces of Magnetism include tenets like professional development and a structure that lets nurses make decisions.

In the language of the ANCC, those aiming for Magnet Recognition are said to be "on the journey." Nevada hospitals joining St. Rose so far include Renown Regional Medical Center in Washoe and Las Vegas' University Medical Center. A joint effort is just starting among the Sunrise Health hospitals: MountainView, Sunrise and Southern Hills.

Joan Trofino, a Las Vegas resident and magnet appraiser for hospitals outside of Nevada, spoke May 15 at the University of Southern Nevada. A dozen or so eager-looking officials from local hospitals attended, with UMC leaders taking up the front row.

The public hospital has been working on magnet recognition for about 18 months.

UMC nurse Judith Hollett speaks during a shared governance meeting at the University of Nevada School of Medicine Building. Photo by Richard Brian

Linda Yi, director of its outreach service through the Family Resource Center, was named leader of the endeavor. At first it was just a few hours a week, but now the program takes up to one-third of Yi's attention.

UMC expects to be surveyed in about 18 months.

"In spite of everything that's happened in the newspaper (with UMC's ousted chief executive and budget problems), there's never been doubt about nursing excellence at UMC," Yi said.

Quality in nursing at UMC derives from the hospital's focus on treating and educating the county's residents, she said. Like many hospitals, UMC leaders felt its practices fit naturally into the Forces of Magnetism guidelines.

It had some areas to work on, too. UMC started a "shared governance" system through which each nursing department has a committee of elected representatives, who work on problems and send ideas up the chain of command.

The next big push will be for nurses to suggest changes based on research in their fields. Recently, nurses suggested that the hospital stop testing pregnant women's urine for certain sugars and protein - a practice that has been proven outdated.

"They did a cost-benefit analysis and presented it to the research committee," Yi said. "The goal at the next meeting is to be able to stop doing this procedure."

At Renown in Reno, the biggest focus seems to be on community outreach. The hospital has collected $1.4 million so far for an endowment, which funds professional conferences and other activities.

The hospital started working toward magnet recognition four years ago. It expects to have the intense, five-day survey around October 2008.

Even with a 15-inch limit on documents, condensing the hospital's efforts will be hard, said Dana Dye, chief nursing officer for the Renown Health medical group. Among achievements so far is a program that immunizes parents and grandparents of newborns against whooping cough.

"This is really a grassroots effort," Dye said. "In the world of management it's easy to tell people what they need to be doing. It doesn't mean they'll buy into that ¦ They're best at telling us how something might work or not work."

Communicating with thousands of nurses when implementing big changes can be a challenge, leaders say.

At St. Rose's three campuses, 1,000 registered nurses hear messages through in-services, poster presentations and one-on-one talks.

The hospitals are currently working on building a shared governance infrastructure. Along the way, they are meeting with the nurses' union, Service Employees International Union Local 1107, for which Wagner worked before being hired by St. Rose.

Trofino, speaking at the recent meeting, said the grassroots work is evident at the final site visits. A lifelong nursing executive, Trofino chose the surveying arm rather than the consulting arm of the ANCC because she enjoys witnessing the achievements.

At MD Anderson Cancer Center in Houston, Trofino said, she heard nurses erupt in cheers after she left a room.

"I ran back - they were just so excited they jumped for joy," she said.