Nursing-sensitive indicators, patient safety culture, and Magnet® designation: A segmented interrupted time-series study in the first designated hospital in Latin America

BACKGROUND: Magnet®-designated hospitals show superior nursing-sensitive indicators, yet evidence from outside high-income settings is scarce. We examined indicator and safety-culture trajectories at a Brazilian tertiary hospital, the first in Latin America to receive Magnet® designation. OBJECTIVES: To examine changes in four nursing-sensitive indicators (inpatient falls with injury, hospital-acquired pressure injury, central line-associated bloodstream infection, and catheter-associated urinary tract infection) and in patient safety culture following Magnet® designation. DESIGN: Quasi-experimental, single-group interrupted time-series study. SETTING: Tertiary-care, private, not-for-profit hospital in São Paulo, Brazil; Magnet®-designated July 2022. PARTICIPANTS: All eligible inpatient units over 31 consecutive quarters (1,546,483 inpatient-days); four hospital-wide survey waves (1476-2536 respondents). METHODS: Quarterly nursing-sensitive indicator data (April 2017-December 2024) were analysed using National Database of Nursing Quality Indicators methodology and international benchmarks, with pre-designation, implementation (January 2019-June 2022) and post-designation exposure states. Segmented models estimated level and slope change at two change points, with Benjamini-Hochberg adjustment for multiplicity. Patient safety culture was assessed via the Brazilian-validated Hospital Survey on Patient Safety Culture across four waves (2017-2023); benchmark attainment was summarised descriptively for the ten composites measured in both 2017 and 2023. RESULTS: Falls with injury and both device-associated infections remained at or better than the benchmark in every quarter; pressure injury met the quarterly benchmark in 42.9% of pre-designation and 70.0% of post-designation quarters. Segmented models showed no statistically robust change in level or trend at designation for falls with injury or either infection. Pressure injury showed a pre-existing downward trend, a pandemic-period rise, and a level reduction at designation (exp(β) 0.31; 95% confidence interval 0.18 to 0.53) not separable from post-pandemic normalisation. Positive-response percentages increased on 10 of 11 patient safety culture dimensions measured in both waves, with the largest increases in Nonpunitive Response to Error (+31.8 percentage points), Handoffs (+27.0) and Communication Openness (+23.0); the number of composites at or above the benchmark rose from two to six of ten. The Overall Patient Safety Grade declined 16.7 percentage points. CONCLUSIONS: Across a multi-year Magnet® journey, three of four nursing-sensitive indicators were sustained at or better than international benchmarks, pressure-injury benchmark attainment rose, and positive-response percentages increased on 10 of 11 patient safety culture dimensions, although the Overall Patient Safety Grade declined, without statistically robust evidence of change attributable to formal designation. These are the first internationally comparable findings on Magnet® in Latin America. REGISTRATION: Not registered (retrospective analysis of routinely collected institutional data). SOCIAL MEDIA ABSTRACT: First Magnet® hospital in Latin America: three of four indicators held at benchmark; safety-culture responses up, safety grade down.